How post-acute care facilities use technology to save time, fight burnout

Six years ago, clinicians at Vitas Healthcare were struggling.

The organization, which operates 49 hospice programs in 14 states, was maintaining information about patient care manually. Because about 80% of the company’s end-of-life services are delivered in the home, staff members were carrying overflowing binders, paper planners and weekly schedules from site to site. Any patient condition changes or schedule updates had to be called in, often several times a day.

The administrative burden was overwhelming employees and contributing to burnout.

Related: AHCA sounds alarm on nursing home staffing crisis

The company decided to move to a technology-centered operation model. It gave a mobile device to each nurse, home health aide and physician, pre-loaded with an app allowing staff to review and manage schedules on a single digital platform. The move has enabled Miami-based Vitas to create a central command hub for every hospice program, giving facility leaders a better understanding of workforce gaps and patient needs.

Employees can send and receive real-time updates on status changes—eliminating reliance on written notes and multiple phone calls—and use the software to order equipment, medications and treatments with a few keystrokes. The tool also quantifies clinicians’ hours, saving them an estimated 60 to 70 minutes each week.

“Probably our biggest challenge in post-acute care and home care is the fact that things do change on a daily basis,” said Patrick Hale, executive vice president and chief information officer. “The logistical challenges are acute in our business and the sense of urgency is very high.”

The past several years have seen an increased demand for post-acute care services, particularly in the home. Faced with ongoing staffing shortages, providers like Vitas have turned to digital platforms for help. The software can automate and streamline administrative tasks, saving time and buoying morale. But it can also present challenges.

In addition to familiar hurdles of employee training and potentially bumpy rollouts, technologies designed to improve workflows in post-acute care aren’t always compatible with those used at other entities such as hospitals and insurance companies—forcing organizations to reconfigure tools or return to manual processes.

According to a research survey by International Data Corp., nearly 40% of post-acute care organizations increased their spending on information technology in 2022 compared with the previous year. Around half of those upped their investment in areas of clinical documentation workflow and infrastructure optimization.

Much of the spending is fueled by attempts to streamline staff members’ administrative activities. Clinicians and office employees can spend hours recording and faxing patient information, navigating referrals, calculating hours, coding, scheduling, billing and sifting through paper records.

Select Medical, which runs more than 100 post-acute care facilities, invests millions of dollars a year in more than 50 tools aimed at automating documentation, billing and other needs, according to Tom Mullin, executive vice president of hospital operations.

The platforms are integrated with Select’s Epic electronic health record system, accessible by employees at the company’s headquarters in Mechanicsburg, Pennsylvania. Centralizing most of the administrative work in a single location enables front-line employees and clinicians to spend more time providing care at the bedside, Mullin said.

Select Medical has been able to reduce the need for administrative positions, including health information managers and credentialing support staff, at its inpatient rehabilitation hospitals. Some tools, such as those focused on payroll management for travel nurses, have saved individual facilities hundreds of hours each month on documentation and scheduling, according to Mullin.

Birmingham, Alabama-based Encompass Health also ensures any tools it adopts will fold seamlessly into its Cerner electronic health record, enabling consistency among its more than 150 rehabilitation hospitals.

“We’re able to update our systems simultaneously and deploy [the updates] to all of our hospitals,” said Rusty Yeager, senior vice president and chief information officer. He declined to offer details about the technology’s costs.

Encompass Health partnered with a vendor in 2013 to build a tool to streamline its patient pre-screening process based on the Centers for Medicare and Medicaid Services’ inpatient rehabilitation facility admission requirements. Since then, it has been maintaining, supporting and upgrading the tool internally. Instead of staff manually entering patient information sent from hospitals and other facilities, the software delivers the data to the EHR for physician review and approval. Staff can then add key updates about arrival needs, diet, isolation status, assessments and discharge comments, sending any required information directly to payers for prior authorization.

Encompass Health also began computerizing its provider order entries using another platform in 2018. Since then, nearly 90% of orders have been computerized, decreasing legibility errors and turnaround time.

Effectively deploying administrative tools requires staff buy-in and careful rollouts to minimize hiccups.

Vitas works to get its business units and clinical teams invested in new solutions by familiarizing them with the technology.

“We have to be able to explain to our clinicians why what we’re giving helps them out, and if we can’t, we probably have no business implementing that project,” Hale said.

Before putting any software into use systemwide, Vitas picks certain sites to pilot the solutions. Hale and other information technology employees often work 10- to 15-hour days during testing phases, trying to turn around fixes to reported bugs as rapidly as possible. The piloting process usually goes on for a month or two before leadership begins discussing full-scale adoption, he said.

All pilot projects have different key performance indicators, such as time saved and clinical performance improvement. If goals aren’t achieved, it’s important to have a backup plan and an option to walk away quickly so operations can continue as normal, Hale said.

Hale characterized Vitas’ executive team as forward-thinking when it comes to putting money toward technology. He did not provide financial specifics, but said the investment “isn’t reflected in the budget alone.”

At Amedisys, a home health and hospice provider based in Baton Rouge, Louisiana, every rollout has been a lesson learned for leadership about strategy and communication, said Keith Blanchard, senior vice president and chief technology officer. The company uses several tools within its EHR to help staff more easily record, store and locate patient information.

The company in 2021 partnered with vendor Homecare Homebase on smart scheduling technology aimed at reducing work for patient service coordinators at the system’s more than 500 post-acute care facilities. During the pilot phase at a few sites, the tool malfunctioned due to a bug in the code and ended up creating a greater administrative burden for the employees using it, Blanchard said. The pilot approach reduced the amount of time that could have been lost, and the software was eventually successfully implemented.

Providers evaluating a new vendor should consider the specific problems they’re trying to solve, Blanchard said. Amedisys is weighing several technologies, including a speech-to-text tool clinicians could use to speed up documentation at the bedside and a virtual assistant bot to help providers more easily access patient information, treatment plans and referral and transfer data. Blanchard declined to share details about how much the company has spent.

Health systems should ask themselves: “Is this going to be fruitful for us as an organization, and are we going to get the outcome that we’re intending to get—whether that’s cost avoidance, cost savings, less burden, making it easier on our administrative staff or improving their work-life balance?” Blanchard said.

As with all technology rollouts, staff training is necessary. Tim Ashe, chief clinical officer at WellSky—which partners with Amedisys and other organizations to automate diagnosis coding and referrals—said some companies might try to shortcut the learning process to fast-track productivity. But spending more time on education helps create a workforce of capable users who can handle the software at its highest level, he said.

“There’s a steep learning curve as organizations implement new technology or advances in technology on platforms that they may already be using,” Ashe said.

Post-acute care facilities could face another hurdle beyond their control. Typically, technologies designed for improving post-acute provider workflows are not interoperable, or able to exchange and make use of information, with software used by hospitals, insurance companies and other entities.

The disconnect means skilled-nursing facilities or long-term care hospitals are often unable to share data with other organizations, according to the American Health Care Association and National Center for Assisted Living. For example, an acute care hospital trying to transfer a patient might not be able to send relevant information about them from one EHR to the other. Post-acute care companies that may have spent millions of dollars on technology must, in such cases, revert to fax machines or pen and paper.

Some post-acute care providers respond by changing existing tools to fit their workflows, which can drag out implementation timelines in a way that decreases systems’ return on investment, said Mathangi Radha, a partner at McKinsey & Co. who co-leads the company’s internal pre- and post-acute service line.

“You see a lot of homegrown solutions, and this causes issues with being able to deploy a solution that works with multiple different in-house technology programs that have been developed,” Radha said.

Such altered tools may not be able to communicate well with each other internally or integrate with the facility’s EHR, she said.

Post-acute providers are also ineligible for financial incentives under the Health Information Technology for Economic and Clinical Health Act and have not been incorporated into the program’s current interoperability standards—meaning any investments in technology compatible with other organizations’ tools must come out of facilities’ bottom line. The out-of-pocket factor could push digital advancement out of reach for some post-acute companies, especially smaller ones.

To address the issue, vendors and post-acute providers will have to work together to create universal platforms, along with advocating for federal regulation that supports the technology’s creation and use.

“Until this is resolved, post-acute providers need to think local when purchasing EHR and other technologies,” the ACHA and NCAL said in an emailed statement. “For example, is the technology being considered able to securely exchange data with key referring hospitals, physicians, insurance companies, and other local entities that the post-acute provider interacts with on a regular basis?”

The high cost of care and labor in the post-acute sector means providers are likely to keep focusing on implementing technology solutions where they can—particularly those supporting capacity management and labor retention, said Nithya Vinjamoori, a partner at McKinsey who works with Radha on the pre- and post-acute service line.

Despite the potential difficulties, Vitas’ Hale urged other post-acute organizations to streamline their administrative processes as soon as possible.

“Swing for the fences, take risks and innovate now,” Hale said. “It’s likely that budgets will get tighter and tighter over the next two to three years. Scrutinize your portfolio and invest in projects that truly matter, even if they have significant challenges in adoption or complexity.” 

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Correction: An earlier version of this story misstated Mathangi Radha and Nithya Vinjamoori’s titles and the number and type of Encompass Health’s post-acute facilities.