Nursing homes pressured to be wired but not with health IT

Many are prioritizing the adoption of consumer technologies to accommodate aging baby boomers but are lagging in EHR adoption.

By — Posted June 3, 2013

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As more senior citizens age into long-term-care facilities, many nursing homes find that to remain competitive, they need to offer electronic technology that has little to do with residents' direct medical care.

“The baby boom population is the most demanding consumer block that this nation has ever seen,” said Greg Crist, senior vice president of public affairs for the American Health Care Assn., which represents long-term, assisted-living facilities. And one thing boomers are demanding is the ability to maintain their technology-driven lives even after they move into such residences.

Although nursing homes have a business case for implementing technology to keep residents connected, the business case for adopting health information technology to connect the facilities to physicians is not as obvious. But because of the changing health care environment, including the rise of accountable care organizations and patient-centered medical homes, that may start to change, too.

Ninety-one percent of seniors use email, 49% have a Facebook account, and 44% play solo games online, according to a June 2012 report by the market research firm Forrester. Many expect to continue these activities as they transition to assisted-living arrangements. Because of the demand from seniors, and other studies showing the health benefits of being socially connected, experts said it's in the best interest of nursing homes to offer online access.

Internet connectivity is becoming standard in nursing homes, said Majd Alwan, PhD, senior vice president of technology at LeadingAge, a Washington nonprofit organization for institutions that cater to the aging population. He said a 2012 survey of chief financial officers of senior living organizations that LeadingAge conducted with investment bank Ziegler found that 90% had invested in wireless technology in general, and 36% had Internet access and social networking for residents and clients specifically.

Not only are these facilities implementing technology to meet growing demands, they also are doing it to improve the overall health of their residents.

Sarah Hoit, CEO and co-founder of Connected Living, an online platform for nursing home residents, said she credits the success of her company to the idea that when someone is socially connected, he or she is more likely to feel better and take the necessary steps to stay well. “It's about living, not dying,” she said. The technology vendor CDW partnered with Connected Living in April to deliver the technology to more facilities across the country.

Alwan published a report in March that said 13% to 25% of nursing home residents have been diagnosed with depression. Social isolation is a major contributing factor to depression, and technology that helps residents stay socially connected and active can help prevent the onset of the illness, he said.

Installing Internet access and wireless technology also can get patients moving and learning. Crist said he has seen several nursing homes with Nintendo Wii gaming units that residents use to play active games with each other and residents of other facilities.

Hoit said getting nursing home residents actively engaged has been a challenge for many facilities. “The conversation the health care world wants to have with seniors is not one they want to have,” she said. “So if it's broached another way, I think there can be a huge impact. And merely getting them back in the conversation is changing their ability to get out of bed in the morning to be productive.”

Health IT adoption still lags

Although nursing homes are prioritizing technology that keeps their residents more engaged and active, many have not yet responded to pressure to implement health IT systems that would connect their facilities to other health care organizations and members of patients' care teams.

A study in the March 2012 Health Affairs found that only 6% of long-term, acute care hospitals and 4% of rehabilitation hospitals had at least a basic electronic health record system. Short-term, acute care hospitals, by comparison, had an EHR adoption rate of 12% in 2012. Adoption in these facilities since has increased to 44%, according to a March issue brief by the Dept. of Health and Human Services Office of the National Coordinator for Health Information Technology. The Centers for Medicare & Medicaid Services reported in April that 80% of hospitals eligible for the EHR meaningful use incentive program had adopted paperless records, but nursing homes are not eligible for those incentives.

Crist said a few nursing homes have built upon their consumer technology by adding health IT components. For example, some that already had installed Wi-Fi wanted their nurses to start using tablet computers for documentation and medication management. Because the wireless infrastructure already was in place, it was easier to implement the tablet technology.

But offering more ubiquitous and basic consumer technology does not necessarily mean a facility will make the larger leap of adopting an EHR system, which can be costly and complex.

“What we've rarely seen [is] — and I can't think of any instances — where somebody says, 'Well, the consumer and patients were demanding Wi-Fi, [so] while you're in the building, let's go ahead and switch” to an EHR system, Crist said.

F. Michael Gloth, MD, chief medical officer for Moorings Park Healthy Living in Naples, Fla., said pressure definitely is mounting for nursing homes to adopt health IT, but the facilities have been “nowhere near the top of the radar screen” as far as government and private payers are concerned. Because nursing homes were left out of the federal incentive program, EHR vendors are devoting their efforts toward meaningful use customers and not developing systems geared toward nursing home use, he said. Additionally, no government standards have been put in place for what a nursing home EHR should be capable of doing.

Dr. Gloth said the economic benefits of adopting EHRs also have not been made clear, even to physician practices, which is why the government had to offer bonuses for doctors to adopt them. He said if the return on investment were clear, nursing homes would be more eager to adopt EHRs.

EHRs could give competitive edge

Crist said nursing homes are prioritizing consumer technology such as Wi-Fi because it gives them a competitive advantage from an amenity standpoint. But as health care moves toward value-based care and the formation of accountable care organizations, he said health IT will become just as important for remaining competitive, though for different reasons.

Under Medicare's rules for shared savings plans and ACOs, nursing homes are eligible to participate in ACOs but not form them. Still, keeping seniors healthy and out of the hospital will be a top priority for all ACO participants who will share in any cost savings, as well as a prerequisite for avoiding penalties from Medicare for high hospital readmission rates.

One of the things that can help reduce hospital readmissions is better follow-up care when patients are discharged and sent to nursing homes, Dr. Gloth said. The key to this communication is electronic health information exchange, which is nearly impossible if nursing homes don't have EHR systems that allow physicians to access crucial information during care transitions, he said.

Even if nursing homes are not an official part of an ACO, physicians and hospitals who are pursuing shared savings will be more likely to make referrals to nursing homes that have technology to make care transitions more seamless and follow-up care easier to facilitate.

Neville M. Bilimoria, an attorney with the health law practice group at the Chicago law firm Duane Morris, said that if nursing homes are interested in joining an ACO, they should talk with the network's partners before adopting a paperless system. Each ACO has its own EHR requirements. If a nursing home adopts a system that can't communicate with other members' systems, it will be wasting money.

Crist hopes that more facilities are moving toward EHR adoption. But Dr. Gloth said it's important that the systems they adopt are designed with physicians in mind — otherwise they will be hard-pressed to realize a return on their investments.

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Meaningful use leaves nursing homes behind

The meaningful use incentive program aimed at increasing electronic health record system adoption rates largely has had the intended effects. An April report from the Obama administration said 80% of hospitals eligible for the incentive program have adopted EHRs. But a 2012 report from Health Affairs shows facilities excluded from that bonus program have “dismally low” adoption rates.

Facility type Adoption rate
Long-term acute care 6%
Rehabilitation 4%
Psychiatric 2%

Source: “Hospitals Ineligible for Federal Meaningful-Use Incentives Have Dismally Low Rates of Adoption of Electronic Health Records,” Health Affairs, March 2012 (link)

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Seniors and their online activities

A 2012 study by market research firm Forrester found that 60% of senior citizens are online in some capacity. Those who have become accustomed to using Internet technology expect to continue using it when they enter assisted-living facilities.

Online activity Percentage of seniors
Use email 91%
Have a Facebook account 49%
Purchase products online 59%
Send/receive photos by email 46%
Play solo games online 44%

Source: “The Data Digest: Digital Seniors,” Forrester, June 2012 (link)

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External links

“Health IT in Long-term and Post Acute Care,” Office of the National Coordinator for Health Information Technology, Dept. of Health and Human Services, March 15 (link)

“The Data Digest: Digital Seniors,” Forrester, June 2012 (link)

“Hospitals Ineligible For Federal Meaningful-Use Incentives Have Dismally Low Rates Of Adoption Of Electronic Health Records,” Health Affairs, March 2012 (link)

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