Long-term care patient management and scheduling has, until recently, presented several problems for physicians who also see patients in the office. The majority of these problems are driven by the varying needs of the organization and the physician, caused not only by regulatory requirements, but also by the very different environments of the medical office, the long-term care facility and home care. Among those problems are managing schedules in multiple locations, communicating patient information between the visiting physician and the organizations and physicians' needs to meet state board and CMS documentation requirements. These and other challenges, including obstacles in charting, data communication and other administrative requirements, have resulted in heavier workloads for providers who see patients in alternate locations. Among other things, medical software software can help streamline documentation, records management and electronic prescribing within the long-term care facility. However, the challenges of scheduling and communicating patient data for providers not based in the facility have caused frustration for both providers and facilities. Because demand for long-term care will become more significant between now and 2030, when the first wave of baby boomers turn 85, resolving this data management issue has become more important than ever. The need to utilize technology to improve, streamline and manage health care for better outcomes, especially among this older population, has never been more urgent. Many of us believe that technology will be key to caring for this growing population, and that includes seniors themselves. A recent survey by Accenture showed that there is growing demand among tech-savvy seniors who want to access health care services from home, but 66 percent are worried that today's technology isn't sufficient to do so. The survey reported that 25 percent of seniors regularly use electronic health records for managing their health, such as accessing lab results, and projections by Accenture suggest it will grow to 42 percent in five years, as consumer-facing tools increase. The Pew Research Center estimates over half of those ages 65 and older (59 percent) were active Internet users in 2012-2013, and Accenture's survey showed that 62 percent of seniors indicated their top reason to go online was to find health information. Most seniors want access to health care technology, such as virtual physician consultations, but less than a third of health care providers offer such capabilities. The technology transition requires that electronic health records provide some additional capabilities, starting with software that can be used in various care locations and meet the varied needs of physicians, facilities and home care agencies in order to facilitate coordinated care of patients. Historically EHRs have been designed for either office or facility care, but not both. This has caused providers who see patients in both locations to put in long hours documenting and communicating patient care for patients in facilities, or to incur additional expense by investing in separate software for each. This lack of EHR flexibility also impacts home health agencies and LTC facilities by requiring increased labor to input patient records into the facilities' systems, causing delays receiving the latest visit information and other problems. From the physician's perspective, storing the patient records solely with the facility or home health agency is unacceptable, due to regulatory requirements surrounding on-demand production. As a result, it's vital for the physician and the organization to have synchronized, up-to-date health records for patients.
Good News
Fortunately, new breakthroughs in electronic health records technology have paved the way for better management of patient data and schedules between off-site providers, facilities and home care. Newer EHR technology provides benefits include:
- Multifacility scheduling capabilities
- On-the-fly patient registration
- Ability to migrate information with easy to use upload file functions
- Records access anywhere, anytime with Web-based software
- Charting at bedside with an EHR designed for full iPad use
Mobile Charting
Servicing patients at home and in nursing homes naturally requires mobility. An EHR designed from the ground up for use on the iPad allows for fast, efficient charting at the patient's bedside without losing the human contact patients need and want. The EHR must also work just as well on a desktop or laptop computer.
Multipatient Fax and Print
When a provider has completed all the visits at a facility or home and it's time to communicate the documentation, communication will be delayed if the EHR only supports single encounter fax and print. The best way to get documentation to the organization and into the patient chart is to fax or print in bulk. This communication should be done in three easy steps:
- View the roster for a facility or agency
- Select patients
- Bulk fax or print
Data Upload
Setting up billing and EHR software is a challenge for all practices, but because of the volume of patients, locations and referring providers, the challenge is steeper for medical practices that care for patients at nursing homes or in home care. A provider should be able to cut the data entry time to migrate information into the system with easy to use upload file functions. If a provider needs to add hundreds of patients, multiple locations or referring physicians, thousands of keystrokes can be saved with simple data file uploads, such as:
- Patient demographics
- Locations (facilities or agencies)
- Referring physicians
- Clinical data conversion
Dual Mode Scheduling
Time-based scheduling just does not work with long-term care. When a provider visits a facility, they need a roster of all the patients that reside in the home and an Encounter Tracker that tracks which patients they visited with that day. When the provider gets back to the office and sees patients, they need the standard time-based schedule. In addition, they need a time-based calendar to track which homes they are scheduled to visit. Ideally, to work in multiple care settings, an EHR needs:
- Patient roster view
- Time-based view
- Patient encounter tracker
- Multischedule view
- Drag and drop appointment management
On-site Patient Registration
Patient registration for long-term care patients should not have the same workflow as office-based ones. If the patient address is recorded as the nursing home address, it's a waste of time to enter that data again. Instead, providers should be able to associate the patient with the facility and the address data prefills. When a provider arrives at the facility and the staff asks them to see a new patient, the EHR should have a scaled down registration form built specifically for providers who need to register a patient at the point of care. Today's seniors expect technology to support their healthcare needs; healthcare providers have similarly indicated that they will not tolerate EHRs that don't meet their needs. And at this point in healthcare IT development, we believe neither group should have to wait any longer for medical software that enhances rather than slows the delivery of coordinated healthcare. With the right EHR software, providers can meet their patients' needs and expectations while still reducing the time they spend charting and managing nursing home and home care patients, and communicate effectively with the organizations and patients they serve.
