Tuesday, April 20, 2010

The Stimulus and Skilled Nursing/Long Term Care

I'm often asked questions about HITECH and its implications for specific organizations and groups. Last week, I was asked specifically about Skilled Nursing Facilities.

John Derr of Golden Living, LLC is a member of the HIT Standards Committee. I asked him for his view. Below is his answer, which I hope you find helpful.

"This email is in response to your email to Dr. Halamka and the HITECH program including Skilled Nursing Facilities (SNF). Even though SNFs and other long term & post acute care (LTPAC) providers were not yet included in the ARRA stimulus funds we have many programs underway to participate in the electronic health record (EHR) initiative. There are representatives of LTPAC providers on the HHS Federal Advisory Committee for both Policy and Standards. I am on the Standards Committee as well as the Quality and Implementation Committee Workgroups. I am also a Commissioner on the Commission for Certification of Health Information Technology (CCHIT) as we have a workgroup underway developing EHR Certification Standards for the SNF and other LTPAC provider applications. I also am on National Quality Forum (NQF) Committees working on the electronic quality measures. I mention this to let you know that after many years where SNF (LTPAC) was not at the table, we now have representation at the committee levels but have not yet received much attention from Congress that is why we are not in the ARRA.

In 2004 at the meeting where Secretary Thompson announced the Presidents Executive Order to develop the EHR the Secretary asked me to coordinate LTC HIT. I formed a collaborative called the LTPAC HIT Collaborative which is made up of all the LTPAC provider and vendor stakeholders. I assume Bethany Home Society of San Joaquin County is a member of AAHSA and CAST. they are both members of the Collaborative. I have attached a copy of the comments the Collaborative made on the ARRA Meaningful Use which provides the names of the organizations.

With that said, we are working very hard to have SNFs and Home Care be part of the incentive programs because many of the eligible hospital and physician "Meaningful Use" electronic quality measures will require interconnectivity and interoperability with SNFs and Home Care Agencies. At this point the HITECH program does require that providers with a large number of Medicaid patients be included in the HITECH program. In fact the states will have to write their plans to include all high census Medicaid providers in order to have their plans approved by CMS and ONC. The Collaborative is working with the states to develop a kit to help them include SNFs in their plans. We are also working with NQF on the "Meaningful Use" electronic quality measures so that a patient will have the same quality measures as they move from a hospital or physician practice to a SNF.

On June 7th and 8th there is an LTPAC HIT Summit in Baltimore where you can receive all the HIT activities concerning LTPAC. I would encourage you to attend this summit and to become involved at the state level. Much of the decisions will be at the state level and the more SNF informed CIOs that work with the state the better our chances of receiving incentive assistance.

Dr. Halamka's work and leadership is so very helpful to us all. Even though SNFs were left out of the ARRA legislation we are all working together to ensure that SNFs have not been left out of the future planning. If you attend the LTPAC HIT Summit you will receive the 2010 - 2012 updated LTPAC HIT Roadmap which can help you in the planning of your HIT system. Plus there is an interoperability showcase where there will be demonstrations of what others are doing to implement the EHR. I have attached a copy of the current draft program and a flyer.

Thank you for asking Dr. Halamka your question and for following his Blog. If you have any further questions please do not hesitate to ask.

John F. Derr, R.Ph.
Strategic Technology Consultant
Golden Living, LLC"


Pat Klelher said...

Thank you John and John for this helpful summary .. As a home care trade association I am particularly interested as whether states are moving on this with regard to VNAs who work with a large % of Medicaid patients: "At this point the HITECH program does require that providers with a large number of Medicaid patients be included in the HITECH program. IF I can not attend the The long term summit, I am hoping there will be good home care presence."

Pat Kelleher
Home Care Alliance of Mass

Valur said...

Whats your view on flexabilety vs standardation. Most patients have some induvitual needs that are outside standardized processes and procedures, to what extent should we try to cope with them?

Anonymous said...

Hi John,

Please consider writing a post on entrepreneurship and healthcare... that is, if you feel entrepreneurship is important.

There appears to be a huge barrier to innovation and yet it is so important to this overburdened market. But most CIOs and purchase decision makers that I have met (with very few exceptions)seem to hide behind the "will they be around in 10 years" excuse. In the age of SAAS and interoperability, this excuse sounds obstructionist. It's an old state of mind to keep things for 10 years.... but in healthcare we need an attitude of ongoing product improvement and toss the old. We do this with our mobile devices now... who keeps their same phone for >2 years? Just the laggards. Healthcare cannot afford to be filled a bunch of laggards anymore.

But the decision makers tend to gravitate to the big players, are overly dependent on BIG glittery advertisements, or wait for word of mouth enlightenment. I heard one actually said that he is too important at this stage in his career to seek innovation and expect it to come to him... but will not open his own mail or email or other forms of communication.

Time out: shouldn't they be just as invested in finding (perhaps cultivating) the best solutions available as entrepreneurs are in innovating the best solutions? What's with the caste system mentality? Vendors are not the "untouchables" and they are not the "brahmin priests."

Do you have thoughts on this issue?

How do YOU seek out all the great new things you share with us? My guess is that you are a speed reader and do not sleep. ;)

Just an entrepreneurship researcher

Anonymous said...

I work as an IT Manager in one of the United States largest ICF-MR state-operated providers. What, if any discussion has included ICF-MRs regarding the implementation of EMR systems. The on-site medical director (a physician) asserts that over 90 percent of our clients (almost all Medicaid patients) receive medical care at the institution and not in community medical clinics or acute care facilities. We are doing an enormous amount of paper charting while regional, private health networks are receiving substantial federal funds to incorporate technology into their environments. There is an increasing disparity between long-term care programs and private medical facilities in terms of EMR.

If you add home and community-based programs (private or state-operated) it gets even more complicated.

Anonymous said...

I know very litle about all this stuff but currently my focus of learning. Transformational change only comes when one really stir things up, remember the blackout! they will turn to you if you have any kind of feasible answer :) Just make it happen if you feel that something bad needs to changed, renovate and even innovate but the latter one cost lot of money. If possible evenly planned steps are the easiest way to change, because stress and fear is your worst enemy.