Tuesday, August 7, 2012

LTC Discussed on the Hill

Experts from government, leading healthcare organizations, partners from HCTAA and NASL, and Hill staffers took part in a lunch briefing on Capitol Hill on August 1st. The event was held on behalf of the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics. The discussion centered on Long Term Care (LTC) and how technology makes it possible for people to achieve an unprecedented level of independence in their later years.

Neal Neuberger, Executive Director for the Institute for e-Health Policy opened the event by introducing Representative Diane Black (R-TN). She recalled how TennCare failed in the state 15 years ago. She told the attendees that initial costs estimated for TennCare were low, but for ten years the state’s Medicaid program’s costs grew unsustainably to where it almost bankrupted Tennessee. She emphasized that it is imperative that the country enact market-based reforms to lower costs and increase access to quality healthcare.

As moderator for the event, Cynthia Morton, Executive Vice President, National Association for the Support of Long Term Care told the group that she wants to see hospitals partner with other organizations to develop ACOs and wants to see further standards development.  

As Director of Clinical Transformation, Beacon Community Program, ONC for Health IT at HHS, Janhavi Kirtane MBA commented on how the Central Indiana Beacon Community is building and strengthening a HIT infrastructure to help patients achieve better outcomes and healthcare.

In this context, Kirtane described how a 53 year old female patient with chronic heart disease, congestive heart failure and eight additional chronic health conditions was admitted into St. Vincent Indianapolis and St. Vincent Heart Center thirteen times in 2011. Twelve of these admissions were readmissions within 30 days of being discharged. In her case, total inpatient and outpatients costs for 2011were over $156,000.

The patient’s providers were frustrated with her prescribed care regimen and the home health agency was no longer able to assist her. At this point, the patient had health monitoring equipment with video conference capability installed in her home for a 30 day period with a nurse stationed at a remote care center coordinating her care. She also received reminders from the nurse to keep her appointments, not only with her physician but also with other specialists, which enabled her to improve her medication adherence. 

Kirtane described how the document “Roadmap for Health IT in Long-Term and Post-Acute Care” (LTPAC), points to several wins. They include the publishing of certification criteria and processes for LTPAC EHR solutions. Other wins produced ONC’s Challenge Grants that went to four states to promote LTPAC HIE initiatives, the continuing adoption of EMR/EHR solutions by the LTPAC sector, exploring how to incorporate health and wellness monitoring technologies by LTPAC providers, and lastly, providing broader recognition and support for LTPAC concerns.

To harmonize standards, the ONC Standards and Interoperability (S&I) Framework is one investment approach adopted by the Office of Science & Technology. According to Kirtane, the S&I Framework is an example of government integrating functions, processes, and tools available to the open community of implementers and experts working together. As of April 2012, 1,100 plus people have registered on the S&I Framework wiki, and 450 plus people representing more than 300 organizations committed to the S&I Framework.

The S&I Framework’s Longitudinal Care Coordination Workgroup is now working on priorities to develop a coordinated longitudinal care plan, transitioning care documents for LTPAC in terms of patients transitioning to and from LTPAC settings, and in the future, plans are being made  to produce a patient assessment summary. A white paper is due to be published shortly summarizing the workgroup’s discussions.

As Kirane summarized, the long term care community wants to see current pilots and initiatives inform the future stages of meaningful use and consider new LTPAC data exchange criteria, provide measures for future meaningful use stages, broaden certified EHR technology to capture and share patient assessment data, and consider access and inclusion of patient care goals and advance directives.

Larry Garber, M.D, Medical Director for Informatics Reliant Medical Group described how people in nursing homes and/or participating in home care differ from hospitalized and other ambulatory patients. Most people in nursing home or involved in home care are sicker than typical non-hospitalized patients which makes communication much more difficult without an electronic record.

Garber described how ONC’s $1.7 million HIE Challenge Grant award in 2011 went to the state of Massachusetts for the project “Improving Massachusetts Post-Acute Care Transfers” (IMPACT). The funding is being used to enable nursing and rehabilitation facilities and home health agencies to participate in community and a statewide HIE, improve the communication of essential clinical data during transitions of care, decrease avoidable ER visits, reduce hospital admissions and readmissions, reduce the total cost of care, and finally replicate this model in other communities.

Overall, the goal for IMPACT is to create a system for information exchange between healthcare providers within pilot sites to allow groups with EHRs and those without to share information about their patients electronically.

Garber explained how the “Local Adapter for Network Distribution” referred to as “LAND and & See” architecture in the meantime is trying to fill in the technology gaps. LAND acts as a data courier to gather and securely transfer data to the HIE if there is no support for DIRECT or IHE XDR.

Deb Mikell, Vice President, Philips Home Healthcare Solutions followed up with a discussion describing how Philips is working very hard to build the home healthcare of the future. Her remarks centered on four specific areas where Philips is working to find solutions to meet the LTC community’s needs:

·        Falls and resulting trauma—One half of the elderly population after a fall are not able to get up. The solution is to have effective alert systems where help can be called immediately
·        Medication dispensing—Multiple medications can be confusing especially for the elderly and one out of ten may not take their medications properly but correctly monitoring these patients can increase the adherence rate
·        Telehealth remote monitoring—Can be used to easily check vital signs at home
·        Sleep disorders—Diagnosing and treating sleep disorders helps to not only manage sleep problems but can produce a reduction in heart failures

The goal for Philips is to improve the quality of life for at-risk individuals through better awareness of the problem, effectively diagnosing individuals, enabling up-to-date treatments, and keep developing products and monitoring technology to do a better job in helping at home individuals.

For more information on the event, email Arnol Simmons, Manager, Public Policy Initiatives at asimmons@e-healthpolicy.org or go to www.e-healthpolicy.org.