1. Network Technology in Long-Term Care Darren Liu, Dr. P.H. Assistant Professor University of Nevada, Las Vegas November 12, 2011 SOUTHERN NEVADA HEALTH INFORMATION MANAGEMENT ASSOCIATION Department of Health Care Administration & Policy School of Community Health Sciences

2. Our Programs… UNLV Department of Health Care Administration & Policy o Chair: Christopher R. Cochran, Ph.D. o Starting from 2005 Degree offered o Bachelor of Science (BS) o Master of Health Administration (MHA) o Master of Public Health - Health Care Administration Track (MPH) o Doctoral degree in Public Health - Health Services Management and Policy Track (PhD) since 2010 Google search: UNLV HCA

3. Outline Define Health Information Technologies (HIT) Processes of HIT Adoption Benefits of HIT Adoption Current Challenges in LTC Patient Protection and Affordable Care Act (ACA) o Accountable Care Organizations o Meaningful Use of Health IT Network Application Technologies for Future LTC

4. Definition Health Information Technologies (HIT) Tools that can be used to capture or process health information (i.e., data, Electronic Health Records) and have the potential to improve quality of care. End-users: Care Providers, Patients, etc. For better quality of care outcomes, lower cost

5. Examples 8 Core Health IT functions in LTC Supportive documentation o e.g., financial, administrative, clinical information Census management Point-of-care (PoC) Computerized physician order entry (CPOE) Electronic health record (EHR) Telehealth or telemedicine Assessment and care planning Electronic prescribing Source: HHS, Evaluation Design of the Business Case of Health Information Technology in Long-Term Care: Final Report, Booz Allen Hamilton, July 13, 2006

6. HIT Adoption Phase I: Preparation Develop Tools & Standards Tools CPOE EHR/EMR POC MDS …, etc. Standards HL7 SNOMED, etc. Phase I: Preparation Develop Tools & Standards Tools CPOE EHR/EMR POC MDS …, etc. Standards HL7 SNOMED, etc. Phase II: Implementation Test Drive Interoperability Usability testing Learnability Efficiency Memorability Errors Satisfaction Confidentiality HIPAA Phase II: Implementation Test Drive Interoperability Usability testing Learnability Efficiency Memorability Errors Satisfaction Confidentiality HIPAA Phase III: Integration Integrate into NHII Primary care Doctors’ office Acute care Hospitals Post-Acute & Long-term care Nursing home Home health care Clinical laboratories Pharmacies Phase III: Integration Integrate into NHII Primary care Doctors’ office Acute care Hospitals Post-Acute & Long-term care Nursing home Home health care Clinical laboratories Pharmacies Redesign Incentive SOURCE: Liu D. Health Information Technology and Nursing Homes, University of Pittsburgh, 2009 (Dissertation)

8. Certification CCHIT Certified 2011 Long Term and Post Acute Care (LTPAC) The Certification Commission for Health Information Technology (CCHIT) Announces first certified EHRs on November 8, 2011 Settings skilled nursing facilities, home healthcare, hospice rehabilitation centers

9. GPS RFID tags Pressure Ulcer Sensor Mats Motion Sensors Preprocessing Parameter Extraction Expert System Online Database Automated Alarm System Family/ Residents Caregivers Doctors Emergency Services TechnologiesHealth Information Technologies Preprocessing Parameter Extraction EHR, CPOE, etc. © Created by Darren Liu, Dr.P.H.

10. Technologies Instruments that can supplement human caregiving and have the potential to improve the quality of life for both older adults and their caregivers End-users: Consumers For better quality of life Definition

11. Source: Pollack, M.E. (2005). Intelligent Technology for an Aging Population: The Use of AI to Assist Elders with Cognitive Impairment. AI Magazine; Vol 26 (2), pp.15 Example

12. More Examples AreaTechnologyPurpose SafetyBiosensors, GPS Mattress monitors for detecting changes in a resident’s skin GPS for locating older adults with AD Activities of daily livingArtificial intelligence Maintain more independence RecreationVirtual reality systems Play games or visit virtual museums Social networkingElder-friendly email, Facebook, Twitter, VoIP (e.g., Skype, Google Voice). Alleviate social isolations, share life stories

13. Benefits of adopting HIT Caregivers o Increase efficiency of care o Increase accuracy of care Healthcare Providers o Reduce costs Consumers (residents and family) o Better quality of care o Managing personal health information o Public reported health related information

14. Current Challenges Legislation o Patient Protection and Affordable Care Act (ACA) of 2010 Major Provisions o Accountable Care Organizations (ACO)  Incentives for Physicians under Medicare/Medicaid with meaningful use of EHR  Hospitals LTC excluded from ACO

15. Meaningful Use Stage 1 criteria include Electronically capturing health information in a coded format, Using that information to track key clinical conditions, Communicating that information for care coordination purposes, and Initiating the reporting of clinical quality measures and public health information.

16. EHRs and Meaningful Use in Long-Term Care In the current proposed ACA rule, LTC providers are NOT included in the ACO groups who are eligible for incentive payments for implementation and meaningful use of certified EHR technology. However, under the original Executive Order of 2004, all care settings were included in the mandate of the use of EHRs by 2014. Meaningful Use con’t

17. Network Applications

26. Future Consumer-driven information o Inside consumer – e.g., staffs o Outside consumer – e.g., current/ prospective nursing home residents Market-driven information o Competition Evidence-driven information o Cost saving o Better quality outcome Government-driven information o Incentive o Regulatory

29. Thank You.