Introduction - Challenges
The technology required in long-term care must be actively managed. The time has passed when allowing the computer systems and other technology used in long-term care to simply exist and assume they are working. An investment in technology must be actively managed to ensure the ever-scarcer primary resource, people, are as productive as possible and clients/residents are getting care they need. Doing so is both a challenge and an opportunity.
The systems and devices must be used, and they must be used correctly and efficiently. Ineffective management will lead to failure. Insufficient attention to the requirements of systems, and failure to adequately staff and train users, has consequences. Saving a small amount of staff or consultant time by curtailing training or system analysis may lead to any of the consequences above, and is a very false economy.
Nearly all providers have made significant investments in technologies to assist in care and meet regulations. Years of experience with many of the nursing home and home care computer systems lead to two conclusions:
1. There are many systems available but no perfect one. (All vendors have to-do lists of things they'd like to add.)
2. Few (if any) providers are using their systems to their full potential.
Nearly all nursing home and home health systems provide care planning support. Still, the staff in many organizations does the real care planning by hand. They may do computer entry to keep the computer and surveyors happy, but the real care is directed by other means. The duplication is costly, and the discontinuity can be problematic.
1. Assign a person to be responsible for ensuring the technology is safe and is used effectively.
2. Inventory all technology in use.
3. Establish a preventive maintenance program with outcome goals.
4. Establish an outcome-oriented training program appropriate for each product being used.
5. Provide appropriate training to all new users, and regularly monitor current users to ensure they are using good practices. If not, remediate.
6. Periodically review all technology in use to be sure it is providing the benefits that are possible. Consider replacement as appropriate.
7. Periodically review processes in depth. Ideally, have this done by someone not part of the organization for a fresh perspective. Consider the following:
Is there technology that could substitute for staff time?
Is it already available?
Are manual processes duplicating what systems do, or could do?
Are the processes more complicated than necessary?
Are all processes documented so someone else could carry on?
8. On staff satisfaction surveys, inquire into opinions, satisfactions, and frustrations related to technology.
Are there requirements or processes that seem unnecessary or overly complex?
Can they suggest better ways to do tasks?
Do they feel adequately trained to use the tools they need?
Do they think new staff is getting sufficient training?
David M. Oatway, RN, MPH, is a long-term care IT consultant based in Key West, Florida. He has been the Chair of the HIMSS Post-Acute Care Special Interest Group, Vice Chair of the American Association of Nurse Assessment Coordination (AANAC), and a member of the American Health Information Management Association (AHIMA). He developed one of the first clinical MDS systems (CHAMP). He is the database manager of the STRIVE national nursing home time study which developed the RUG-IV Medicare PPS. He can be reached at firstname.lastname@example.org