Long Term Care - Improving Patient care and decreasing costs through EHRs

Long Term Care: Improving patient care and decreasing costs through EHRs Amy Blakely and Stacy Hawthorne The University of Texas at Austin Health Information Technology Fall Certificate Program – 2011 _________________________________________________________________________ Table1: Adverse Events cost implications and Quality Improvements ________________________________________________________________ Falls Falls are the leading cause of injury among adults aged 65+, result in 1,800 deaths in nursing home care and cost the United States $19B annually. 7 As a key indicator of other health problems, falls are twice as likely to happen in a nursing home setting than living in the community. The cost of care after a fall is determined by the severity of the injury. Annual cost per fall in long-term care setting is $6,859. 8 After implementation of the EHR, new falls in the nursing homes were reduced by 32% (Figure 4). Poly-pharmacy 24% of nursing home patients in the United states take 9 or more medications. 9 Innovations in technology, new categories of medications and multiple physicians treating a single patient are some of the contributing factors to poly-pharmacy. 10 With the addition of dashboard quality indicators and quality measurers and real-time clinical alerts and reminders, poly-pharmacy was reduced 21% when the EHR was used in the Sands Point Study (Figure 4). Pressure Ulcers Pressure Ulcers cost more than $355M in LTC annually and affect up to 28% of nursing home residents. 11 Between 1999 and 2002 87% of legal verdicts and settlements involving pressure ulcers were awarded to the plaintiffs and of the 54 lawsuits reviewed, the average monetary recovery was more than $13.5M. 12 EHR use in the Sands Point Study showed a 27% decrease in the number of residents with pressure ulcers (Figure 4). Anti-psychotic drug administration In a study conducted by the Office of the Inspector General in 2007, 88% of Medicare claims for atypical anti-psychosis drugs were associated with FDA boxed warning, alerting caregivers to an increased risk of mortality when prescribing anti-psychotic medications for elderly patients with dementia. 13 In addition to the inappropriate prescribing issue, $63M of the total number of Medicare claims studied were not administered according to CMS standards. The Sands Point study showed a 100% reduction in the practice of giving anti-psychotic medication in the absence of a diagnosis of psychosis (Figure 4). Amy Blakely – amyblakely@gmail.com Stacy Hawthorne – stacyhawthorne1@gmail.com Source: CMS Source: US Bureau of Census Figure 2: Population 65+ by Age: 2010 - 2050 Figure 1: US Healthcare Spending - 2008 Source: CMS Figure 4: Quality Measures – Pre- and Post-EMR Implementation according to Sands Point Stud y 2 Figure 3: Projected Healthcare expenditures by setting Long Term Care (LTC) facilities are the setting of care for growing numbers of our nations older population leading to unsustainable health care expenditures. The aim of this poster is to determine if electronic health records (EHR) can reduce or prevent adverse events in LTC facilities thereby improving patient safety and reducing associated costs. This was a literature review in two parts. First, a look at prevalent adverse events in the LTC setting. And secondly, a review of existing research into the use of EHRs in LTC. The findings of the poster show that the features built into EHRs, when used in LTC, have the potential to reduce the number of adverse events including falls, poly-pharmacy, pressure ulcers and inappropriate use of anti-psychotic medication. These finding, in conjunction with the recent adoption of standards for LTC specific EHRs by Commission of Health Information Technology (CCHIT), offer a framework of action for researchers, LTC leaders, and policy makers. ABSTRACT Under the American Recovery and Reinvestment Act (ARRA), federal incentives were offered for implementation of EHRs in a variety of healthcare settings. Studies indicate the use of health information technology increases efficiency, reduces costs and improves patient outcomes. 1 However, LTC facilities were left out of the funding and to date, only 1% of skilled nursing facilities in the country use the full EHR system. 2 Even though LTC is behind other settings in EHR use, Medicare and Medicaid certified nursing homes have electronically reported on the Minimum Data Set (MDS) since 1998. MDS is a 15 category assessment, reporting on all residents on items such as medication use, skin condition, psychosocial-wellbeing and disease diagnosis. The MDS report determines the facilities Resource Utilization Groups (RUG) for reimbursement. In 2008, LTC made up 6% of the total healthcare spending in the US (Figure 1). Currently there are approximately 1.5M elderly currently residing in nursing homes. 3,4 As can be seen in Figure 2, the aging of the US population is increasing 10-35% every 10 years through 2050. By 2020, the oldest-old (85+) and the highest consumers of skilled nursing, are expected to increase by more than 32%. 5 More, expenditures for nursing home care is expected to double by 2020 (Figure 3). With the passing of the Patient Protection and Affordable Care Act of 2010 (PPACA), Title VI addresses LTC settings by offering the first grants to utilize a certified EHR. 6 In October 2011, CCHIT published a set of standards specifically for LTC EHRs. The purpose of this poster is to look at four common adverse events in LTC settings; falls, poly-pharmacy, pressure ulcers and anti-psychotic drug administration, and determine if EHRs could reduce the number of adverse events, improve the quality of care and reduce LTC expenditures associated with the events. INTRODUCTION An electronic search of Pubmed and Google Scholar was conducted for articles published after 2002. Additional references were obtained by reviewing the references in several major reports prepared by private industry. Search terms included Long Term Care, EHR use in LTC, adverse events in LTC, poly-pharmacy, falls, anti-psychotic drugs, pressure ulcers, and combinations of the se terms. METHODS RESULTS With the increase in the aging population over the next 40 years, residents within LTC settings will continue to strain the nation’s healthcare system. In the literature review of four adverse events: falls, poly-pharmacy, pressure ulcers and anti-psychotic drug administration studies shows that features built into the EHR assist in medical error reduction (Table 1). The literature also suggests that the EHR offers better documentation of care, resulting in higher RUGs and thus an increase in reimbursement rates. Further, a University of Pittsburgh study found a close linkage between MDS software and clinical HIT, where 87% of LTC were already utilizing third party software, to electronically submit MDS reports to CMS. 14 This linkage may allow for an easier transition to full EHR use. Because studies suggest there is a possibility of reducing adverse events, improving quality of care and reducing healthcare expenditures, we believe that EHR adoption in LTC is a viable practice model. Like other settings, the most significant barriers for LTC facility adoption includes costs and training. While LTC facilities were excluded from ARRA, the industry was noted in the PPACA, Title VI through grant awards starting in 2011-2014, although as of November 2011 funds have yet to be appropriated for the grants. 6 In October 2011, CCHIT approved the first EHR for LTC. Assuming additional vendors become certified for LTC EHRs, LTC facilities will have access to EHRs with greater functionality than presently exists to solve their specific EHR needs. DISCUSSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],REFERENCES

Long Term Care - Improving Patient care and decreasing costs through EHRs

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