Department of Health Care Administration & Policy
School of Community Health Sciences
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
• UNLV Department of Health Care Administration & Policy
o Chair: Christopher R. Cochran, Ph.D.
o Starting from 2005
• Degree offered
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Bachelor of Science (BS)
Master of Health Administration (MHA)
Master of Public Health - Health Care Administration Track (MPH)
Doctoral degree in Public Health - Health Services Management
and Policy Track (PhD) since 2010
Our Programs…
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Google search: UNLV HCA
• 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
Outline
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
Definition
8 Core Health IT functions in LTC
• Supportive documentation
o e.g., financial, administrative, clinical information
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Census management
Point-of-care (PoC)
Computerized physician order entry (CPOE)
Electronic health record (EHR)
Telehealth or telemedicine
Assessment and care planning
Electronic prescribing
Examples
Source: HHS, Evaluation Design of the
Business Case of Health Information
Technology in Long-Term Care: Final Report,
Booz Allen Hamilton, July 13, 2006
Incentive
Incentive
Phase I: Preparation
Phase II: Implementation
Develop Tools &
Standards
Test Drive
Interoperability
Usability testing
Learnability
Efficiency
Memorability
Errors
Satisfaction
Confidentiality
HIPAA
Tools
CPOE
EHR/EMR
POC
MDS
…, etc.
Standards
HL7
SNOMED, etc.
Redesign
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
HIT Adoption
SOURCE: Liu D. Health Information Technology and Nursing Homes, University of
Pittsburgh, 2009 (Dissertation)
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
Certification
EHR, CPOE, etc.
GPS
Preprocessing
Parameter
Extraction
Preprocessing
Parameter
Extraction
Family/
Residents
Expert
System
RFID tags
Preprocessing
Parameter
Extraction
Pressure
Ulcer
Sensor Mats
Preprocessing
Parameter
Extraction
Motion
Sensors
Preprocessing
Parameter
Extraction
Technologies
© Created by Darren Liu, Dr.P.H.
Automated
Alarm
System
Online
Database
Health Information Technologies
Caregivers
Doctors
Emergency
Services
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
Example
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
Area
Technology
Purpose
Safety
Biosensors, GPS
•Mattress monitors for
detecting changes in a
resident’s skin
•GPS for locating older adults
with AD
Activities of daily living Artificial intelligence
•Maintain more independence
Recreation
Virtual reality systems
•Play games or visit virtual
museums
Social networking
Elder-friendly email,
Facebook, Twitter, VoIP (e.g.,
Skype, Google Voice).
•Alleviate social isolations,
share life stories
More Examples
• 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
Benefits of adopting HIT
• 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
Current Challenges
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.
Meaningful Use
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
Network Applications
• 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
Future
Thank You.