Monday, 08 February 2016 04:28

Valued Quality Coordination of Care: eAssessments

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This is the fourth article in a series of articles addressing the value proposition of long-term, post-acute care (LTPAC) providers and health IT vendors. These articles are based on the LTPAC health IT collaborative brief written in May 2015 for Karen B. DeSalvo, national coordinator for health information technology and acting assistant secretary for health with the U.S. Department of Health and Human Services (HHS), titled Health Information Technology Use & Value Delivered By The Long-Term & Post-Acute Care (LTPAC) Sector.

To assist the first-time readers of this series, the following was covered in the first three articles:

The first article, published in October 2015, included an overview of the LTPAC sector of care and the role that these providers play in the spectrum of care, as well as the percentage of hospital discharges that are transitioned to LTPAC providers. 

The second article, published in November 2015, introduced the five VQCC differentials that the LTPAC provider care sector has, as compared to the ambulatory and acute-care sectors. This also introduced a suggested definition of person-centric electronic longitudinal care.

The third article, published in December 2015, focused on the second value quality coordination of care (VQCC) duration differential that LTPAC has in the quality proposition of the new spectrum of care. LTPAC providers have persons under their care in an controlled environment, with physicians, nurses, pharmacists, therapists, dietitians, social professionals, etc. available for diagnosis, care, the creation of a person-centric longitudinal care plan, and the establishing of a maintenance plan for rehabilitation in the transition to the next care site.

This article will address the second VCQQ: eAssessments. Each LTPAC provider is required to conduct electronic assessments. The regulation requiring the performance of a Centers for Medicare & Medicaid Services (CMS) standard electronic assessment went into effect years before the Health Information Technology for Economic and Clinical Health (HITECH) Act. Initially, the eAssessment was required to ensure that specified care was conducted at a specific time for each patient. As the years have passed, however, eAssessments have been used more in the development of the person-centric longitudinal care record and predicative medicine. You cannot have a longitudinal record that looks at a medical condition over time without having a standard electronic assessment tool on which to build the trending of medical elements and alerts. Today there are software programs that can assist the provider in trending specific conditions that could predict the possibility of a re-hospitalization. The provider has to be aware that the required timing of conducting an assessment nonetheless might be too late to predict a re-hospitalization. 

The major VQCC eAssessment differentials that LTPAC providers have, as compared with those of the other providers listed in Appendix I of the ONC brief, are:

  • A comprehensive clinical and functional electronic assessment of the patient;
  • An eAssessment performed in adherence with CMS regulations and approved standards that is updated to a schedule and altered as necessary;
  • An eAssessment conducted by a coordinated team of licensed personnel in accordance with CMS regulations; and
  • Clinical knowledge over a long duration of time, allowing an electronic medical record (EMR) software application to develop pattern recognition and alerts to potential incidents, preventing re-hospitalizations regardless of the site of care.

Some think of the eAssessment as an EMR. In my conversations with CMS personnel and others developing the updated eAssessments, however, it has become clear that it is not the intention of CMS to have the eAssessment serve as the EMR. The eAssessment should be a byproduct of a comprehensive enterprise EMR. It is worrisome that some leaders of independent skilled nursing facilities (SNFs) and home health agencies think that the SNF MDS and the HHA OASIS is their clinical EMR. Today’s EMRs are very comprehensive in how they acquire data, apply analytics, and provide professional care providers the information and knowledge required to produce high quality of care and improved quality outcomes. The eAssessment is developed and submitted from the EMR.

The following is a 2015 graph that is being updated as CMS develops eAssessments that fit into person-centric electronic longitudinal care plans through the spectrum of care. As you may know, eAssessments across the spectrum of care have to be in harmony, as we do not want a person going from one site to the next to have a different clinical assessment just because he or she changed sites or went home.


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Last modified on Tuesday, 09 February 2016 17:27

John F. Derr, RPh is CEO of JD & Associates Enterprises specializing in Strategic Clinical Technology with a focus on person centric electronic longitudinal medication management and LTPAC. He has over fifty years of top executive level experience Squibb, Siemens, Tenet (NME), Kyocera, MediSpan and EVP of AHCA. He was SVP, CIO and CTO for Golden Living, LLC. He is a member of Corporate Boards providing guidance on clinical Health IT and medication management. He represents LTPAC and Pharmacy as a member of HHS HITECH Committee on Standards. Derr is a graduate of Purdue School of Pharmacy and a 2006 Distinguished Purdue Alumnus.