Tuesday, 12 July 2016 05:07

Valued Quality of Care Coordination (VQCC): Technology Differential

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This is the seventh article in a series addressing the value proposition of long-term, post-acute care (LTPAC) providers and health IT vendors. The articles focus on five major valued quality of care coordination (VQCC) differentials between LTPAC providers and acute/ambulatory care providers. This series is based on the LTPAC health IT collaborative ONC brief written in May 2015 for Karen B. DeSalvo, national coordinator for health informationtechnology 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 and Post-Acute Care (LTPAC) Sector. Readers can find the ONC Brief on the LTPAC Health IT Collaborative website.

Technology is a broad subject, and it includes much more than health information technology (IT). First we must expand on the word “technology.” Specifically, we must begin to talk about “clinical technology.” In today’s world and in the future, the two functions cannot exist separately. Clinical initiatives such as  quality measures, clinical outcomes, new pay and care models, and clinical partnerships are all in the mix. I have tried to get providers to understand that they have to be partners with their health IT vendor, and in the case of small, independent skilled nursing facilities (SNFs) and home health agencies (HHAs), I have suggested that the vendor sit in on strategic clinical meetings. The IT vendors have to think clinical technology, but the providers continually separate the two functions.

This is a slide I have used for years to illustrate that the past and current thinking is not the future. 

Since the release of the 2009 HITECH Act and the development of the meaningful use incentive program, when the LTPAC as well as behavorial health segments were left out, LTPAC health IT has been under secunity. I feel that it is the adoption of Health IT that is lagging behind; after all, the applications are available. If LTPAC were provided with financial assistance, the adoption rate would be much higher. ONC has done its very best to provide grant fundng, and the new Medicaid financing helps with interoperability, but it does not the assist the SNFs or HHAs in upgrading their electronic medical records (EMRs).

The important point in the  technology VQCC is that the technology in LTPAC is different than that of hospitals and physician offices. As we move to transitions of care, some technologies like telehealth and telemedicine, as well as interoperability technology, will bring the clinical technology of the three segments of care closer.

Hospital instrumentation includes areas such as computerized axial tomogaphy (CAT), magnetic resonance imaging (MRI), positron emission tomagraphy (PET), surgical, cardiac monitoring, etc. Health IT is an aggregation of departments to central billing by a person. There is not really enough time in a person’s LOS to develop a longitudinal record. Physician office technology has a person-centric focus to cover what the person is seeing the physician to fix. Health IT is being upgraded to develop a person-centric longitudinal care plan, but it’s going to be made up of personal input and long periods of time between visits – and a number of specialists becoming involved that are not part of the office practice (i.e. therapists).

The ONC brief states that the technology VQCC:

  • Provides a “person-centric electronic care EMR that covers a long duration of care;”
  • Aggregates all personal medical data functions over a long duration, allowing for trending and alerts to prevent incidents;
  • Uses devices to track activities of daily living; and
  • Provides a controlled clinical environment where advanced clinical technology can be tested and utilized by hundreds of persons to assist in public health technology.

The following is a quote from the ONC brief’s Appendix L:

“As previously stated, there are VQCC differentials between the care given in LTPAC and acute care. These VQCC differentials cannot be realized without state-of-the-art technology.

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Last modified on Wednesday, 13 July 2016 18:25

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.