In this paper, we will compare and contrast Skilled Nursing Facilities from 20 years ago to today. Skilled Nursing facilities of today are both similar and different from what they were like two decades ago. Similarities comprise of the organizational structure, including different departments, and the various roles within those departments. The roles of nurses, doctors, administrators, and therapists have not changed much in the last 20 years, and it is still the same hierarchical approach where a top down approach to administration and management is used .
The differences outweigh the similarities as many changes have taken place over the years. Most of the changes have been as a result of the advances in information technology in health care. Some of the differences include utilization of information systems such as e-mail for communication, documentation using electronic medical records (EMR), and utilization of advanced medical equipment. Two significant advances in health care information system over the last two decades has been the use of EMR and the advances in medical devices.
These two advances have changed how care is being delivered in health care in general and more specifically, in skilled nursing facilities. Two decades ago, majority of documentation was done by hand, often resulting in disjointed, redundant documentation without the ability to extrapolate meaningful data for analytical and benchmarking purposes. By contrast with the current EMR documentation, there is very little duplication of documentation, and internal and external benchmarking is available for quality improvement purposes.
Today’s skilled nursing facility is dependent upon computer and information systems to run practically every aspect of the organization. Billing systems, pyxis systems for medication dispensing, minimum data set documentation and transmission to The Centers for Medicare and Medicare Systems are just some examples of the use of computer technology used in nursing facilities of today. Skilled Nursing Facilities using outdated technology, hand- written documentation, and outdated medical equipment will have to adapt to and invest in technology and equipment if they want to stay competitive with the market.
Information System in Skilled Nursing Facility of Today The skilled nursing facility that I currently work at is a long-term care facility founded in 2001 and is affiliated with a local nonprofit hospital. This 150-bed state-of-the-art facility has 40 sub-acute beds, 30 dementia beds, and the remainder, are long-term beds. The sub-acute unit has all private rooms. All beds are Medicare and Medicaid certified. This modern facility has electronic medical records and uses internal and external benchmarking data to track and trend data.
They use this data to improve clinical and financial outcomes and as a result of this, have been able to improve their financial viability and have a five-star rating on the CMS Nursing Home Compare website. The physicians and nurses can access lab results, and x-ray results online via a secure connection. The admissions department can cost out patients medications and the rehabilitation department, in collaboration with the MDS coordinators can determine reimbursement based on patient needs, prior to the patient being admitted. Data is stored in a data warehouse (server) where it can be mined by authorized personnel only.
The advanced medical equipment use has resulted in high level of job satisfaction and resulted in staff retention. Analysis of Data Used: 20 Years Ago to Now Twenty years ago, skilled nursing facilities did not have the ability to collect and analyze data. The need to collect data was there, and some manual data collection was done, but it was impossible to collect significant clinical and financial data and use it for analytical purposes. Fast forward 20years to the present and we now have the ability to have access to significant data that can be used to improve systems and processes
for better outcomes. Of significance has been the minimum data set in nursing homes. The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident’s functional capabilities and helps nursing home staff identify health problems. Care Area Assessments (CAAs) are part of this process, and provide the foundation upon which a resident’s individual care plan is formulated.
MDS assessments are completed for all residents in certified nursing homes, regardless of source of payment for the individual resident. MDS assessments are required for residents on admission to the nursing facility, periodically, and on discharge. All assessments are completed within specific guidelines and time frames. MDS information is transmitted electronically by nursing homes to the national MDS database at CMS. National and regional benchmarking is available through reports and government rates nursing homes based on these benchmarks.
Examples of available benchmarking are percentage of restraints used, facility-acquired wounds, infection rates, falls, and decline in activities of daily living. Two Major Technological Advances influencing Health Care Information System (HCIS) Health care information systems are a prerequisite for coordinated, integrated, and evidence-informed health care. Introduction and use of EMR has changed how health care is delivered across the spectrum and will continue to change. It has allowed us to collect clinical data and use it to use evidence-based best practices.
It has given the ability to decrease redundancy in documentation and increase patient safety by flagging medications that may be contraindicated if given in combination with another medication. Another major technological advance has been in the area of medical devices and equipment. Advanced medical devices used for diagnosis has helped detect diseases more rapidly and as a result, saved lives. The use of telemedicine is for patients who wish to remain in their homes versus a nursing home have been significant. Nurses can check patients’ vital signs frequently and collaborate with the physician to monitor patients and change treatment as
needed before patient becomes acutely ill. This has lessened the need for the patients to be re-hospitalized, hence, better outcome for the patient as well as lesser financial impact. Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smart phones, wireless tools, and other forms of telecommunications technology.
Conclusion There are some similarities and vast differences between the operations of a long-term care facility of today versus one from 20 years ago, specifically as it relates to information systems and how data was used than in comparison with the way it is used today. Today, every process, and system in a long-term care facility is dependent upon information technology to function. Financial and clinical outcomes are measured and compared with other organizations, both, nationally, and regionally to gauge and improve processes.
One major technological advance has been in the area of use of EMR and access to patient information, such as lab results being readily available, enabling providers with quick decision-making ability. Another major technological advance has been in advanced medical equipment and telemedicine, allowing exchange of information for improved patient health status. Future advancement in information technology will change the way health care is delivered and facilities that embrace this change and use it to their advantage will come out ahead. References www. americantelemed. org/learn www. cms. gov www. lse. ac. uk
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