LTC Expert Article: The Big Picture

Ask any veteran nurse or billing manager that has been working with paper their entire life: Technology can seem very complicated and a huge burden of extra acronyms and techno speak. That is until one day that light bulb flashes inside our heads and the blurry big picture comes into focus.

The truth is that technology is simple because it breaks down to two things that everyone can relate to. First and foremost, technology improves resident outcomes and the quality of life we are able to provide to those we care for. Why? Because computer documentation advises staff what to do, proves that it was done and has the ability for real time access. And second, we cannot forget that it also greatly impacts the hard dollars and cents of our facilities – in a word, billing. We all love what we do to help improve people’s lives, but we simply can’t ignore it, money talks, and it is what allows our organizations to stay in operation and, by the way, pays for all of our salaries!

So how do we reach that moment of enlightenment, that elusive “a-ha!” state that allows us to see past the mumbo jumbo which inevitably comes with technology?  First, we must understand that the base of our blockage comes from within our own organizations. We have departments that are silos: the clinical staff, the MDS Coordinator, the billing staff, the rehab staff, the home health staff, the physicians, the pharmacy, even the financial staff and others all are separate entities with their own agendas and requirements. To begin to see the big picture, you need to float above the day-to-day activities in your particular role and look at it from the resident’s perspective. All they know is that they require information and assistance of some kind or another from each of these parties, but they have to repeat their needs and re-communicate information to each sector of your facility in order to achieve their own big picture – a respectful and dignified life as they define it. If we are to be truly resident-centered organizations, we must use technology to make sure that each resident’s big picture is shared appropriately at every necessary level of the organization.

What we often talk about in our industry are MARs, TARs, MDS, ADLs, Care Plans and RUGs among others. These are all smaller components of the larger picture which all come with a technology tool. So we ask ourselves, which vendor has the best MDS tool or eMAR/eTAR or admissions and census tool and we may buy a few different tools to satisfy the need of one component, but we’re missing the target entirely. It is not the singular piece that matters; it’s all of the unified pieces which give us the bigger picture.

Sound too idealistic? Does it sometimes seem like your organization is constantly struggling with managing all of the different technology pieces of this complex puzzle we call Long Term Care? Maybe you have too many vendors involved. As my fifth grade teacher used to say, “Keep It Simple!” Your organization can do the same – all of your documentation should live in one place where it can be shared appropriately and securely throughout your entire facility. It should flow through to your financial and billing departments, right down into your financial outcomes. This is something you simply cannot achieve by having dozens of disjointed technology pieces floating around your organization. So what we propose is to have a “Master Technology Plan” which helps you reach your goal of “The Resident’s Big Picture”.

The Master Technology Plan

1.  Have as few vendors as possible. More vendors add complexity and as was noted, you want to spend your time on the “Resident’s Big Picture”, not trying to manage dozens of vendors and technologies every day. It takes away valuable time and effort that can be put to better use. It is also important, especially in these economic times, to check out the financial strength and other customer experiences of your vendors. You don’t want to discover any surprises down the road.
2. Start with an expansive and integrated core system. As we learned in high school, popular isn’t always better and neither is simple to the point of stupid. You should make sure that the core system you’re buying has the wherewithal to handle your operation today and in the future. You can always turn off features you don’t need today. It will be much harder (and expensive) to add them on tomorrow to a system that doesn’t even offer them. Don’t fall for a smoke and mirrors presentation, either. If the vendor claims they have a feature, they should be able to show it to you. If not, then you know they’re trying to sell you “vapor ware” which is what we refer to in the software industry as software that hasn’t even been created yet. They should tell you up-front about the fact that they don’t have the feature and then it’ll be up to you to decide if you want to wait for it or not. Keep in mind that new features aren’t always 100% perfect the first time around, so you might be waiting quite a while.
3. Beware of different definitions of integration. Some vendors will swear to you up and down that they have an integrated clinical and financial system. Only for you to find out later that what they really have is an interface to a different financial system by another vendor that is not suited to Long Term Care because it was written for generic industries. This is clearly not the same definition of integrated by any real standard of what that word means. An integrated system is built by one vendor, not by different vendors.
4. Question the need for ANY interfaces. In reality, you will need interfaces to address some part of the puzzle that will be through a different vendor, but this is a slippery slope you’re on. Your goal here is to limit the number of interfaces necessary between different software companies in order to keep your IT footprint as small as possible. You can only do this by selecting a system that has a significant core of features. Keep in mind, they will also have interfaces to other systems, for example, to pharmacy systems and hospital systems that aren’t within their core and that’s fine. You just don’t want multiple interfaces to be the primary way for them to offer you all of the functionality you need.
5. Realize that the sum of the parts does not equal the whole. Other vendors will try to sell you on the “best of breed” concept meaning that you should have many different vendors each with their own specialty in order to get to the best possible solution for your facility. While it is an interesting theory, what really happens when you put too many different breeds together is that you end up with a really ugly mutt. Instead of this Frankenstein approach, you absolutely must stick to your Master Technology Plan of limiting your vendors, limiting your interfaces and working with a core system that has all of the necessary functionality you need. It will pay off for you in the end by positively impacting the two things that matter most, your residents and your bottom line. It will also save you a few gray hairs in the process!
6. Recognize that the software isn’t enough. You’re not buying software – you’re buying a small piece of the company that is offering you the software. It is your responsibility to conduct your due diligence, as you would with any other investment. Ask your vendor what level of technical support is available. Ideally, you want a support technician team that has separate specialists in the financial and clinical areas. Ask for their specialists’ biographies to determine if they have industry experience and would be capable of understanding your organization’s real needs. Find out how often the system is upgraded and how soon can you expect regulatory requirements to be implemented. Ensure that there is ample “hands-on” and onsite training and accessibility to trainers to suit your organization’s needs. It is critical to remember that purchasing a software system without adequate training is tantamount to throwing your organization’s money away.

To lift that final veil of puzzlement, we can offer something that you already intrinsically knew: as caregivers we have the responsibility to improve outcomes through our decisions, or as we should call it from now on “The Resident’s Big Picture”. So when the next vendor comes knocking on your door with the latest technological do-dah that you simply must buy, ask them how it fits into your Master Technology Plan and the Resident’s Big Picture. If it doesn’t, well then your decision just became that much easier. You can then stop spending time fielding their sales calls and more time caring for your organization and its residents.

About Don Frazier
Don Frazier is the Vice President of Professional Services at AOD Software. Don has extensive software implementation and training experience with Long Term Care facilities across the US. He also has over sixteen years of service- installing, training, and supporting software systems in the Banking industry; having installed software systems for more than 100 financial institutions throughout the country. 

An edited version of this article was published in the October 2009 issue of Advance for Long Term Care Management Magazine.