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One on one with... Larry Wolf

October 4, 2013
by Lois A. Bowers, Senior Editor
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Technology-related issues and trends in long-term care were on the agenda when Larry Wolf, health information technology strategist with post-acute service provider Kindred Healthcare, recently spoke with Long-Term Living.

Has information technology transitioned from being a documentation system to being more of a business strategy that long-term care needs to embrace?

Definitely. While Kindred has chosen to focus on the shorter-stay folks, even the longer-stay folks are generally sicker than they’ve been before. They need more true healthcare and services than they’ve needed before. It’s not just support with activities of daily living. Coordinating the other services they need increasingly is assisted with electronics, and increasingly we are going to see [in long-term care] the kind of monitoring devices that people have at home to help them manage an elderly or disabled friend or relative. This is not a technology issue; this is a care process and business issue.

What are the biggest technology-related issues facing long-term care right now?

Under Meaningful Use 2, starting in October for early-adopter hospitals and in January for physicians, there are incentives to exchange information electronically and in a standardized way with other providers, so their systems need to be certified to be capable of sending and receiving. And where are they sending information? Wherever the patient goes. And for 35 percent to 40 percent of hospital discharges, that’s somewhere in the post-acute, LTC space—LTC acute hospitals, patient rehab, nursing centers, nursing rehab centers and home health. That’s a general environmental shift.

Also, we have started seeing a move in long-term care for a different kind of system. It’s no longer enough to have a paper-based MDS process with a back-office data-entry person who’s managing paper and then does an electronic submission. We’re actually creating a workflow that becomes part of the routine care for patients, and we’re getting systems that support that workflow—everything from certified nursing assistant documentation to nursing assessments to, sometimes, the electronic collection of levels of rehab services. Even with the existing tools that use the MDS environment, we’re seeing a shift in the tool sets that long-term care, particularly nursing center-based long-term care, has. And similar things are happening in home health as well—additional documentation and more people moving toward mobile apps that go with the nurse who’s visiting the person at home. Vendors are very much aware that there’s a need [for LTC providers] to be able to receive these standard-based documents and, when someone leaves our care setting, to be able to send those standard-based documents with them.

Also, states are receiving funding to create health information exchanges, and several of them have specifically looked to include long-term care in their outreach. Often, a nursing center only needs an Internet connection and a basic personal computer and then on a Web-based tool can view the information that other providers are collecting. And some tools now take the information that long-term care has available and add that in.

What other trends are you seeing in long-term care related to technology?

I’m seeing a general movement, not just at Kindred, but broadly in the industry, toward more automation in the nursing facility, more options for how technology gets delivered—certainly the cloud-based technology is growing as a way to deliver systems, and getting better all the time—so you don’t have to have as much local expertise to do things.

In terms of who’s adopting the technology, two groups are moving us forward: large organizations such as Kindred, which have a very big infrastructure and a big technology base, and small and mid-sized regional chains. Because they are smaller organizations, if they take on an initiative, it’s taken on by the whole organization. They’re small enough that the leaders are physically present. They’re geographically close enough together that they can see what’s happening electronically and can watch and talk to the people who are providing the hands-on services. They can see where there are glitches. They can make the changes in physical layout to better position the computers. They can redesign patient rooms, nursing stations and common areas, and because they’re doing it on small scale, they’re not looking at multipliers of hundreds of buildings.

Also, for a lot of reasons, the rest of the healthcare world has discovered or rediscovered the LTC and post-acute worlds, so we need to rediscover them. We need to start paying attention to what’s happening broadly on the national front, to changes that are happening that have been driving the acute-care world for the last four or five years. Increasingly, we’ll be driving the post-acute and LTC worlds. And so I think about my own experience with the national Health IT Policy Committee, where I’ve been advocating since 2009 for long-term/post-acute care as an equal player with the acute care folks, and that even though we’re not getting the incentives, that the regulations need to be written in a neutral way. The system certification needs to be written in a neutral way so that it, in fact, is a useful regulation for us. It may not be a regulation that applies to us, but it’s a regulation that gives us a useful structure, it’s a regulation that has the acute-care folks doing things in a way that makes sense to all providers. They should not just see us as somewhere in the darkness, but actually coming much more to the forefront, and I’m pretty confident that we’re going to see a lot more of that coming from the federal government as well.