A friend, who resides in a nursing home, asked me to give him one example of how information technology is improving his health.
He had just undergone an extensive yearly assessment known as the annual nursing home resident assessment and care screening minimum data set (MDS). This 45-page document is meant to paint a picture of the mental and physical state of a nursing home resident. If the resident is currently utilizing Medicare benefits, the answers to those questions would also determine the daily rate of reimbursement Medicare would pay the nursing home. Furthermore, that document (electronically uploaded to Medicare through your state Health Department), contributes to the statistical pool of information that calculates the quality of care of record in the nursing home.
Having put much time into understanding the way the MDS works, I believe I can understand his frustration. The questions range from inquiries into continence, to how many times you walked through the halls, whether or not you felt depressed, or listened to music, or even whether or not you could remember three simple words during a discussion. If I thought that my life was being documented to this extreme, then I too would feel very vulnerable and question if I was benefiting from giving all this personal information. And I ask myself: how can we be sure that the data being captured is actually improving health care
It took me some time to answer my friend’s question.
To begin with, as an IT person by trade, I want to say that the vast complexity of the software required to capture, calculate, and transmit the MDS is a tremendous source of job security for yours truly. But then again, I was pretty sure my job security was not what was on his mind.
Secondly, I know that state surveyors are going to use those data to ensure that he and other residents are getting the best possible care they could get given their circumstances. But somehow I felt that my friend would consider that answer to be a copout.
I ended up giving the following response:
The range of questions and related responses are meant to give your care giver a basis by which to formulate a plan of care geared to improve your quality of life. If your care givers do not know these aspects of your life, then how could they ensure that you are getting everything that you need from them?
My answer was not well received. He waved a hand at me and said, “never mind.” All I could do was request that social services look in on him.
In my opinion – with the advances in technology, reporting, and documentation requirements meant to improve the life of nursing home residents – I could not help but wonder what was missing that would result in the resident feeling that he is properly cared for?
In January, CMS released its second year of Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF). This data set provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities, and contains information on utilization, payment, submitted charges and beneficiary demographic and chronic condition indicators organized by CMS Certification Number, Resource Utilization Group (RUG), and state of service. Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about skilled nursing facility services, the dataset also has a number of limitations, including that it does not indicate the quality of care provided by individual skilled nursing facilities.
Perhaps the Quality Assurance and Performance Improvement (QAPI) initiative from the Centers for Medicare and Medicaid Services is one method of addressing this need. It is a different set of documentation requirements aimed at forcing the provider to use management tools and practices to identify and remedy quality of care issues for residents in nursing homes.
As nursing facilities put this program into practice and has access to additional data repositories, my hope is that the effect will help my friend answer his own question.
- How can data be turned into information for the patient to improve the patient experience?
- Are there other sources of data that can be accessed and tapped for use in improving patient care in post-acute care settings?
- How can mobile technology be leveraged in this situation?
- Do you have stories to share?
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