Data-mining in the nursing home?

Electronic health records are far less prevalent in nursing homes and rehab centers than in hospitals.

The cost of new technology is part of the reason, but there is also a reluctance to overhaul systems.

“Change is tough for people,” said Dr. Scott Rifkin, an internist who also owns 18 skilled nursing and rehab facilities, all equipped with EHRs. “And there’s lots of work involved [with implementing these systems].”

Many long-term and post-acute care centers are small, and operating on small margins. Many are also family-owned, and have been run the same way for generations. Their clients, the elderly and ill, might not notice whether their medical records are transmitted on paper versus electronically, and they likely aren’t in a position to demand the latter.

But as hospitals have new incentives for maintaining patient health after they are discharged, experts say tech-savvy post-acute facilities are likely to be more appealing partners.

Post-acute and long-term care centers will eventually be required to report more information about their operations and their patients to federal regulators. Electronic health records will make that process much easier, according to Mary Jean Herron, chief financial officer for Keswick Multi-Care Center in Baltimore.

Herron also said the demands on these facilities will increase, given the trend in the medical field of providing the right care, at the right time, in the right place. This so-called “Triple Aim” means that hospitals aren’t the default setting for medical care. More services are being provided in outpatient clinics, post-hospital rehab centers and physicians’ offices.

“Particularly as the population ages, more care will often occur in facilities like ours,” Herron said. “So it’s critical going forward that these facilities have electronic health records.”

But the ultimate goal isn’t to just connect a few wires and bring in some computer monitors. The real value of electronic health records, says Rifkin, is their potential to make workflow more efficient and help optimize patient care.

“The idea isn’t just to have electronic records,” he said. “The idea is to have records that compile data that you can use in smart ways. Data-mining — that’s what this is really about.”

Rifkin has installed data-mining software in most of his 18 facilities, and plans to do so for the rest of them within the next several weeks. The software costs $400 to $700 per month, per facility. That’s on top of the tens of thousands (if not hundreds of thousands) it cost him to install the EHR systems.

Here’s what data mining can do for him: Let’s say a patient, Mrs. Jones, only eats 50 percent of her food every other day. On the other days, let’s say she has trouble in the bathroom.

If each nurse only sees Mrs. Jones once or twice a week, maybe none of them will notice the pattern. But if each nurse inputs that data — as well as information about Mrs. Jones’ sleeping habits, vital signs and bathroom behavior — into the computer system, the data-mining software will identify the trend.

“So then I can intervene,” Rifkin says, “and try to figure out why Mrs. Jones is having those particular problems” before it becomes serious enough to warrant hospitalization.

“Nurses are required to track all these things,” he continued. “And they’re all going to put it into the medical record. But the end game is knowing what’s actually in that record. That’s where data mining comes in. And that’s what the standard of care ought to be.”

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