This article is sponsored by PointClickCare. In this Voices interview, Skilled Nursing News sits down with PointClickCare Senior Director of Clinical Product Management Brian Buys to learn how PointClickCare is reinventing the paradigm of the electronic health record, helping skilled nursing facilities (SNF) see data as a starting point — not an end point — and shows how data is helping nurses do their jobs.
Skilled Nursing News: You came to PointClickCare in 2016; you moved to the clinical area two years ago. What influenced your move to PointClickCare?
Brian Buys: I think, honestly, it was the opportunity to make a big impact in a really important segment of health care. I’ve always thought that it’s incredibly motivating to use technology to make a difference in health care, and senior care is a really interesting place to make that difference. You have a highly vulnerable, complex population and unique challenges related to the ratio of patients or residents to caregivers, as well as the increasing complexity of seniors, in terms of their comorbidities.
Then finally, the resources are not only fewer in terms of caregivers — the resources are also spread further apart. In the hospital, the whole care team is in the building. The pharmacy is in the building, the lab and the radiology departments are in the building. As you move out of the acute care hospital setting, the puzzle gets more challenging because the resources are spread further apart. PointClickCare has positioned itself really well to have a positive impact on this important area of health care.
You lead PointClickCare’s clinical product management efforts. What is ahead for PointClickCare in skilled nursing settings this year?
We are reinventing ourselves. We are moving away from the traditional definition of an electronic health record as a data collection system. Our vision is to move beyond that paradigm to an intelligent system that recognizes the unique roles of different members of the care team and creates workspaces for those members. We want you working in a workspace that leverages the data from the health record, instead of working in the filing cabinet, so to speak. You’re freed to be closer to the residents and patients, do real-time things, have intelligence in a workspace that’s really designed for you in a particular role.
There are three roles that we are most focused on. The first is the aide or certified nurse’s aide. The second is the nurse. The third are the practitioners: physicians, nurse practitioners, physician assistants, folks who can prescribe medication.
When you look at 2020, we have active work in each of those persona areas, and we are evolving the workspaces that we offer them. Last year, we introduced a unique workspace for the aide or universal caregiver in senior living. It’s called Companion. We’ll be bringing that to skilled nursing this year. We also introduced Nursing Advantage, with a focus on changing how nurses collect data, and supporting them with sophisticated alerts. That’s just the beginning of nurse workspace, which we will continue to evolve this year.
Lastly, we are making significant investments in our practitioner engagement tool. Working in those three areas aren’t the only things we are doing, but developing these role-based intelligent workspaces is a big focus for us.
You focus heavily in your work not so much on the data, but the process by which it’s collected. How do you help SNFs collect their data?
I think the ultimate vision is using the full context around the resident to make sure we understand the most important data to collect. From a nursing perspective and a medical or practitioner perspective, one of the things that we know is their medical diagnosis. When we have that information, we can start to use it to make sure that, for example, if someone has congestive heart failure, we are collecting information more frequently on weight changes, or lung sounds, or edema.
These are things that are pertinent to that particular condition or disease state. We have to walk a fine line — we can’t make every question required simply because someone has a certain diagnosis, but when we understand a resident’s unique set of conditions, we can understand to a degree the most pertinent parts of the information. We can then remind people to focus on collecting that information.
What is the biggest challenge that comes with having so much data, and how can SNFs overcome it?
I think there are two big challenges. One, as we just alluded to, is that it’s important to only collect the data on a resident that is most pertinent. That’s where an intelligent system can help drive efficiency — by not putting everything in front of every clinician all the time. We don’t want to replace that great clinical judgment, but we can narrow things down.
On the flip side, we’re cognizant of alert fatigue. We have to increase our focus on how we make our alerting more sophisticated. That’s one of the things we’re working on: multi-criterion alerts, where it’s not just, “This number was out of a normal range.” We consider things like a resident’s age, their medications, a number of other things, and then trigger an alert.
What is the most important way that data improves a nurse’s job?
I think it improves it in every way. Nurses have three primary jobs. The first is to establish and maintain a care plan. The second is to carry out physician orders for medications, treatments, and tests. The third is something we often forget, which is monitoring a resident’s current health status and trend.
That’s where data is most helpful. Having information that is summarized allows nurses to quickly answer the questions that they’re often asked, which are simply, “How is my loved one doing? Are they doing better or are they doing worse today?” Having data allows you to answer that question definitively and quickly.
What is the biggest trap that SNFs fall into with regards to data collection in 2020?
I think the world has changed around all of us. Right, wrong or indifferent, we are in the midst of a transformation, from compliance to quality management. In a compliance world, it was about making sure we checked the boxes on having the right data and submitted it. The minimum data set and their submissions to CMS were often where we started historically. There was not large accountability for quality outcomes.
The transformation that’s happened around us is focusing this entire industry, health care in general, but in particular long-term and post-acute, on quality outcomes. These are public measures of how customers are doing in terms of meeting quality metrics, keeping people healthy and sustaining their level of independence.
I think one of the biggest challenges is transforming hearts and minds in staff. It’s not that people don’t want to deliver great quality care, but transforming from a compliance mindset to a quality mindset often requires reengineering the way we think and work.
How has the Patient-Driven Payment Model (PDPM) changed the need for data in the SNF world? How are providers adapting to the change?
I think PDPM is an attempt to put the resident at the center of care. It is, after all, the Patient-Driven Payment Model, and it puts the resident at the center of a multidisciplinary approach, including nursing, therapy, medicine and social work.
With PDPM, there are some simple truths that we knew were going to be profound. One is that diagnosis is going to be critical. The second is that supporting documentation of evidence of caring for those diagnoses specifically is going to be required.
What we continue to learn is that the MDS itself is not sufficient for supporting documentation. It is really a data submission tool, not an assessment of resident status or a primary data collection tool. The MDS needs to be seen as the endpoint that collects the data or aggregates the data that are collected during routine care and management of resident conditions and then submits it to regulatory authorities, not necessarily always at the beginning.
The irony here is that you have less time to submit your initial five-day and get your diagnosis all nailed down, but that’s not enough. I think the critical piece there is that’s just the starting point.
In your opinion, what is the most important data point for SNF operators to understand in a post-PDPM world?
There continues to be a focus on re-hospitalization rate. There are many definitions of that rate based on CMS calculation et cetera. Ultimately, I think that will continue to be the primary focus as the largest indicator of quality outcome management. The goal here, particularly for that short-stay population, is a successful return to community. That’s a different metric, which is the inverse of 30-day re-hospitalizations, but the goal is to return residents to community care. I think a continued focus on that will dominate.
The question, however, is not what is the number, but what are we doing as a vendor and what are our customers doing in partnership with us to meaningfully impact that number and reduce that re-hospitalization number? I think that will continue to be front and center.
In one word, describe the impact that PDPM will have in 2020.
“Contemplative.” I think it will continue to force us all to be introspective and contemplative about how we’re actively managing quality.
Editor’s note: This interview has been edited for length and clarity.
PointClickCare is the leading electronic health record (EHR) technology partner to North America’s long-term post-acute care industry. To learn more about how PointClickCare can help your business, visit them at pointclickcare.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected]
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