This article is sponsored by PointClickCare. In this Voices interview, Skilled Nursing News sits down with PointClickCare Vice President of Data Intelligence Nancy Chi to learn why real-time data collection is vital in skilled nursing, how preparation for the Patient-Driven Payment Model (PDPM) was an unwitting trial run for the data collection needs of COVID-19 and a look at the work PointClickCare is doing with AHCA and the CDC.
Skilled Nursing News: What are the biggest pieces of your career prior to coming to PointClickCare that inform what you do in your current role?
Nancy Chi: A lot of my career was spent in large payers in the U.S., where I had the opportunity to take on multiple roles in different departments. What that allowed me to do was understand different perspectives of the organization, and how the underlying data flows through the entire company. That perspective is what I carry with me throughout my experiences: the importance of understanding data, which allows me to connect the dots.
What I seem to rely on and go back to again and again is my ability to understand how financing and operations work, and then see how that impacts patient care or patient services or patient outcomes. That’s been something that I have valued over the years and really draw upon.
We talk a lot about data in a way that it almost feels like an empty word, because we’re talking about it so much. I feel like sometimes anybody in the industry can just start to say “data” and they’re just using it as a placeholder for a vague concept in their head. You work in data. From your perspective, why is it so important in skilled care?
I think at a macro level, all the right pieces are finally coming together. The whole health care industry has gone through this digitization process where paper records turned into electronic records, and we have a push for interoperability and integrations across systems.
All of the data from devices and monitors are showing up so that you can track and monitor everything at home. Your phones, your watches — so many wearable devices are collecting health data. All this medical content and research is showing up online and on social media where you can share sentiment really on everything and everyone. That’s all coming together.
Add to that artificial intelligence development, technology advancements and the ability to process a ton of data, and all of that is making it possible to mine data that wasn’t possible before. These complex models weren’t possible. You just can’t get to that with humans — it’s too time-consuming. The only way to leverage all of these great advancements is in the data. It’s not just how much gets collected but how good it is.
I think for us in the long-term care industry, we must continue taking big steps toward collecting more data and creating more standardization around that data, or we risk lagging behind in innovation and any disruptive technology that’s stemming from all these advancements. Data is the new oil. I think there’s probably been different ways to describe it, but it is essential and part of our critical path forward.
Agencies were prepping for PDPM in 2019 — which is obviously data, data, data. We didn’t know COVID was coming, but it’s probably true that your preparation for PDPM made agencies a bit more prepared to deal with COVID than maybe they otherwise would have been. Is that something that you’ve seen?
Yes, absolutely. In hindsight, it was a precursor to being prepared. PDPM really shifted the focus to capturing diagnosis codes, to documentation, and then collecting all the comorbidities that suddenly matter now because there’s reimbursement tied to it. That was truly an early framework that helped with COVID.
PDPM also highlighted the need to collect this information upfront. We must identify conditions at admissions, though ideally before admissions, to truly understand and assess the needs of the patient or the resident and all the services that are needed.
Those who were working to improve that documentation and the data capture for lab orders — like vitals or diagnosis codes to support the MDS assessment process — I think were way better off and more prepared once COVID came out.
What would you say are the biggest data points that are most important for driving outcomes and efficiency in skilled care?
Real-time data collection. The vitals and the medications and all the data points that are a collective record of what’s going on with that patient. I know that a lot of times it’s burdensome to collect, but that will improve, right? Automation or monitors and devices. I think that’s where we need to get to: understanding all those little data points, which are indicators over time.
This isn’t about simply collecting that data — it must be standardized so that we can actually develop benchmarks and baselines. The biggest challenge is trying to make sense of the data right now, because it’s collected in different ways and they don’t thread across how people are using them or how people are collecting them. I think that’s the biggest challenge: standardizing the ways of collecting real-time data, consistently over time.
With that in mind, what are some of the more interesting areas of work that you’ve been doing around COVID?
At first we didn’t really understand it, and so we were looking at everything and anything. Then things started to settle a bit and people started to use the same sources like Johns Hopkins, or same models like University of Washington, and that really allowed us to move more confidently with the data that we have and the models that we were using.
It wasn’t until we started to really switch to predictive indicators and using machine learning models that we started to see some interesting things. We started to bring in data from the county, like demographics, how many deaths and outbreaks were occurring. We pulled in skilled nursing facility five star and quality outcomes. We brought in density and age and acuity levels of the population.
We found some of the top attributes that drove that prediction were higher occupancy in the building, larger number of residents, higher county COVID case density and higher county population density. It sounds very logical — a “duh” moment right now — but at the time, in the first three months when no one understood or knew the patterns, these insights were really helpful.
Tell me about the exciting things that PointClickCare is doing with American Health Care Association (AHCA).
We find ourselves to be in a unique position to have a large market share where we can represent most of the country’s skilled nursing facilities. We can represent their data and then be able to compile it quickly and consistently. That was actually very critical for AHCA.
We were working together on PDPM, but for COVID in particular, it really had a lot of value to them, because they were trying to keep up with a lot of the policies, and they were trying to get data points and collect information to support and try to help shape some of the policymaking. We found that we were able to help provide data for them in those times. It’s been a really good partnership since then.
I’m also curious about PointClickCare’s partnership with the CDC.
We engaged very early in the COVID outbreak with the CDC, but we’ve actually been working with them for about four years now. During that time, we’ve been focused on research to understand and describe the epidemiology of antibiotic use within nursing homes. They’re only able to cover a few hundred facilities at a time. With our partnership, we’re able to run millions of records and provide data and analysis on antibiotic use and prescribing patterns.
It’s been really exciting to be working with them over the years. We are looking forward to sharing some of our results through a joint manuscript that they’re authoring. Going forward, we’ve got plans to look into other infectious diseases like respiratory infections, because of COVID and what we’re seeing there, but also with infections other than COVID, such as urinary tract infections. We’ve got exciting plans for the future.
What would you say are the most important lessons that PointClickCare has learned that can help skilled providers moving forward for the rest of the year and into next?
Don’t let up or ease up on anything related to capturing data. I’m not saying that because I’m in it and this is what I love. It’s very important to me, but I truly believe that data is the key. Don’t let up on that. Don’t let the gas off of good data capture and documentation and standardization of that documentation.
I do think that the year 2020 with COVID is this sort of delineation in everything that we’re doing. Everything is either pre-COVID or post-COVID. We’re looking at data from pre-COVID to post-COVID. I don’t think we know exactly what the future is going to look like and so we keep looking for evidence before and after. I think that’s going to be important to keep tabs on.
Editor’s note: This interview has been edited for length and clarity.
The long-term care data you collect on a daily basis needs to be accurate, accessible and actionable. To learn how PointClickCare can give your frontline heroes the sidekick they need to succeed in a post-COVID world, visit 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]