Matthew Wayne, M.D., chief medical officer of the CommuniCare Family of Companies, a Cincinnati-based long-term and post-acute care provider, is not waiting to catch the biggest wave of data interchange in long-term and post-acute care--that wave is still out there on the horizon. In the meantime, Wayne expects a cloud-based EHR, currently live in almost 30 of the company's 44 facilities, to be 100 percent implemented by this fall.

"Where are we today? All the way at step one, which is embracing technologies we believe will allow us to share information," he says in summarizing the post-acute information exchange landscape.

Wayne, who is also a past president of the American Medical Directors Association, realizes his segment of the industry has been "kind of an afterthought" in the land rush to install EHRs, but the CommuniCare chain is going full steam ahead on installing an EHR and also a mobile practitioner engagement platform that will allow the company's clinicians anytime, anywhere capabilities such as records reviews, HIPAA-compliant texting, and electronic order signing. Both platforms are made by Mississauga, Ontario-based PointClickCare.

"In the post-acute and long-term care setting, we are probably 'least furthest along,' if you look at outpatient, hospital, and long-term care settings, and part of that was a lack of incentives that were focused on the post-acute setting to help make the transition," Wayne says. "We were kind of an afterthought. That doesn't mean an organization like mine wasn't still very committed to saying 'This is where we're headed and whether we are incentivized or not, we still have to get there.'"

He is also very bullish on his vendor's mobile platform, saying it should increase the convenience factor for the physicians who are often off-site during the most critical times of care transition.

"A lot of times, hospitals discharge patients later in the day to the nursing home, so it's not atypical for me to get an admission at 8 or 9 p.m.," Wayne says. "Sometimes, these patients are on 10 or 12 or 15 different medications, and no matter how hard I concentrate on that list as a nurse reads them off to me, it's very hard for the brain to hold on to a list that long and try to figure out possible interactions. With the app, I can go back and review what I just okayed. And, that app will allow me to see the list, but also help me identify obvious drug interactions or duplications. It's another layer of safety for the patient."

Wayne says the mobile app has been a "smash hit" in three of the four buildings in the pilot -- "in the fourth building, the doctor is resistant, so we have to look at what the resistance and where the problem is"--and the company is now looking to evaluate it on a wider basis.

"We just had our monthly call with our medical directors, and I said at this point it's voluntary," he says. "We'll probably go from three to six to 10. The efficiencies are obvious, but you have to prove that out."

Wayne also says that, no matter how quickly clinicians at CommuniCare adopt the new platforms, much work remains to be done in integrating any patient's entire record.

"The other variable which is fascinating but makes it increasingly challenging is, it isn't just a matter of PointClickCare or the nursing home wanting to access the hospital record--the hospital has to metaphorically open the door so we can access the information. As an example, in the Cleveland market, we've been talking with the Cleveland Clinic, and I don't want to characterize the clinic as being resistant, they've been very interested--but allowing the sharing of information has been an eight-month conversation and we still haven't been successful in creating a trial bridge. It's very challenging. It will happen but there are a lot of variables to get aligned."

As the company steadily builds the technological infrastructure, Wayne says it is also creating a business culture that can accommodate it.

"We have to build non-technology solutions as well. For one example, we have created a new position called a care transition manager, an RN who has a very specific role to help navigate the patient through transitions, that two- to five- week period in which we flesh out our understanding of the person, what was going on before hospitalization, what happened in the hospital, and how do we safely get them back home again. I think that plays a role. The infrastructure is starting to be laid, it just isn't happening yet in the post-acute and long-term care setting, but the intent is absolutely to go there.

"We need to understand that data doesn't give you answers, it just helps you ask better questions. This is just the beginning. It's not just for documentation, it has to be a way of helping us be smarter and take better care of people, and there is a way to do that that benefits everybody."

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