Getting ready for HCFA's software mandate - Health Care Financing Adminstration - Conference Call - Interview

Nursing Homes, Jan-Feb, 1994

Whether or not the Health Care Financing Administration adheres to its controversial October 1 deadline for computerizing the Minimum Data Set, that mandate is obviously only a matter of time. Its inevitability was obvious from the day Congress adopted the MDS as part of OBRA. In its organization, its logic and its wealth of detail, the MDS seems tailor-made for computerization. Not so obvious to many facilities, however, is how to accomplish this. With a view toward helping facilities get through this adaptation as painlessly as possible, Nursing Homes recently asked four of the leading vendors of nursing home software to share their insights and recommendations. What are some of the problems that you have seen with nursing homes attempting to computerize the MDS and care planning processes, and what suggestions would you offer?

Roland: The most important thing is to make sure that the care plan is resident-specific, and involves the clinical judgment of the entire interdisciplinary team. It should not be canned or designed only to comply with OBRA. The caregiving team must develop its own care plans.

Dooner: I agree with that, and would add that the nursing home staff should have realistic expectations as to the length of the implementation process. It takes time and careful planning to get the job done right the first time.

Roland: Staff members should also make sure that they have an adequate manual MDS process in place before they computerize.

Dooner: That's true, the old saying holds: Garbage in, garbage out. If you have a good manual system in place, the computer can do wonders for you. If not, you may find this very detrimental to adapting to computers.

Roland: Furthermore, everyone in the facility must understand their particular facility's style of communication. It is crucial for information to be entered in a style that everyone understands.

Oatway: That's why it is so important to realize that the most current nursing home software available is library-driven, allowing users to customize the library to their facilities and their care plans to residents. If facilities will take the time to identify their specific needs, they will find options available to craft the system to their own resident management styles.

Dooner: It may have been true that six or eight years ago you would have had to build a clinical management system from scratch, but today's software gives you good basics to start with and the flexibility to adapt to your own situation. Roland: That's the key point: If your clinical information system does not realistically reflect your residents and their specific needs, you can run into problems at survey time.

Decker: I would add that a facility needs advocacy from the Director of Nursing concerning the usefulness of computers in developing care plans. The DON shouldn't see this as just a word processor for the MDS form, but as a way to build a care plan more completely and efficiently. The lack of this kind of advocacy from the DON could end up being the facility's biggest obstacle to successful adaptation.

Dooner: They have to see computerization as not only as a logical method of working with the MDS, RAPs, triggers, guidelines and so forth, but as a means of getting their nursing staffs away from doing paperwork and out on the floor delivering patient care.

In adapting the MDS to computerization, are there any particularly innovative nursing homes that come to mind?

Oatway: One of Chesapeake's customers is a large nursing facility in Pennsylvania, called Gracedale, that makes a point of doing interdisciplinary teamwork in performing the assessment and developing the care plan. Each discipline does its own portion of the MDS, prints it out, and then gets together with the other disciplines in a care conference prior to finalizing the MDS. The computer also generates trend reports for each resident, so that they can readily adapt each resident's plan. This approach to planning ends up being more time-consuming, but the result is a set of care plans that are more focused and specific to the residents.

Dooner: Two organizations -- Orchard Cove in Massachusetts and Integrated Health Services in Maryland -- come to mind for their innovation and professionalism. For example, they had realistic expectations as to the work needed to be done prior to the installation. Four to five meetings or more were held with key staff members discussing their goals and objectives. They utilized a Total Quality Management approach when installing systems.

Roland: We have many nursing home customers that apply both teamwork and time to developing the care plan. The major supporting factor is a complete commitment from senior management -- the ownership, the administrator and the DON -- to be involved with setting up a good resident assessment and care planning system. Decker: We have just such an advocate in Marty Goetz, administrator at River Garden in Jacksonville, Florida. Because of his interest and enthusiasm, they routinely run care planning meetings involving families, physicians and staff at the computer terminal. They realize that with this approach, they can deliver a higher-quality care plan with a more satisfactory outcome.