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Skilled-nursing homes leverage technology to improve care HEALTH TECHNOLOGY By Paul T. Liistro M ention the terms electronic records, monitoring, compliance or some special gadget, and most long-term care providers seem to start twitching and get nervous at the mention of technology. Then, they start to tell you all the reasons why technology won't work, that staff are not trained or there is no funding. Whatever the reason, it does not do much to enhance the image of post-hospital care. But the tide is changing. Even though the Affordable Care Act (ACA) overlooked the post- acute sector in terms of funding, smart long-term facilities are taking advantage of a robust industry of IT companies producing hardware, writing soware and integrating with other developers' products that are achieving ACA-demanded increased levels of productivity and improving patient care. It starts with the electronic health record. Skilled-nursing facilities should be using electronic file storing systems as the building blocks for patient information, including detailed biographical information, medical information, assigned medical professionals, payer sources and billing data. Additionally, skilled-nursing facilities need to use a common assessment form: the Minimum Data Set (MDS). e MDS is a 38-page, over 500 response resident assessment instrument, which is completed by an interdisciplinary team at admission and on a regularly scheduled basis. Developers have created functionality so that this form can be completed using soware that allows reports to be generated, viewed and electronically transmitted to the federal government. e government uses this data to assess the quality of nursing home care and reports it on NursingHomeCompare.gov. e MDS collects patient characteristics regarding care, and is the basis for billing Medicare. Due to the importance of MDS data, third-party soware has been developed to check the integrity of the responses, yield quality-of-care information, and create predictive analytic models forecasting a patient's probability of falling or being returned to the hospital. As the fee-for-service world is being replaced with a value-based payment approach, information management and technology are becoming more important. For example, a Pratt & Whitney jet engine produces almost a terabyte of information flying across the ocean. Monthly, a skilled-nursing facility generates a terabyte of information caring for 200 long-term and post-acute patients. To improve patient care, this amount of data needs to be managed, analyzed and find its way to patient-care plans. e digital highway in a facility must be a secure, fast, wireless network. Wireless connectivity allows mobility and real-time access to information. Recent additions to the IT arsenal are applications like vital signs equipment, which allow for more accurate measurements delivered on a timely basis that permit individualized warnings for patient- centered care. Other examples include ZOE machines that monitor fluid buildup impacting cardiac recovery and bladder scanners that alert staff to residual urine lingering in the bladder. Nurses, personal-care assistants, therapists, dining staff, administrative, social services, medical directors, building services staff and others all have a footprint in this digital world by using specialized soware, technology and tools to improve care. All staff can learn, apply and contribute to the patient's medical record and improved plan of care. Paul T. Liistro is the managing partner of Arbors of Hop Brook, Manchester Manor and Vernon Manor, all nursing homes in Connecticut. Tips to jumpstart a workplace wellness program EMPLOYEE WELLNESS By Sara Tarca R ecent research shows that roughly half of U.S. employers with at least 50 workers now offer wellness benefits at some level to their workers. Is your company thinking about jumping on the wellness bandwagon? While wide-ranging in design, and difficult to succinctly define, wellness programs oen share several key goals: encouraging healthier lifestyles, lowering health spending, boosting worker productivity and serving as an employee-retention tool. Before getting started, it's best to spend time defining what goals are important to your company and which activities best align with its overall corporate mission. Worksite wellness programs oen aim to improve employee health by offering preventive health screenings, which identify and make individuals aware of particular health risks, and educating employees how to lower those risks through lifestyle changes. e scope of these programs has expanded over time from simple educational strategies, like "lunch and learn" sessions on nutrition or heart health, to workforce wellbeing and total population health that expands the scope of wellness to include elements targeting mindfulness, fiscal stability and emotional wellbeing. In recent years, many employers have added incentives and enhancements intended to drive employees toward healthier behaviors. Incentive trends may include insurance premium discounts, cash or gi cards, or a paid "wellness day" off from work. Incentives are oen tied to participation in biometric screenings, preventive physicals, fitness challenges, weight loss and smoking-cessation programs. Best-practice programs begin with a baseline evaluation of the worker population, using an evaluative tool known as a health- risk assessment questionnaire. is baseline is a critical metric in monitoring a program's successes and trends in population health. e second step involves educational campaigns and initiatives that encourage employees to make positive changes. More than half of wellness programs include disease- specific features targeting diabetes, heart disease, cancer and other conditions, according to a 2016 RAND Corp. survey commissioned by the U.S. Department of Labor. ese programs are referred to as outcomes-based or results-oriented wellness programs. Before investing your time and money into a wellness program, there are some key factors to consider: • No wellness program can be successful without the support of management at all levels. • Look back to previous corporate initiatives that were successful. What worked then will tend to work with embedding wellness programs too. Wellness should be treated as part of an overall business strategy. • Reflect on the worksite environment. Oen, when the importance of workplace culture is overlooked, both time and money are wasted, and management may brand wellness as a failure. • Employee feedback on wellness programs is important. By forming a wellness committee the program will influence the entire population. • Incentives are more likely to increase employee engagement; thinking creatively regarding incentives will excite and motivate your employees. • Don't aim to accomplish too much too soon. A multi-year strategy allows for cultural growth and effective worker engagement. Look to industry standards, through organizations such as WELCOA or a benefits advisor, to help determine where to start. Sara Tarca is a workforce health consultant with OneDigital Health and Benefits in Farmington. H H GREATER HARTFORD HEALTH • Spring 2017 21