Last week I had a great discussion on the challenges of healthcare IT for long-term care, as opposed to acute care. Talking with Greg Fortin , CIO at Isabella Geriatric Center, I was struck by the value of relatively small innovations he's developed on the ground, close to the day-to-day needs of a complex organization.
For example, over a period of ten years, Greg's team developed a series of real-time reports on top of their EMR system (from ADL Data Systems ). Although the business intelligence system project was never officially funded, over time the reports evolved into a dashboard which became essential to the nursing home's administrators and clinical compliance teams. Another simple but targeted tool ("Wanderer Alert Notifications") makes it easy to send out email alerts to the staff in the event a resident of the Center is found to be missing. (It is essential that nursing homes have proactive tools to ensure their residents are safe and secure; most organizations just have alarmed doors.)
Greg recently implemented a Computerized Physician Order Entry, Electronic Medication Administration, and Electronic Treatment Administration system that communicates electronically with their pharmacy. The system assists the clinical staff in being more efficient, reduces the chances for medication errors, and improves clarity of doctor’s orders to the pharmacy.
Greg has an interesting point of view on healthcare informatics and the evolution of IT in general.
Although cloud-based platforms and application service providers are gaining in popularity, outside of security issues, he's resistant to any solution that makes it more difficult to get free access to the underlying data, because he needs to use the data in the development of business analytics outside of 3rd party applications. Most systems do not provide true analytics to assist in making business decisions across the organization. And he's less interested in best-of-breed applications if they make it more difficult to integrate information to support real-world processes.
One interesting aspect he notes regarding the current spotlight on healthcare IT: it's overwhelmingly focused on acute care, with very little attention to long-term care. And yet long-term care may prove to be the more difficult and expensive challenge for our society over the next decades.
Greg is constantly looking for practical, affordable solutions to the specific needs of his community. He's willing to test any innovative product that comes on the market. Recently he considered the Vocera  communications device for the floor staff as a way to reduce noise in the hallways. “If we are going to provide a home-like environment, I would like residents to have peace and quiet and be able to get the rest they need.” He found it too expensive for the current budget, but he's still looking.
He is thinking about possible ways to use RFID and biometric thumb-print devices for secure mobile access to data, and how to help staff keep track of residents when they are bused to other locations. And he's struggling with a major issue ... developing a reasonable approach to system recovery after a disaster or service interruption (either a physical problem or software glitch). How to set reasonable expectations for the staff, when there's no funding for a major overhaul of the Center's IT infrastructure?
This kind of incremental approach to innovation is driven by necessity, but it's incredibly productive nonetheless. A more disruptive and large-scale model would have long ago exhausted the budget and brought day-to-day operations to a halt. By being consistently open to new technologies and proactive about finding solutions, Greg is pushing the envelope without breaking the bank or losing sight of the organic needs of his community.