There has been a lot of buzz about personalized care. Can you talk about the need for personalized care?
“Great question. At the end of the day, as Health Care Professionals, we get caught up in the scope of practice between medicine, physicians, nursing, therapy, etc. Sometimes those discussions end up in the forefront versus putting the patient at the center and making sure the entire care team is aligned around the patient’s needs holistically. It’s important to speak the same language and to make sure that all care team members are aligned around the patient’s unique needs.
Typically, in the aging population, we share two goals:
1. Functional independence—helping people live as independently as possible in their activities of daily living
2. Optimizing the patient’s level of health
If care providers can take a step back and keep those two things in mind, no matter the scope of practice, the rest starts to fall away, and we know we are focusing on the right thing—truly personalized care.”
Is this the same as person-center care that we keep hearing about with the new Mega Rule regulations?
“The Mega Rule and different legislations focused on person-centered care are a result of us as caregivers not doing a good job at what we just talked about. So, legislation is trying to force something that’s not happening now. A lot of the focus is around planning care. There are two elements to planning care:
1. Personalizing the plan—this is focused around the goals of the resident for functional independence
2. Professional standards—these are goals that are more medically focused. These are using evidence-based best practices to meet the resident’s specific disease needs.”
Has the Mega Rule been effective at improving person-centered care?
“When you look at the Mega Rule, you see these person-centered care elements that the government wants care providers to be focused on. A lot of providers are already doing this, but it’s siloed. Each unit is making their own plans individually. Therapy is creating a plan, there is a medical plan, nursing plan, social work plan, and so on. There is some overlap in these areas, but when they are siloed, they are not truly focused on the resident. We start focusing on checking a box, which is not a person-centered approach to care. The Mega Rule is trying to force collaboration from these silos.
I think the response to these changes are often missing the point. What you see is nursing trying to personalize the care plan by adding the patient’s name to goals and interventions. Then you see a response from medicine, trying to drive standards of care from a medical perspective with care pathways or protocols that are disease-specific. An example is a heart failure protocol. A hospital says if you want a heart failure patient, you have to follow these protocols because the hospital believes there must be an absence of professional standards because even the Mega Rule is pointing it out. So, the hospitals try to dictate those standards. Then before you know it, you have five referring hospitals, each with their own heart failure protocols, forcing a long-term and post-acute facility to manage different residents different ways. This is, in effect, driving more confusion.
So, I think even the response to things like the Mega Rule are making things more confusing. This is clearly despite the original intent.”
How can care providers achieve this level of person-centered care when they are already so busy and new regulations continue to pile up?
“I think the way that we can do that is to utilize technology to hide some of the complexity. When we are gathering information to create a plan, we need to be clear about a data model that is focused on the resident. From a system perspective, we have to use the same data elements on the back end, and we have to flag inconsistencies where they exist.
We can use technology to help get better organized, create more clear roles, and create more clarity around the rules that drive care. This standardizes the data that is being collected on patients and helps cut down on redundancy.”
What is the benefit of standardizing protocols?
“Ultimately, when we standardize the data, we can create rules that hide the complexities of care. With technology, we can leapfrog the checklist phase. If we standardize data on the back end and create rules to drive care, we can actually create a technology that is so much smarter than we could be just as individual caregivers working in our own discipline.
What do you think will be the greatest opportunities and challenges in long-term care in 2018?
I think the biggest challenge is always inertia. We are all looking at the impending population wave that’s coming, and we’re trying to figure out the challenges and opportunities from that. What everyone knows is that we can’t manage the problem the way we have been managing. We can’t just throw money at the problem. So, it’s a question of how we react to that. It’s hard to react by changing direction. We tend to react by pushing the accelerator. We tend to do more of what we are already doing but faster.
But our biggest challenge is stepping back and thinking a little bit differently. We need to apply technology in new and different ways. These problems can’t be solved by squeezing a little bit of efficiency here and there. It needs to be a dramatic change; we need to change direction and standardize data sets to deliver efficient, personalized care.”
About Brian Buys, Senior Product Manager, Care Content, for PointClickCare
Brian is a healthcare ‘lifer’ with broad experience in clinical care, medical devices, and health IT. He is passionate about innovation and strategy for healthcare transformation—namely, the thoughtful deployment of technology to build community, optimize health, and improve outcomes for individuals and populations. Before joining PointClickCare, Brian had positions at 3Pound Health, Welch Allyn, Cardinal Health and Epic Systems.
Brian has a BS in Nursing from Calvin College and an MBA from The Ohio State University, Fisher College of Business.
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