Trying to connect the dots at the AHCA conventionOctober 23rd, 2013 by
I had the privilege of representing LTC physicians during an Oct. 7 discussion at the American Health Care Association (AHCA) convention. The program committee accepted a late proposal for a presentation on connecting LTC physician and facility medical records.
This was arranged by American Health Tech, a leading nursing home EMR vendor and partner in piloting the National Council for Prescription Drug Programs (NCPDP) workflow. My contributions focused on how to approach the “shared care” record model developed by the NCPDP.
Everything that happened over the two days I attended the conference reinforced my belief that the NCPDP 10.6 Script standard and the efforts of Work Groups 11 & 14 are the best short- and medium-range solutions for LTC specific data definitions and communication models. No other organization is tackling “inter-provider” standardized data definitions that work across the spectrum of facility, physician and pharmacy.
During the convention, the NASL HIT Committee invited me to participate in its activities. The National Association for the Support of LTC is a consortium of the major vendors that serve the nation’s LTC facilities. Membership includes EMR, MDS and billing software vendors, therapy providers, and the myriad other suppliers who are needed to operate a facility.
The Committee, while I was present, was grappling with a “demand” from their LTC customers to improve their use of standards and interoperability. This was in the form of a white paper titled “Electronic Health Record (EHR) Solutions LTPAC Providers Need Today” from the LTC CIO Consortium and the Nurse Executive Council, two groups that represent the interests of the larger LTC facility chain organizations.
The NASL HIT committee was trying to reconcile the expectations of these two groups with the fact that no clinical interoperability standards exist for LTPAC. That is where I believe everyone has overlooked the opportunity presented by the NCPDP 10.6 Script standards. While these data transfer specifications were written for LTC facility-pharmacy message exchanges, they are very broad. They are currently broad enough to satisfy the needs LTC physicians have for CPOE under the Meaningful Use measures. The NCPDP has a robust standards-setting task force and a broad industry representation. It also allows the attachment of embedded CCDAs – a highly adaptable “pay load” that can contain any number of items (documents, images, data, etc.).
CMS has a number of initiatives that also focus on the LTPAC community. All of these contemplate a messaging model that uses either a HIE as the intermediary or a Direct Message. While these are both valid protocols, I personally believe they are not the optimum tools to use in the active management of the nursing home-assisted living resident. The NCPCP Script standard has an added benefit – it was written specifically to incorporate data elements unique to the nursing facility setting. These were added when the previous NCPCP 8.x standard proved inadequate for LTPAC messages. It is also the only regulatory “standard” that CMS mandates (effective Fall 2014) for nursing facility clinical data transmitted electronically. Vendors who adopt this format for their messaging model can be confident – it is a standard!
It seems doubtful that a new LTPAC standards-setting entity will arise in the near future. There is no CMS mandate for the adoption of EHR technology in LTPAC, nor any widely available stimulus funding. In the absence of outside funding, the industry is going to have to collaborate on standards. The NCPDP Script standard seems like a good place to get started.