Simplifying clinician workflows using technology with Joy Herring, vice president of clinical analytics, LTC Consultants

In this episode of the Post-Acute POV, our host Amy Ostrem, vice president of strategy and portfolio management for MatrixCare, is joined by Joy Herring, vice president of clinical analytics for LTC Consultants, Cassie Diner, RN, MatrixCare product manager, and Kelly Danielson, MatrixCare clinical product manager. The group has a conversation on the importance of simplifying caregiver and clinician workflows using technology.

Join Amy, Joy, Cassie, and Kelly as they discuss the tools and data that matter most when it comes to senior care, improving resident care, increasing productivity, and the importance of machine learning to drive more proactive care and interventions. This episode explains how technology can be used to support organizational visibility and regulatory compliance as well as best practices for integrating data into senior living communities. Listen to their discussion below.

Topics discussed during today’s episode:

1. [01:02 – 03:16]: Amy, Cassie, Joy, and Kelly introduce themselves and provide a brief insight into their experience supporting post-acute care technology.
2. [03:30 – 05:43]: Cassie shares how technology can streamline the onboarding process for a new caregiver or agency staff member and help them build confidence in their role.
3. [6:00 – 7:51]: Kelly provides insight on how machine learning can also help a new caregiver by providing resident baselines, identifying residents/patients with higher acuity levels, and supplying alerts like out-of-range vitals.
4. [8:13 – 11:22]: Joy details the value her organization has gained since utilizing Clinical Advanced Insights including individualized interventions and improved outcomes. Joy and Cassie dive deeper into a resident scenario by detailing how technology can be used to help a resident/patient who has been identified as high-risk.
5. [11:32 – 13:28]: Cassie shares how having a mobile device can help caregivers spend more time with residents/patients. Kelly provides an example of how technology can help manage triggers and alerts and expedite documentation.
6. [13:50 – 16:50]: Cassie speaks to how technology helps with non-resident or community tasks that staff need to pay attention to during documentation throughout their shift.
7. [17:17 – 23:46]: Joy explains how an analytics dashboard helps her organization focus on both preventive and proactive care. Cassie and Kelly touch on how visibility throughout an organization is crucial in creating confidence and addressing immediate care needs.
8. [24:05 – 25:12]: Kelly explains how an actionable dashboard can help directors of nursing and wellness stay on top of their residents’ statuses and make informed care decisions.
9. [25:27 – 28:19]: Joy describes how technology and analytics can assist with tracking wounds and provide a correlation with infection trends over time.

Resources

• Find out more about LTC Consultants: https://gotltci.com/
• Listen to more episodes of the Post-Acute POV

Transcript

Speaker 1

Hi, and welcome to The Post-Acute Point of View, our discussion hub for healthcare technology in the out-of-hospital space. Here we talk about the latest news and views on trends and innovation that can impact the way post-acute care providers work, and we take a look at how technology can make a difference in today’s changing healthcare landscape in both home-based and facility-based care organizations and the lives of the people they serve. Let’s dive in.

Amy Ostrem

Hi, everyone. I’m Amy Ostrem, the vice president of strategy and portfolio management for MatrixCare. I focused on healthcare technology and out-of-hospital care for more than 25 years. It’s a pleasure to be your moderator today as I feel that data and technology are taking the seat front and center as we move forward with today’s challenges and specifically needing to do more with less while improving quality and also outcomes. Hey, Kelly. You’re up.

Kelly Danielson

Hi. Thanks, Amy. I’m Kelly Danielson, clinical product manager for MatrixCare machine learning team. I’ve been in long-term care my entire career, starting out in dietary, then as an LPN, an RN, MDS coordinator, director of nursing, nurse consultant, and a legal nurse consultant. So I’m happy to be here today to talk with you about machine learning and other intuitive technologies. Cassie?

Cassie Diner

Hello, everyone. I’m Cassie Diner. First, I just want to say thank you for all joining us today and I want to point out that everyone in this industry is truly a hero. So a little bit about myself. I’m a product manager for MatrixCare where I focus on clinical areas. I’m currently still an RN charge nurse at a community, which includes all different levels of care. So I’m really excited to be here today and talk to all of you because it is MatrixCare that allows me to utilize both my nursing skills and love for technology to make a difference and improve residents’ lives. Joy?

Joy Herring

Thank you, Cassie. Hi, my name is Joy Herring. I am the vice president of clinical analytics for LTC Consultants. We utilize our MatrixCare as our electronic health record. I have over 26 years of long-term care experience with a focus in nursing informatics. My area of expertise lies within MDS, process development and implementation, Medicare, managed care, PDPM, analytics and more. I am so happy to speak with you today about leveraging technology as a vital resource to impact residents’ outcomes.

Amy Ostrem

All right. And with that, if there’s one thing that’s for sure, that’s this group of expert panelists is going to cover a lot of ground today. We’re going to hit on over a dozen questions and focus on value-driven topics, including the latest trends in technology-enabled senior care. We’ll talk about how technology can help simplify workflows and decrease time to productivity. We’ll go through the importance of machine learning and how it can drive more proactive care and interventions, and we’ll also focus on the significance technology has on overall visibility and compliance.

Amy Ostrem

Let’s get started with our first question. Cassie, we’re going to kick it off with you for your insights. Can you start by speaking to how technology can help a new caregiver or agency staff member?

Cassie Diner

Sure. Yeah. It’s such an important question. As we all know right now, agency staff overall is really crucial to combat this staffing shortage that we have. So agency staff typically walk into a facility or a community not really knowing the residents fully or their baseline statuses. They’re typically unfamiliar with their surroundings overall and need to be able to jump onto the floor quickly and begin their shift. Now, this is where technology comes in and is key to their success. They need to be focused on three things, I think, and it’s technology that can help as they walk into the facility or community where they don’t know the residents very well.

Cassie Diner

So one thing is having confidence and knowing the care needs of the residents. Also, focus on compliance, making sure their work is complete while they’re there, and technology can help with ensuring everyone is working as efficiently as possible.

Amy Ostrem

Excellent points around the importance of a new caregiver’s time to productivity and having confidence. So Cassie, could you continue by giving a few examples of what technology can bring in the form of dashboards? So having that instant oversight into all of the key things going on within a care setting and how that can drive better outcomes and improved compliance and productivity. Could you give some specific examples of this?

Cassie Diner

Yeah. Definitely. Utilizing dashboards is definitely an example of viewing an overall single snapshot of multiple areas at one time. So some examples I would say I would be notifications and alerts such as vitals out of range or maybe lab results that recently have come into the EHR documentation that’s in progress due or overdue at the time. Any recent incidents. So if you think about falls or infections, and any new admissions that are come in or orders and much more than just the examples I gave.

Cassie Diner

It’s important to be able to utilize technology when initially logging into the EHR system to quickly see what’s due to be documented, and any pertinent resident real-time alerts to assist with time management. Technology also helps with having protocols and procedures at the fingertips, and this can be especially helpful for agency staff or any new staff working.

Amy Ostrem

Thanks, Cassie. And staying on the topic of the agency or new staff members, Kelly, as a machine learning expert with years of clinical and leadership experience, can you speak to how machine learning helps new staff members?

Kelly Danielson

Absolutely. As mentioned before, agency staff, they’re not quite as familiar with resident baseline statuses like people that are in the facility all the time. So a direct line of insight to those that have recently increased in risk or maybe have had a recent change in their condition is important. So technology, and more specifically, machine learning helps new staff to be productive even faster. Machine learning allows technology to do the work to monitor hundreds of clinical elements and real-time changes being made to them, automatically identifying residents whose acuity have increased in say the last 24, 48, or 72 hours.

Kelly Danielson

You can look quickly to see which residents have had a change and where they’re located. And then from there, you can drill down into the data indicating specifically what has changed that caused the increase in that acuity score. Things that could because an increase could be things like the resident has a new diagnosis or a new medication, or maybe there’s a vital sign out of range, or maybe the resident is now needing more assistance with an ADL or a change such as maybe there’s a decrease in the meal intake.

Kelly Danielson

So having a quick picture of who is at risk for those residents and being able to pass that information on to caregivers where their focus should be for the shift is invaluable. It allows the caregivers such as new staff members or agency staff to proactively focus on the residents that are at risk, which helps to prevent potential adverse events. This can be especially helpful on the night shift to help ensure there’s additional monitoring for residents who might be, say coughing or getting out of bed unexpectedly. This visibility can also save significant time as you prepare for meetings and overall collaboration such as your at-risk meetings.

Amy Ostrem

Yeah. Great points on time to productivity, communication and prioritizing focus for those at-risk residents. Joy, with your recent machine learning and MatrixCare clinical advanced insights experience, could you tell us about the value that you’ve gained from this even beyond just the new caregiver?

Joy Herring

Oh, sure. Thank you, Amy. Yes. Clinical advanced insight has afforded the clinical leadership team to really spend time analyzing the data for individualized interventions that may improve quality outcomes instead of pulling over numerous of documents to identify those at-risk components in a documentation. So we love to refer to clinical advanced insight as interventional insight for it highlights those changes and conditions, those at-risk residents, and the team is able to manage an effective workflow while enhancing the outcome of their residents. Technology has truly become a valuable interdisciplinary team member.

Amy Ostrem

Oh. I love your points on interventional insights and how technology is now that valuable interdisciplinary team member. Let’s dive into a resident scenario a little deeper with some specifics. So Cassie and then Kelly, can you take us through a scenario of a resident who’s identified by technology for now being high risk due to changes over the last 24 hours and incorporate how technology can bring those caregivers more confidence?

Cassie Diner

Yeah. And I was actually able to fully understand what it felt like to be that new nurse in a facility or part of an agency staff. When the pandemic began, I worked at a sister facility near Chicago. And I can tell you that building confidence is definitely very important. So you can identify through technology and machine learning at a senior living facility a resident who’s currently at a higher risk because of recent changes, such as an increase in temperature. Maybe they’re now requiring oxygen or they have a decrease in blood pressure. Another example would be a resident who now requires maybe more assistance to the dining room when they were completely independent previously. Technology pulls the data from all those different areas of the chart into one intuitive view due to the recent changes. Technology can capture the timeline and bring that story of the resident together for you. Technology can notify staff or agency staff of what documentation is still due for that resident as well.

Kelly Danielson

Exactly, and I can add to that, Cassie. While the documentation is captured, DHR can provide guidance and real-time alerts to take further action. The documentation can provide data on who is at risk. And overall, the technology can provide an intuitive user experience for capturing items such as activities of daily living or required level of assistance, behaviors, activity of tenants, meal intake, et cetera, flexibility and documentation, and the ability to use even a mobile device, since technology allows responsiveness so that the browser and device you use is presented in a way that offers the best user experience. Increased compliance and accurate documentation since you can bring that device with you is adding joy to our staff members as well.

Amy Ostrem

So you mentioned bringing a device with you. Can one of you tell us more about how bringing a device with you can help promote patient care?

Cassie Diner

Sure. I can take this one, Amy. One example I can give you is when I worked in memory care and having the device with me to document at all times allowed me to be more focused with the resident longer instead of waiting in line at a kiosk or waiting till the end of the shift to document my completed tasks. I found myself and other staff at many times actually preventing falls by being even more involved with the residents throughout their day. This also allowed me to be more proactive and able to do more interventions even faster to prevent any of those adverse events.

Cassie Diner

So I’ve heard others say they’re worried about the cost of a tablet or phone being lost or stolen. However, the benefits definitely outweigh those risks, and when it comes to measuring outcomes. Plus, there are additional security measures that the IT department or other staff can help to protect those devices.

Amy Ostre

So Kelly, focusing on being faster and preventing those adverse events, as Cassie mentioned, can you speak to alerts and triggers and maybe describe an example of how technology can help with alerts, triggers, and faster documentation for resident care?

Kelly Danielson

Absolutely. So if a resident spikes a temperature and EHR knows that that temperature is out of range for the facility or maybe even it’s the resident-specific temperature guidelines, and that temperature can easily be entered by utilizing technology via vital sign devices, those vital sign devices can provide time savings, accuracy, and compliance overall while using technology and getting vital sign updates in real-time. The HR can then send alerts to other caregivers when out-of-range documentation has been completed. It can trigger the nurse to take those next steps or the EHR can automatically trigger and update within machine learning to the resident’s overall risk level.

Amy Ostrem

Thanks, Kelly. And when we think of alerts, triggers and compliance, I also think of tasks that commonly go on in a community that are not necessarily tied to a specific resident. So back to Cassie, could you speak to those community type tasks and how technology can help even for an agency nurse?

Cassie Diner

Sure. Yeah. So as you mentioned, while caring for residents, there’s also many non-resident or community tasks the staff have to be in charge of documenting throughout their shift. Agency staff might not be aware of what needs to be documented or where in that building to even go to complete some of those tasks. However, with technology, the nurse can be confident knowing that they are alerted to complete those specific tasks throughout their shift. This also helps ensure facility avoids potential citations and continues to remain compliant.

Cassie Diner

So I can give a few examples of that. Examples of these tasks might be when an agency staff who’s taking care of a resident, they may also at the same time have to ensure the temperature of the refrigerator that stores the vaccinations remains at the appropriate temp. Technology can indicate that those things not related to the resident are completed.

Cassie Diner

Technology can also guide the nurse to where to go to complete the task. So for example, indicating where that actual refrigerator is located on a specific hallway or unit will tell them where to go to complete that task. Reminding them maybe to clean off equipment and stay compliant with infection control also helps. And this helps agency staff with confidence to either complete the task or they can delegate it to someone else on their shift.

Cassie Diner

Another example would be supplies or replacement of supplies. And that’s really critical to a great shift-to-shift handoff. So technology can be used to remind agency staff to complete things near the end of the shift, such as filling water pitchers or ensuring that that next nurse has enough straws, med cups, any other supplies that’s needed. Overall, technology can further help instill confidence in the current staff along with satisfaction knowing that resident care and non-resident tasks are completed before that agency staff leaves their building.

Cassie Diner

Without technology, it’s difficult to really hold staff accountable and ensure these tasks are done, especially now when facilities are short-staffed. However, technology can be the solution for that accountability and compliance.

Amy Ostrem

All right. So in summary, technology can provide agency staff with a new level of confidence to quickly see what needs to be documented. And documentation status brings not only confidence, but it also assists with time management, compliance, and that overall feeling of job satisfaction. Job satisfaction is especially obtained when staff can balance that compliance and care with increased valuable time spent one-on-one with the residents. Overall, technology can be used to complete tasks efficiently while knowing as a caregiver that you’ve met the expectations of a particular facility. Technology can offer alerts and notifications to things that are occurring that are out of the ordinary. And as Joy mentioned, technology can present data that is able to then be analyzed for individualized interventions.

Amy Ostre

So that takes us to the next question. Let’s hear more from Joy and dig into the next steps around preventive proactive care and how technology can help. So Joy, once you’ve determined that there’s been a change in condition alert with machine learning, how does your staff make modifications to what they’re doing based on that information?

Joy Herring

The reviewing of the dashboard really identify those high acuity scores alerts, so those are reviewed daily during the clinical meeting. And then we take those that have moderate alerts, risk changes, and we review those weekly at your at-risk meeting. Modifications can then be made with patients based on the interventions to enhance quality outcomes. It helps you with maintain a regulatory. For example, was the patient, representative, or physician notified with changing condition? It really helps you observe for those significant change and proceed as warranted, and it is a great resource for reimbursement to ensure that you’re capturing the acuity for the proper revenue and service plan if they’re under managed care for optimization. And lastly, we utilize it to assist with our quality assurance programs.

Amy Ostrem

Thank you. And keeping on the topic of leadership or the wellness director level, obviously the bigger picture view is so critical. Can you bring us up to speed on the level of oversight across an entire senior living care setting and some of the benefits technology can bring? Maybe we’ll start with Cassie on this one.

Cassie Diner

So technology also gives that DON or wellness director the confidence needed to understand what’s going on across the entire facility or community and address any immediate needs. For example, a dashboard may include which staff may need assistance with either completing tasks still or the required documentation. With technology, the DON or wellness director can have oversight to monitor compliance throughout the shift. And with a high-level of compliance we know comes a higher quality care, better quality measures, and even a reduced service creep. Without technology, that DON or wellness director mostly relies on verbal updates and information from other staff and would need to sort through paper charting for any holes in documentation.

Cassie Dine

Unfortunately, a lot of that compliance discovery actually happens without technology at the end of the shift or when there isn’t even enough time to fully complete any of those tasks. And without technology, from a time management perspective, it’s extremely challenging to figure out what documentation has been fully captured.

Kelly Danielson

Exactly. I can add another example of compliance and oversight, and that’s monitoring vaccination statuses over time. Using machine learning and technology, COVID-19 severity risk factors are captured, compiled, and can be displayed visually to understand where the community is at in real-time. It’s crucial for the director of nursing or the wellness director when they receive a positive COVID-19 test on a resident, for example. So technology allows for a quick action plan to combat the spread. For example, the need to test other residents and employees in the area and utilizing technology to review compliance. Technology allows for a quick and efficient way to enter a batch of COVID test entries that can be combined and submitted or reported on overtime for regulatory purposes, and COVID observations or assessments can be quickly scheduled and documented for our residents.

Kelly Danielson

With the action plan in place, technology allows the director of nursing or wellness director to monitor completion and compliance of COVID assessments, and it helps assure caregivers are working as efficiently and effectively as possible. Overall, technology allows the director of nursing or wellness director to quickly put an action plan around combating the spread. This is especially important because nurses and caregivers are often so focused and heads-down with care, and at times, no one realizes the bigger picture and overall situation until the director of nursing or wellness director puts all the pieces together.

Amy Ostrem

Excellent examples of technology and how important data and monitoring can be. Let’s talk about how technology can also assist that director of nursing or wellness director in being proactive. Can you help give our audience out there just a glimpse into how technology can help with proactive and preventive care planning?

Cassie Diner

Yeah. I could probably take this one. So great point. The further shift to being proactive is where the industry as a whole is headed. Increasing the focus on being proactive is critical to the caregiver of the future. Here, technology can allow the DON or wellness director to focus even faster on critical details that need to be care planned but could have been missed without technology. And that’s because they’re needing to comb through charts and running many reports, going to different areas of the EHR to put all that together. So this intuitive visibility allows the facility or community to address these items now in order to prevent any further decline of the residents.

Cassie Diner

This visibility also provides a nurse with data that further supports critical thinking in the overall care plan process. A director uses that same information then to revamp the admission processes to help ensure new residents meet the care and services that are offered at that specific community.

Joy Herring

You know, Cassie, and when it comes to changing condition, technology can really be utilized to ensure the following areas our care plan, like pain, change in nutritional status, they had a decrease in intake, even a lack of interest in daily activities and infection, which you know that can lead to fall risk and a risk for potential skin injuries. You have the ability to really analyze the patterns that you see with those psychotropic medications. If no pain was noted, was a pain interview conducted? Where you’re able to make those changes to the plan of care. You could review with the candidate if they’re a gradual dose reduction with such the focus on psychotropic medications. It helps the data be organized in a facility dashboard so that the facility can really identify those potential changes required that may be related to your policy or procedure. Technology is a valuable resource really with your quality assurance performance improvement plan.

Amy Ostrem

Thank you for your insights around the proactive side of care and quality assurance performance improvements. How about we walk through some insights that can be gained from data going across an organization or corporation? Kelly, can you take this one?

Kelly Danielson

Absolutely. And yes, great point. The technology can be used by the director of nursing or wellness director not only for monthly meetings, but on a regular basis to look across facilities during the quality assurance process. This allows them to focus on opportunities or where the facilities are doing well. And other things technology and analytics can guide the DON or wellness director and organizational management on are analyzing false statistics over time or repeat hospitalizations. What are the reasons and the focus of the rehospitalizations? Maybe it’s the time of day and specific physicians who are always sending residents to the hospital. It’ll also help you understand demographics of prospects in relation to census recovery and overall measuring outcomes.

Kelly Danielson

And analytics points out what your quality improvement plan should be, quickly identifying facility opportunities such as managing infections such as COVID, or decreasing pulse, and looking at what services are effective and what needs to be added.

Amy Ostrem

Thanks, Kelly. Joy, can you speak a little bit to how technology and analytics can assist with tracking wounds and seeing a correlation with the trending of infections over time?

Joy Herring

Sure. With the help of technology, what was once an instrumentable task of tracking the wounds in the facility is now a manageable, effective workflow. Technology has allowed that real-time documentation that enhances that end user with accurately to document. It is a critical, time nursing leadership, for customarily, they spend those times tracking wounds and infections. Now they can spend that time adequately analyzing the data. With tracking and trending, you can be proactive approach versus reactive in identifying those potential risks, improving resident outcomes, developing a resident center plan of care, which in return reduces the number of citations and with wounds such a big focus for litigation cases, it helps you reduce the risk of litigations as well.

Amy Ostrem

Great point. And Cassie, could you also share on this topic of wounds and trending of infections? Maybe speak to the analysis of the discreet data that’s captured and figuring out then where the success drivers are.

Cassie Diner

Yeah. So with infection comes many reasons that may lead to skin injuries, such as decrease in mobility with the residents. We also know that it’s critical to track if a wound was acquired within that community or facility or if they were admitted with a specific wound. Technology allows the DON or wellness director to have that quick glance at where the wounds are and the status of each of them.

Cassie Diner

Technology also allows you to track wound data, where you can view that data and you can analyze it over time. Technology helps ensure accessibility for that full interdisciplinary team. Typically, technology makes it efficient for staff by providing an intuitive workflow to accurately document wounds and the exact location. This in turn leads to better compliance with documentation overall. Technology also makes it efficient for staff by allowing documentation to be done, as we mentioned earlier, with a mobile device. That way, the device can be used at the point of care.

Cassie Dine

With better documentation, compliance, and using mobile technology to track that discrete data comes the ability to further analyze across the organization. For example, an organization can access wound rates, trends, statistics, and comparisons over time, which support the quality assurance programs. You can see which facilities are improving and then dig into the reasons behind that success. Then after identifying the reason for improvement, the specific interventions can be adopted across the organization as a whole.

Amy Ostre

I can totally appreciate how technology can assist from that time management perspective around compliance.

Cassie Diner

So that wraps up the questions, but I just want to make one last comment that I challenge you to use technology, analytics, or integrations in a way that you haven’t before. Now is a great time to look at what technology you’re using, and most importantly, what technology you’re not utilizing and that is available for you today. There are time savings and return on investment or revenue optimization out there that you could capitalize on. A wise mentor always told me that what got you here won’t get you there. And as leaders in our industry constantly striving for better outcomes, I do encourage all of you to be agents of change and technology for senior living.

Speaker 1

That concludes the latest episode of The Post-Acute Point of View from MatrixCare. We have a lot of guests and topics coming up that you won’t want to miss, so be sure to subscribe. If you’ve enjoyed today’s podcast and if you have a topic you’d like us to discuss, leave us a review. To learn more about MatrixCare and our solutions and services, visit matrixcare.com. You can also follow us on LinkedIn, Twitter, and Facebook. Thank you for listening. Be well and we’ll see you next time.