Whatever one’s sentiments are about those famous acronyms PPS and RUG–the Medicare Prospective Payment System and the Resource Utilization Groupings used to calculate those payments–on one thing almost everyone agrees: They won’t work without good software. The complexities of completing the Minimum Data Set (MDS), of tracking it with “triggers” and Resident Assessment Protocols (RAPs), and of linking all this to a RUG that defines (and defends) payment–they’re made to order for computers. And, of course, facilities are required by law to transmit these data to their government paymasters electronically. But, in practice, how well is the computerized approach working? Recently, Gary Jorgenson, RN, the technical advisor who helped Diane Carter realize her vision of an online “virtual organization” called the American Association of Nurse Assessment Coordinators (AANAC)–some 2,500 nurses specializing in PPS documentation–commented on the state of the art in an interview with Nursing Homes/Long Term Care Ma nagement Editor Richard L. Peck. He was amply qualified to do so. Although he serves both as AANAC’s Webmaster and as clinical director of information systems for NCS HealthCare, the national long-term care pharmacy firm, he has also had several years’ experience as a staff nurse and director of nursing for an Ohio nursing home. In short, he can view the vendor/nurse software relationship from both sides.
Jorgenson: Definitely. Aside from the fact that electronic transmission of data is mandatory, trying to do the MDS assessments and RUG calculations by hand would be an enormous task. In view of the challenges involved, computerization seems to be a “natural” process for this.
Peck: At AANAC meetings I’ve noticed that most of the problems NACs encounter with this system seem to be software-related, i.e., often the answer is “see your vendor about that.” Is that a correct impression?
Jorgenson: Yes, it is. And as a software developer and a nurse, I can see both sides of the situation. The nurse feels frustrated because she can’t always get the software to do everything she wants. But from the vendor’s side, these regulations change so often that it is a pure nightmare to keep up. Then, once vendors have made the change, there are questions regarding distribution of the changes and staff training to consider.
Peck: With a significant change, how long would a vendor’s response typically take?
Jorgenson: It depends on several factors. Vendors are creating software using a variety of platforms–everything from second-generation language, for which updates are a huge task, to fifth-generation language, for which changes come relatively easily. Then there is the variety of distribution methods–diskette mailers, patches posted on the company Web site, and a few application service providers (ASPs) who centralize software maintenance and eliminate distribution as a factor. Across the board, it is an amazingly broad spectrum.
Peck: In striving toward a workable software solution, what would be the ideal relationship between vendors and their NAC customers?
Jorgenson: If I were to advise a nurse about anything regarding this, I would say look for support, support, support. But here, too, one encounters unusual situations. A vendor might be marketing 15-year-old software that is all but obsolete, but the company provides excellent support and has a strong user base. Another vendor might offer new, state-of-the-art software but have no support mechanism in place. The best thing for the nurse to do is to contact some of the customers of the vendors in which she’s interested. In fact, with the AANAC Web site, NACs have a national forum available to talk with customers nationwide.
Peck: When it comes to improving the relationship, what should nurses consider?
Jorgenson: They really need to try for a greater level of computer literacy. It’s not that nurses are computer-illiterate. It’s that they’re computer-uninterested. They went into nursing to care for patients, not to manipulate computer keyboards. But they should still try to expand their knowledge base to some extent though books, magazines, seminars or college courses. In fact, that seems to be happening–in my contacts with facilities throughout the country, I see more and more nurses taking on the role of the “information system (IS) nurse.” That’s becoming an actual job title.
Peck: How about vendors; what should they do to improve matters?
Jorgenson: I would urge them to have a greater Web presence, to use the Internet not only for marketing purposes, but for interactive customer support. There is some of this going on, but not much as yet.
Peck: What would you say is the major future issue that they should all be addressing?
Jorgenson: Nurses should take care to ask vendors about security issues–about patient confidentiality protections, and such terms as firewalls and encryption. These are about to become major issues for all healthcare organizations that transmit data electronically, because of the issuance of regulations pertaining to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Act hasn’t had much direct impact yet, but regulations continue to emerge, and some are going to require compliance by late next year. That’s a responsibility both for vendors and for users.