Operational Modernization: Why Automation Should Not Be a Dirty Word for Long Term Care Organizations

Many administrators in the long-term care (LTC) industry uphold traditional methods for managing staff credentialing and corporate documents with good reason. These methods often integrate various tools and technologies, blending spreadsheets with electronic storage, calendars, and email systems. For instance, many nursing facilities and home health agencies rely on spreadsheets to track crucial corporate deadlines, manually send email reminders, and store documents on unsecured drives.

The shift from paper-based to digital tools in healthcare occurred rapidly following the enactment of the Health Insurance Portability and Accountability Act (HIPAA) in 1996. HIPAA's introduction spurred the industry to embrace technology for improved billing processes and safeguarding patient privacy. During the 1990s, spreadsheets, emails, electronic storage, and calendars became the go-to solutions, captivating the healthcare sector. Before this digital revolution, patient charts resided in paper folders, claims were filed via fax, and medical records were duplicated or faxed to other providers. Despite advancements in automation elsewhere, healthcare remained tethered to these 1990s technologies, reluctant to transition to more sophisticated more automated systems.

Healthcare administrators exhibit resistance to automation for valid reasons, as traditional methods have proven effective and entrenched themselves within the industry for sound causes. Familiar tools such as email, document storage, calendar systems, and spreadsheets are universally understood, minimizing the learning curve for staff transitioning between facilities—particularly crucial in high-turnover sectors like LTC. New hires swiftly acclimate to these established practices, assigned an email address and granted access to existing spreadsheets and electronic files, enabling them to seamlessly integrate into their roles. Hence, these technologies have become ingrained as standard practice within the industry.

At the heart of organizing administrative functions lies the versatile spreadsheet tool, empowering administrators to create and manage lists of crucial due dates. For the technologically adept, spreadsheets offer the capability to employ macros for additional functionalities, such as implementing chromographic notifications or receiving automatic alerts for impending deadlines.

In a supporting capacity, storage tools facilitate the electronic preservation of documents, offering administrators platforms like Microsoft OneDrive or Google Drive. These tools enable seamless collaboration on projects and document creation by allowing users to share documents with colleagues. Notably, platforms such as Google Drive adhere to HIPAA compliance standards, permitting administrators to securely store documents containing sensitive patient data, such as survey reports.

Email tools represent another cornerstone of administrative efficiency. Since their widespread adoption in the 1990s, these tools have evolved significantly. For instance, Gmail now boasts features such as scheduled email delivery, integration with Google Tasks and Google Calendar, enhancing overall productivity and efficiency for users.

Furthermore, calendar tools have also undergone notable advancements, facilitating integration with other tools such as email providers. This integration streamlines processes like sharing meeting times and sending tasks and reminders to colleagues, further optimizing administrative workflows.     

Despite notable advancements, the current standard practices and traditional patchwork of management tools in the healthcare sector struggle to keep pace with the demands of the complex, heavily regulated, and fast-paced environment. Long term care (LTC) providers increasingly expect more from administrators while reducing staff numbers. Regulators now require stricter recordkeeping and easier document access, while surveys impose tougher standards. Furthermore, rules mandate heightened information security, patients are presenting with more severe conditions, and expectations for service quality are escalating—all while reimbursement rates remain stagnant. LTC administrators bear the brunt of these pressures, operating within a challenging environment characterized by downward price pressures and rising expectations.

Persistent time and budget constraints have resulted in job dissatisfaction and chronic burnout among LTC administrators and staff. Given that compensation decisions largely rest with the federal government and payers, the primary avenue for relief lies in achieving savings. To adapt, change is inevitable.

Prioritizing time and cost savings is imperative for LTC administrators and executives. One of the most effective strategies for achieving this goal while simultaneously enhancing compliance is to increase operational efficiency. In the healthcare industry, where many operations still rely on manual, traditional systems, automation presents a clear opportunity for significant efficiency gains and improved compliance.

Automation Should Not Be a Dirty Word in the LTC Industry 

Let's delve into why "automation" should be embraced rather than shunned, especially in LTC operational management.

First and foremost, operational automation represents a ripe opportunity for cost savings. Companies often falter in their automation endeavors due to a lack of optimized processes. However, healthcare operations, already well-optimized and heavily policy-driven, present an ideal landscape for automation adoption. Years of meticulous organization and optimization using traditional methods make the transition to automation relatively seamless and significantly reduce the risk of failure.

Moreover, once an automated system is established, it functions consistently over time. Because healthcare is highly regulated, business operational parameters seldom change, making this initial investment of time yields long-term benefits. Automated systems can effortlessly manage mundane inefficient workflows such as date adjustments, alert notifications, email reminders, and task assignments, streamlining operations and reducing time-intensive administrative burdens in the long run.

Secondly, the regulatory landscape is evolving, with a heightened focus on compliance and stricter scrutiny of staff credentialing and qualifications expected in 2024. Credentialing deficiencies, such as nurses' competency to care for specific patient demographics or the validity of supervisory licenses, rank among the top administrative-related deficiencies in LTC surveys. Addressing these deficiencies consumes considerable administrative time, necessitates extensive documentation, and potentially impacts an organization's ratings and financial bottom line.

Automation of credentialing processes, facilitated by the right tools, offers a solution to enhance compliance efforts. By automating credentialing procedures, for example, organizations can improve oversight, delegate monitoring responsibilities, and distribute compliance maintenance duties among multiple stakeholders. This approach not only streamlines administrative tasks but also strengthens the organization's ability to meet regulatory requirements and safeguard its reputation and financial standing. 

Given the array of tools and technologies at our disposal, maintaining reliance on inefficient, outdated methods is simply unsustainable. In addition to the evident time savings and enhanced compliance potential, automated systems offer superior technological capabilities compared to the status quo. However, before initiating any transitions, administrators must conduct a thorough analysis of various business aspects, including:

• Recognizing the shortcomings inherent in traditional methods;
• Understanding the benefits offered by more sophisticated tools;
• Acknowledging the unsustainable nature of outdated practices;
• Determining whether the advantages of adopting new management tools outweigh the associated challenges; 
• Understanding the return on investment they would obtain from making a technology change;
• Conduct comprehensive research on available tools to ensure informed decision-making and selection criteria; and most importantly,
• Committing to embracing change and transitioning to more efficient, automated processes.

Shortcomings of Status Quo

1. Spreadsheets: Spreadsheets, despite their widespread use, come with notable drawbacks in managing due dates and credentials within the long term care (LTC) sector:

• Limited Efficiency: Spreadsheets struggle to maintain efficiency when handling large volumes of data. As the dataset grows, the process of creating and managing spreadsheets becomes cumbersome and prone to errors.
• Lack of Security: Spreadsheets lack robust data security measures and audit controls. In the event of spreadsheet corruption, the entire dataset may be compromised, posing significant risks to operational integrity.
• Inability to Integrate: Integrating spreadsheets with other systems presents considerable challenges. This limitation hinders seamless collaboration and data sharing across different platforms within LTC organizations.
• Error-Prone: Human errors are prevalent in spreadsheet-based processes, primarily due to manual monitoring of deadlines. These errors can lead to compliance issues and undermine the reliability of the monitored data.

For a comprehensive exploration of the pitfalls associated with spreadsheet-based credentialing and insights into available automation tools, refer to our article titled “Modernizing Employee Credentialing in Long-Term Care: Top Tools for Automation in 2024.”

2. Email Tools: Email tools exhibit shortcomings despite their advancements in functionalities. While they offer numerous features, they lack seamless integration with documents, making it challenging to automate reminder email generation or task assignments. As a result, administrators are compelled to manually create reminder emails for numerous staff credentialing deadlines and assign tasks to employees each time a due date approaches.  

3. Share and Storage Drives: The shortcomings of storage tools are equally concerning. Share drives like Microsoft OneDrive or Azure lack a centralized system for document maintenance, resulting in a decentralized organization of documents within a shared environment. This decentralized approach becomes problematic when a staff member departs and their account is terminated, leading to the loss of all documents they had shared. In organizations where administrative staff work on vital documents such as Emergency Preparedness Plans or HIPAA policies and procedures, the loss of critical data can have severe consequences, including penalties and liabilities. To mitigate these risks, automated environments must offer centralized document storage systems to ensure the safe and reliable maintenance of critical and archival documents.

4. Calendar Software: Utilizing a calendar for reminders can often be cumbersome and ineffective. While users can configure reminders and have the calendar dispatch notifications to participants, this approach proves impractical in practice. For instance, LTC administrators overseeing a hundred patients may contend with over 4,000 annual due dates solely related to employee credentialing. Setting reminders for such a large volume of due dates can monopolize calendar slots, hindering scheduling for meetings and other calendar-related tasks. Additionally, calendars lack integration with the document storage tools, necessitating administrators to manually search for the relevant documents in shared folders upon receiving reminders.

Well Designed Automation Systems

Robust automation systems adhere to the following core standards:

• Centralized System: Shared systems risk the loss of critical information and documents. A centralized system empowers administrators with full control over documents within their purview.
• Secure Storage: LTC organizations handle sensitive data, such as employee criminal background results, which demand strict confidentiality. Any inadvertent disclosure of such information could result in criminal repercussions. Secure storage environment should be a core principle for automation tools. 
• Easy-to-Use Interface: The most effective systems boast intuitive interfaces designed to mirror existing optimized processes, ensuring seamless adoption and operation by users. Reducing training and the onboarding time should be a crucial concern for any automation tool. 
• Field-Specific Functions: Each healthcare field has unique and specific needs and requirements. Automation solutions tailored to LTC must address unique requirements distinct from other healthcare providers, such as clinical laboratories, to effectively meet industry demands. Providing automation for all “healthcare” in general is a red-flag that the automation provider would not offer healthcare field specific functions in the long run.
• Versatility in Operations: One-size-fits-all systems often fail to accommodate the diverse needs of LTC organizations. Administrators require the flexibility to customize workflows to align with their specific operational requirements. For example, systems built on HIPAA compliant AI capabilities are more versatile that non-AI systems.  
• Transparent Pricing: Transparent and reasonable pricing structures are essential to prevent unexpected costs and ensure long-term financial sustainability. LTC organizations must scrutinize pricing and fees to avoid potential financial pitfalls associated with complex contracts and hidden charges.

‍Common Administrator Objections to Automation

Time to Onboard and Implement. Administrators often express concerns about the time required to onboard and implement automation systems. However, for organizations aiming for growth, profitability, and compliance, automation becomes indispensable. By automating time-consuming, non-income generating tasks, organizations can quickly realize significant dividends. Automation liberates staff time, allowing them to focus on more critical income generating tasks while simultaneously enhancing compliance and productivity.

Expense. Another common objection is the perceived expense of automation. However, it is essential to evaluate the purchase of any automation tool from the perspective of its Return on Investment (ROI). Simply dismissing automation as expensive overlooks its potential long-term benefits. Consider a scenario where automation costs $500 per year but annually saves the business $1500. In this case, the ROI of the purchase is threefold. As an example, traditional methods of managing employee credentials may consume 825 hours per year for every 100 employees. With a conservative estimate of automation improving efficiency by 50%, organizations can save over $4,000 annually for every 100 employees. The exact ROI depends on factors such as the number of employees, the hourly wage of staff managing the process, and the volume of credentialing documents per employer. Tools like Perla’s ROI Calculator can help visualize the potential ROI of automation in staffing and document management.

“Our current systems work fine. It's crucial to recognize that automation isn't universally applicable, and not every organization stands to benefit from it. Certain LTC organizations have invested in elaborate processes utilizing spreadsheets and other tools to optimize or semi-automate tasks like credentialing. These organizations have dedicated substantial time to staff training and have grown accustomed to receiving data in a particular manner. Understandably, they may harbor concerns that adopting new methods could lead to oversight.

However, relying solely on software patchworks for optimization or semi-automation has its limitations. These patchwork systems may be susceptible to security vulnerabilities, particularly if they involve disparate tools cobbled together. They could also prove challenging to operate when staff turnover occurs or necessitate excessive reliance on IT consultants for maintenance. Moreover, such systems may demand significant staff time for organization and monitoring and could be prone to human errors.

Some LTC organizations may find that their current EMR software vendors offer compliance, document or credentialing management services.  However, these enterprise software organizations may not provide the specialized focus required to address unique challenges effectively. Opting for enterprise software that aims to cover multiple bases such as ERM, billing and compliance, can be suboptimal, as these entities generally charge more and lack the agility and depth of specialized vendors in addressing specific issues. In contrast, specialized vendors can offer tailored solutions that align more closely with the organization's needs, potentially enhancing the return on investment over the long term. 

Security. LTC organizations utilizing spreadsheets and shared document storage tools are prone to security lapses. These organizations face vulnerabilities such as data loss, cybersecurity breaches, and internal data manipulations due to the inherent shortcomings of their current systems. These patchwork solutions, further, lack adequate safeguards against security threats, lack access permissions, access logs, and are ill-suited to the specific needs of LTC organizations, often resulting in data loss, especially during employee transitions.

While it's imperative for LTC organizations to thoroughly vet automation systems before adoption, it's worth noting that newer, comprehensive systems generally offer enhanced security and data recovery measures compared to mass-market general tools. These advanced systems are better equipped to meet the unique security demands of LTC administrators, providing greater assurance against potential breaches and data loss incidents.

In conclusion, automation should not be viewed as a dirty word in the LTC industry but rather as a necessary step towards modernizing administrative processes and meeting the evolving needs of healthcare organizations. By understanding the current operational shortcomings, embracing automation and leveraging the latest technologies, LTC organizations can enhance their operations, liberate their administrators' time, reduce burnout, enhance employee job satisfaction, improve compliance, and ultimately position their organization for faster growth and better patient care.