VOICES: Christopher Miller, Chief Technology Officer, Real Time Medical Systems
This article is sponsored by Real Time Medical Systems. In this Voices interview, Skilled Nursing News sits down with Real Time CTO Christopher Miller to learn how his team is helping SNFs optimize their limited staffing resources through live data automation. He walks through the implementation process and explains the benefits of taking analysis out of the equation to provide skilled nursing staff with timely, actionable insights.
What career experiences do you most draw from in your role today as Chief Technology Officer at Real Time Medical Systems?
Christopher Miller: I learned early on that when you prioritize people first, with process second, technology falls in line. And the biggest part of finding the right people and process is your culture. Culture and creativity are everything. They both enable innovation and successful use of technology. Building a culture that promotes teaching and learning, with some acceptable level of risk, is critical, and this notion is gaining momentum worldwide.
High performers are rare, in my experience, so giving them space to excel and ownership of their areas of expertise is important. To that end, a significant number of our team members have been referrals, and it’s really helped us continue to operate at a high level.
How are technology solutions helping nursing facilities better manage care during staffing shortages? And how is Real Time’s Interventional Analytics solution helping ease this problem for nursing facilities?
Miller: Staffing shortages aren’t new. They’re more acute now than ever, but it’s been a problem, particularly in post-acute care, for decades. Administrators, DONs (Director of Nursing) and corporate leadership have dozens of proactive initiatives that they would love to execute. But many times, these initiatives are not possible given current staffing limitations.
No matter your circumstances, there are several guarantees in this business. You must care for your residents. You must feed them. You must help them. Anything that allows you to be a bit more proactive is important because those initiatives can easily be left off the table. Real Time plays an important role because we automate many processes that operators don’t have time to consider, let alone perform manually. Staff can’t evaluate every word of every set of narrative notes to look for potential concerns, among many other time intensive tasks.
You can automate anything, but if all it yields is another report, it is difficult to act. Our goal is to turn what we’ve automated into meaningful information that staff members can pivot into action plans immediately, thereby reducing administrative work and improving care. Our tools and resources also enable facilities to bring new hires and agency staff up to speed quickly. That’s how we help these facilities with increasingly limited resources.
You’re talking about action plans and actionable items, which tie into Real Time’s Interventional Analytics and its ability to pull live EHR data to provide immediate insight into resident care. How is this creating consistency in care delivery, especially when so many facilities are, as you said, using agency staff?
Miller: Real Time provides standard clinical interventions, though the facility can add or modify protocols as well. These interventions are independently understandable. We’re not trying to create something that’s arcane and difficult to use.
Instead, what we’re producing is universally valuable from the word “go.” Then, upstream from that, we are aligning live patient data. Standardizing data, whether it’s within one facility, among multiple facilities or between different EHRs, is part of our product delivery. By the time data reaches the client, it’s already been standardized. That makes it much easier for our users to act on it right from the beginning.
Again, they’re looking at steps they can take to streamline workflow and impact patient care. They’re not looking to interpret the data. Most dashboards out there require an analyst. We don’t target analysts as our primary users. Instead, we put actionable information into the hands of the clinicians and other staff who are administering direct care.
What early data insights can nursing facilities gain to help minimize the spread of COVID and other infectious diseases?
Miller: O2 sats (oxygen saturation) and other vitals are easy to measure, but they generally present beyond the early detection phase, especially in the context of highly infectious respiratory diseases. Facilities require more timely, comprehensive data. You can look at a given facility and say, “You’re in the middle of an outbreak,” but it’s generally too late and the mitigation processes are very different at that point.
COVID, in particular, is exceptionally transmissible, and with incubation periods being what they are, by the time most of these measures and diagnoses are documented and reviewed, an outbreak could be well underway.
Real Time scours free-text notes – physician notes, consultant pharmacists, nurses, aides, therapists and so on – looking for subtle indications of patient condition changes in a way that’s holistic. An individual note of shortness of breath may not be an indication of an early outbreak, but reaching a particular patient threshold across your facility may provide an early warning before the disease transmission phase.
We’re looking for dozens of these phrases and keywords that can reveal early symptoms of infectious disease in ways that allow facilities to act early, ideally before an outbreak is inevitable or underway.
Are there any reimbursement insights that facilities can gain from technology solutions?
Miller: Yes. It’s one of the most concrete ways SNFs can measure the value they’re getting from our software. Facilities should regularly review reimbursement levels to ensure they’re getting paid for the actual care that they provide. Using our system, facilities can gain actionable insights into exactly that.
This is another example of how Real Time can ease staffing shortages by automating manual processes. If you were to ask those responsible for reimbursement within a facility, in particular, MDS coordinators, “Wouldn’t it be great if you could identify cases where nursing documentation is inconsistent with your reimbursement?” they would say, “Absolutely. But how much time do we have?”
Well, Real Time’s platform automates a substantial amount of that analysis and calls attention to discrepancies between documented point of care and reimbursement levels.
What are the top two to three challenges SNFs face in adopting new technologies?
Miller: There are several considerations, since implementing new technology is never just about the price tag. First of all, new technology often changes user workflow, which can be disruptive at first, so the change has to be justified. Many times, it also requires adjustments to core clinical work, such as how and where documentation is performed. User training can often be cumbersome and there’s the added burden of yet another set of logins for a product that could pose new security risks. Those are the top several challenges we see and understand that the industry deals with most.
We don’t want to make these heroes’ work any more difficult than it already is. Real Time has eliminated most of these challenges right out of the gate. We work to fit our solution into the facility’s workflow as best as we can, preventing substantial changes to their documentation. We also provide comprehensive training that lasts less than an hour.
We’ve implemented our solution in as few as two weeks, with an average being about a month. An implementation begins with a group call among a few key individuals in which we learn how the facility uses its EHR. After completing our data acquisition protocol, we conduct quality tests and then provide training. It’s a straightforward process. The average user will invest less than a couple hours’ time from the beginning of the implementation to the point that we go-live.
What can SNFs do to overcome these technology adoption challenges, and what does Real Time do as a technology vendor to help customers overcome these challenges?
Miller: They should choose technology partners that understand their business and challenges. They should also be demanding, giving their partner feedback on what they need to get the most out of the product. Yes, it’s a product, but it should permit enough customization to align with facility workflow, documentation style and EHR. It should not be a plug-and-play experience based on how the vendors define their world.
Entering this year, no one knew fully what to expect in the skilled nursing industry. What has been the biggest surprise to you, and what impact do you believe that surprise will have for the remainder of the year and into 2022?
Miller: From my perspective, it’s how soon we are facing boosters for COVID and the management of that. I think most were optimistic and hopeful that the vaccines would provide longer-term benefits. More studies indicate the need for boosters, particularly for vulnerable populations. Most of the EHRs we work with have recently created the fields necessary to document administration of COVID boosters.
Staying ahead of new documentation needs is important from a product standpoint, but we also realize that while infection preparedness is more normalized than ever, with IPC staff and standard protocols in place, facilities will still face outbreaks and more rounds of vaccinations, both for their resident population and their staff.
We know post-acute care staff are some of the best people you’ll ever meet. They deal with a lot of difficult situations on a regular basis, and I think this will bring back a greater sense of routine — not in terms of complacency, but in terms of being ready to respond at a moment’s notice. Infection control is now in the front seat. Therefore, documentation and awareness of predicting and managing infections is more routine and top-of-mind now than it’s ever been.
That’s going to affect product choices, it’s going to affect workload, staffing, visitors, and family as well. I think that will continue to shape skilled nursing well into 2022 and beyond.
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