Online Screening System Speeds Care for Nursing Home Patients

With help from a Sacramento-based technology firm, the state has converted to an online program for screening patients before they’re placed in one of California’s 2,000 nursing facilities.

The digital screening process is significantly faster, more thorough and saves money, officials say, helping patients more quickly get access to long-term care that best suits their needs.

“It helps ensure patients have the highest quality of care,” said Anand Adoni, president of the consulting division for Cambria Solutions, which built and integrated the online Preadmission Screening and Resident Review (PASRR) system.

PASRR is a federal requirement before anyone is admitted to a Medicaid-certified nursing home for long-term care. It screens for mental illness or intellectual disabilities, using results to come up with a long-term care plan that incorporates patients’ needs and personal preferences. The goal is to make sure patients get the services they need in the least restrictive setting possible, whether that be inhome care, a nursing home or an acute-care facility.

The Department of Health Care Services (DHCS) was ordered to update its paper-based PASRR processes after the Centers of Medicare and Medicaid Services determined it was taking too long to process its 20,000 annual screenings, putting California out of federal compliance. A federal review also found California was potentially under-identifying residents who might have disabilities that require special treatment.

To address these issues, the online system processes evaluations more than 85 percent faster in most cases, dropping the wait time from 45 or 50 days to less than five days, according to DHCS spokesman Adam Weintraub. Users can submit their paperwork online rather than faxing or mailing it in, cutting down on errors from illegible text. They’ll get immediate feedback on whether they need to submit additional information, and they can check the status of their evaluation at any time.

The new system also asks for more detailed information than the paper-based system, helping to better identify patients who might need additional screening before deciding what level of care would best suit their needs.

Cambria Solutions spent about nine months building the program, Adoni said. The online system went live Jan. 2, with updates April 2.

The technology itself wasn’t particularly tough to implement, Adoni said, using proven frameworks and with strong support from the state. The biggest challenge has been scheduling the typical fixes needed for all new programs, Weintraub said, with this one used around the clock by nursing facilities.

“DHCS had to work closely both in-house and with our system stakeholders to coordinate maintenance work to minimize disruptions,” Weintraub said, “but so far we’ve been able to squash the minor bugs that have cropped up since launch.”

Another challenge has been getting users to adapt to the new system, Adoni said. The state has been holding training sessions for months to get everyone on board, with more trainings planned through the end of June.

“DHCS has enrolled about 800 facilities and 3,000 users in the new system in the first five months,” Weintraub said, with help from the agency’s partner organizations. “However, the state estimates that another 800 general acute-care hospitals and 400 nursing facilities could benefit from enrollment, and DHCS is working to spread the word about the new system to reach them.”