DEL - ivering the goods

While it's not one of the flashiest acronyms in letter-happy healthcare, the so-called “data element library,” or DEL, has a lot of people in long-term care buzzing.

Years in development led by the Centers for Medicare & Medicaid Services, the DEL is a new database that supports the exchange of standardized and universally readable electronic health information.

Experts are praising it for its promise to streamline care, improve outcomes and make the overall business more efficient. Many add, meanwhile, that the DEL is still a work in progress.

Many Winners

Proponents are quick to point out the litany of benefits the DEL will bring to care, outcomes and reimbursement.

For information technology vendors in particular, CMS maintains that the "one-stop shop" feature of DEL will make the process for incorporating various data elements into provider electronic record systems less burdensome. It's meant to improve interoperability, which  will allow important health information to transfer between providers.

Plus, long-term care should benefit, experts say.

For one, the DEL could help develop and implement measurable, outcome-based systems.

For another, the ability for providers across the continuum to literally be on the same page will go toward improving resident care at the bedside.

"The standardization for regulatory assessments in the post-acute industry will align care coordination between the transistions of care our patients often encounter," says Hannah Patterson. "Having the same data seen across multiple episodes should allow providers the tools necessary to streamline the care needed to improve the highest quality outcomes."

Provider readiness

In all, vendors and technology experts like Majd Alwan, executive director of LeadingAge Center for Aging Services Technologies, believe critical mass of large post-acute providers are in a good place to take on DEL implementation.

That's because they are vested in electronic health records.

"A majority of long-term care providers have EHRs, but smaller standalone providers, especially rural ones, have lower adoption rates," Alwan says.

Long-term care has done a fantastic job implementing electronic records for services it providers, says Carrie O'Connell, RN, executive vice president of clinical informatics at Health Care Software Inc.

"The challenge exists in patient transfer and getting information from the hand-off locations electronically, timely, and with systems that can ingest this information once verified," she says.

Continuing the embrace EHRs will have a snowball effect by contributing to improving interoperability, "which has been one of the factors impeding EHR adoption more broadly," Alwan says.

Extent of Impact

For now, experts are mixed on the long-term impact DEL will have.

Alwan says he believes the DEL is a transformational event because it supports the integration of CMS-mandates assessment data elements, such as functional assessment.

"While these assessment data are an integral part of EHRs used in our LTPAC settings, they did not necessarily have a place in acute care settings like physician and hospital EHRs, and hence were not appropriately incorporated and considered in transitions of care and shared care," he adds.

Alwan lauds the DEL initiative as the first effort to map such data to standardized data sets recognized by Office of the National Coordinator, like Logical Observation Identifiers Names and Codes (LOINC), a medical labs database, and the Systematized Nomenclature of Medicine Clinical Terms (SNOMEDCT), a standardized, multilingual vocabulary of clinical terminology that is used by physicians and other healthcare providers.

"All of this should help advance harmonization of data elements, including harmonization efforts of cross-setting functional assessment mandated by the IMPACT Act," he adds.

Meanwhile, O'Connell points to a sticking point in DEL: the fact that for now, hospitals aren't required to collect the information that DEL needs.

"The captured information from various data sets is very important. However, it is limited to the specific "look-back window" per data set rules and is not real-time assessment data," she notes.

O'Connell explains the conundrum this way: "Facilities have a few days after the assessment window to complete the assessment and then another set of days to transmit. A resident's cognitive status and/or functional mobility could be quite different by the time the data is entered into the data set. So, a resident could be confused, requiring extensive assistance within the assessment window, but the day the data is collected, the resident's confusion could have cleared and they only require limited assistance."

O'Connell points to other potentially missing vital information, such as vaccination data, demographics, prior function and wounds "that would be extremely meaningful to the hand-off facility to reduce provider burden".

Current medication lists with allergies, recent vital signs and diagnostic data are among elements missing from the current data sets, she adds.

Impact on Care

Improved care coordination and outcomes are high on the list of providers, clinicians and payors. And DEL delivers on that front, experts say.

Better data, shared across the continuum, will invariably lead to better assessments.

"The standardization in assessment reporting across care settings that DEL supports will enhance the industry's ability to identify and track changes in care requirements," says Susan Reese. "This will not only improve communication across care settings, but it will serve to better inform the industry of changing care requirements that may need to be addressed by adjustments to staffing. A standardized assessment of care requirements may enable more accurate adjustments to staffing that take into account not only the numbers of staff provided, but the skills required."

The operative word for O'Connell is consistency.

"The database promotes consistency and how we communicate assessment data for a defined window of time," she says. "Having a starting point with the ability to speak the same language allows for accurate outcome reporting. Once this data is consistently being assessed and entered, the analytical possibilities are endless and exciting."

She quickly adds that raw data alone paints an incomplete picture and does not reveal whether a provider is delivering good care.

Clinical decision support will likely improve as well, says Alwan.

"Sharing this data electronically in a standardized format with a hospital or a physician, either in a transition of care or shared care situation, means the receiving clinician has a better understanding of the patient's functional and cognitive abilities, reduces the burden of unnecessarily repeating these assessments, and can consider and incorporate these factors in the treatment and subsequent care plan, which leads to better outcomes and reduces costs," he adds.

More efficient workflow

CMS has stated how the DEL supports the agency's "Patients Over Paperwork" initiative aimed at reducing administrative burden on providers so they can focus on patients. Experts see significant efficiencies in workflow as a result.

The easy to access library is searchable with built in reports, according to Jane Belt, curriculum development specialist for the American Association of Nurse Assessment Coordination.

"A provider can compare items across settings and see the response options available for each item," she adds. "At present, the reports can provide information to the provider, but the greatest advantage at the present provably is for the software vendors who can use library to create reports for a particular user request."

Optimism and speed bumps

With fall around the corner and a few months of discovery having passed since the DEL June announcement, there are a lot of items on experts' wish lists.

Until and if SNF's primary referral partners - hospitals - are required to collect data DEL needs, O'Connell predicts low overall adoption. But there's still hope.

"The demand from the industry will drive change," she says. With all change, there are early adopters leading the way for the rest of the industry. Based on that trend, this can become a routine exchange, or no exchange at all."

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