LeadingAge Magazine · March-April 2017 • Volume 07 • Number 02

Vision: An Optimistic Take on Technology Adoption

March 15, 2017 | by Gene Mitchell

A talk with Peter Kress on electronic medical records, health information exchange and the training of a technology-able workforce.

For all the promise that technology offers to aging services providers—more efficient and streamlined operations and information exchange, increased service offerings and greater resident engagement—its adoption has presented challenges for a long time. Lack of funding, interoperability problems and inertia have made, for instance, adoption of electronic medical records (EMRs) slower than might have been expected a decade ago.

For perspective on where our field has been and where it is headed with respect to EMRs, the strategic role of technology planning and the training of a technology-able workforce, we interviewed Peter Kress, vice president and chief information officer for Acts Retirement-Life Communities, Inc., West Point, PA. Kress has long been a leader in LeadingAge’s Center for Aging Services Technologies (CAST), serves on the CAST Commission, and is a frequent speaker on technology issues at regional, national and international conferences.

Peter Kress
Peter Kress

LeadingAge: Part of the impetus behind development of the CAST 7-Stage EHR Adoption Model was the idea that providers should not only adopt electronic medical records (EMRs), but try to use the full functionality of a package instead of leaving it at a few very basic functions. How well are we doing this, in your opinion?

Peter Kress: We’ve achieved a really important milestone—the fact that most providers understand that we need an EMR, and are deploying capabilities that could be described as EMRs, and are very aware that there’s a whole set of capabilities that they haven’t employed yet.

For the last 10 years the challenge for long-term and post-acute care [LTPAC], including life plan communities, was that organizations struggled to find a financial model or justification to move to a digitized model for supporting health and transitions. There was no funder out there for our sector as there were for other sectors, yet we knew we had to try to find ways to adapt.

There is [still] no funder out there who’s going to say “We’re going to make it worth your while to deploy an EMR.” Instead, there will be a whole set of business realities and business relationships that will drive adoption; some will be policy-related and regulatory, but some will be about how you construct an effective business. It won’t be some theoretical scorecard, but what will drive it is the fact that we [must] survive and/or thrive because of what we do; that’s what will motivate it.

That’s why we’ll move toward a maturity model for adoption; we’ll find really interesting ways, not necessarily sequential, to progress in each of the stages. We’ll find, for example, that electronic signatures will drive electronic documentation for companies—a later stage—who have not yet progressed in some of the earlier stages, because it dramatically simplifies a particular process for them. Another way of saying this is that in some cases deployment of an EMR will mature into sharing health information, while in others, automating information sharing will drive further adoption of an EMR. What’s going to drive all of that will be business need.

"There will be a whole set of business realities and business relationships that will drive adoption; some will be policy-related and regulatory, but some will be about how you construct an effective business."

The next complexity is that, in our sector, our excellence is in broadening our continuum of care. But even so, that continuum is still made up of many silos. And some those may have distinct regulatory or differing models. That’s all rooted in that fee-for-service model, which we know is giving way rapidly, but very unevenly, to new person-centered models.

These many levels of care will soon be components of a value equation about how we deliver services to clients or engage in business partnerships. As we do that it’s not just one EMR we’re deploying; but perhaps as many as 3, 5 or 7 different care disciplines or care processes that may be supported by multiple, hopefully integrated, EMRs.

I celebrate the fact that, in my opinion, everyone understands we need an EMR and is moving toward adoption, and this is setting up an environment that will allow people to adopt incremental changes quickly. But I also am aware that the real work of crafting impact in terms of service delivery, outcomes and business value is in its very early stages. I feel like we’ve rolled the boulder over the top of the mountain, and it’s rolling downhill now—this is all going to happen—but there are an awful lot of trees and ravines and other things in the way and it means that boulder is a long way from the bottom of the hill yet.


LeadingAge: The development of health information exchange (HIE) capabilities has been a major focus in health IT in recent years, and is of great interest to aging services providers hoping to work in integrated networks. Where do we stand on HIE right now?

Peter Kress: We’ve come off the research and discovery stage, and those research efforts had a wide range of results, from moderately positive to no impact whatsoever. Because [this research] was funded on the local and state level it yielded hundreds of HIE organizations across the country. All of them are trying to figure out ways to achieve a fairly common set of services but with all sorts of local nuances.

Now we’re ripe for rapid consolidation as we move into an early-adopter stage. It’s the same theme I mentioned before: The first stages of all these exchanges were not driven by normal business and health care delivery processes. They were delivered more as proof of concepts: “We’ll fund your development of this kind of entity.” It’s sort of like building a highway; no one drives on it until it’s built. What we have is a whole set of mid-stream construction projects of which only a few will deliver viable results.

The case for post-acute care participation [in HIE] lags. There is an evolving set of needs as people sense we will be able to have real benefits. We’re watching very closely as a number of HIEs try to build viable business and value models in an evolving health information marketplace. In other words, we’ve half-built an infrastructure. Now how are we going to make this really work?

Long-term and post-acute care has many small ways in which it’s starting to participate in HIEs, but there are no master models working yet that everyone is going to be able to follow as a best practice.

Now people might say to that statement, “Boy, what an empty glass, what a waste of money,” but I think of it very differently. I think we’ve been in an absolutely necessary state of chaos. The investment of the last 10 years probably accelerated the ability for viable solutions to start emerging now.


LeadingAge: In the past you have spoken about better health IT training for workers. In general terms, where does our field stand in terms of creating a technology-able workforce? What could we be doing better?

Peter Kress: At Acts, our approach is very pragmatic. We train around capabilities, and that’s different at different levels of the organization. In my opinion, when technology requires too much training to use, it’s not viable. From early on, when we started deploying touch screens 15 years ago, we were using approaches to technology that were intended to require no formal training.

I think the story of technology is how do you make it transparent, how do you make it disappear, how do you make it so people don’t have to learn it? Specialists learn technology, but everyone else has to learn how to be more effective at using tools to solve problems. A little of that is about the technology and a lot is about learning different ways of thinking.

We’ve rolled out about 1,500 mobile devices and will roll out a couple thousand more this year, so 80% of our workers will carry devices with them while doing work.


LeadingAge: Are you talking about tablets for the most part?

Peter Kress: Actually iPod Touches and some tablets. Our goal is not that people will use them a lot. We don’t want a technology-centered environment, we want a technology-enabled environment, and the more passive and invisible the technology, the better.

We think work is changing and that every worker needs to not only be a task-doer, but also a better critical thinker. We think about [employees’] ability to engage people and apply appropriate best-practice care. We expect more, cognitively, of our workforce, but it doesn’t really mean we need a far more technically literate workforce.

The worker of the future will be a universal worker who can handle a wide range of tasks. There will still be specialization, but workers will be adaptable. They’ll be able to play a variety of roles; what will be at the heart of it is the ability to truly engage residents and produce great experiences.

[At Acts] we’re putting a handheld in every pocket, and one thing on every handheld is a learning management system. It’s our purpose to be able to deliver training and ongoing learning continuously, and do it where people are and at the point of need.

"I think we’ve been in an absolutely necessary state of chaos. The investment of the last 10 years probably accelerated the ability for viable solutions to start emerging "

LeadingAge: In a conversation we had a few years ago you talked about “front end” devices and the possibility of tablets as master remote controls that residents would find easy to adopt and use for both communication and for controlling things like heating or cooling in their apartments. Has that future come to pass at your organization and in other places?

Peter Kress: We certainly have in our communities a lot of iPad training activities and entertainment. We’ve not yet started handing out tablets to residents as they move in. We’re in pilot mode on both portal and app experiences for residents.

We have developed a request/response system [for] residents, and we’ve reorganized our whole approach to low-voltage systems (safety, wandering, personal emergency) and connectivity systems (communications, network) and amenity systems (TV, voice, Wi-Fi) so they’re all sitting under a single committee that’s committed to build what I call the Internet of persons, places and things. The idea is a well-mapped, well-equipped digitized environment supporting smart persons, smart apartments, a smart campus and smart transportation.

We’ve used personal emergency response systems for a long time. People are starting to understand now that the personal emergency response system is actually a feature of our broader connectedness. So today, as we look at the next step in personal response technologies, we can re-vision it as part of the wearable and mobility movement. Today’s residents are already wearing the wearables, carrying the devices and leveraging services that make up the “connected person.” So personal emergency response becomes a service available to the connected person. It’s just one feature of the transition toward a cardless, cashless, keyless and eventually even cashierless life.


LeadingAge: CAST has actively encouraged organizations to tie their technology planning into their overall strategic planning. One result of that approach is that more organizations are now hiring CIOs. Could you talk about your own history in that position and how it has changed over the years?

Peter Kress: I’ve been leading the Acts IT department for 20 years now, and I’ve been CIO since 2000. At the time there were a handful of us in the field who had a “director of IT” or “CIO” kind of title and who were members of our leadership teams in one way or another. We’ve seen that grow rapidly.

Every organization is different in terms of what will be most effective. The common denominator is that technology and strategy conversations need to intersect on a regular basis. It can mean that your technology plan development informs your strategic plan or vice-versa, and it’s best if it flows both ways. I don’t care about how the titles line up, but I agree 100% that the innovation in our field will be, if you dig down deep enough under the hood, technology-enabled innovation. Therefore, the leading organizations in the future of aging services are the ones who master the digital age most effectively to deliver new strategies for hospitality and wellness.


LeadingAge: Even though you’ve acknowledged some difficult issues, you sound like an optimist.

Peter Kress: We’re on the very edge of a convergence of technologies that have been percolating for a decade now, all arriving at the same time: conversation technologies; machine learning technologies; the Internet of persons, places and things; and the mobilization and ubiquitization of technology.

Machine learning should not be underestimated. Our ability to work for residents increasingly will be based not just on our own insight, but also on the data that we’re collecting and that machines are analyzing and interpreting for us, and helping us to build more effective person-centered ways of having conversations with residents and delivering services and experiences. That, combined with the demographic shift, may partly explain some of the chaos we’re experiencing as a society; under the hood that chaos is about the fact that whole new ways of doing things are competing right now.

It’s an interesting time, an optimistic time for aging services; not necessarily for legacy models, but for aging services, an amazingly optimistic time.

- Gene Mitchell is editor of LeadingAge magazine.