By Mary Butler
For Maria Moen, who’s been working to improve the use of health technology and interoperability in the long-term care (LTC) health IT space for almost 30 years, the industry too often misses the target in its implementation and use of technologies when it focuses primarily on the technology and not on the ways that these same platforms allow users to make a deeper human connection.
Instead of tangible benefits from the systems and applications they put into place, providers find themselves chasing the data trail, which doesn’t help anyone—not the least of whom is the patient. From her first professional job in the reimbursement department of Manor Care’s corporate offices in Silver Spring, Maryland, to her current role at ADVault, a company that is dedicated to making people’s advance medical decisions secure, digital, and accessible from anywhere, Moen is driven by the desire to make technology seamless and unobtrusive during every healthcare encounter.
“When it comes to health IT, you cannot lose sight of the fact that, strategically, we have to enable computers to be able to extend what we’ve done for so long on a human basis,” Moen says. “If our humanity alone could carry the day, we wouldn’t need technology to normalize the information and reach across time and space to deliver it. And yet COVID has shown us that without technology, we are unable to carry our humanity into the distributed workflows and processes that ensure my message at point A gets to point B correctly, securely, and quickly. [Technology] is an extension of servant leadership to the patients we serve, in my mind.”
At a time when providers and health information management (HIM) professionals are busy preparing to comply with the new information blocking regulations starting this spring, it’s easy to lose sight of the people behind the data points we are all preparing to welcome into our “data gardens.” Remembering the humans behind the data we store, protect, and carefully reveal is what drives Moen—and it’s that outcome that Moen has worked toward her entire career.
Be Excellent to Each Other
Until very recently, Moen’s career mantra was “in people’s darkest moments, try to be the brightest part of their day,” which she helped instill in her daughter, an emergency room nurse. But a viewing of Bill and Ted’s Excellent Adventure bestowed a new phrase she’s bringing into every conversation: Moen sees Bill S. Preston, Esq.’s commandment to “be excellent to each other,” as directive to communicate clearly and compassionately.
“We need to be excellent to each other. By the same token, it is shortsighted to think that as humans without the tools that are within reach, we’re going be able to do everything that we need to do to provide high-quality care based on extensive amounts of information about the person we are treating. So, when I look at HIT, I look at accessible mechanisms to dissolve miscommunication and under-communication,” Moen says.
Her approach to leveraging digital tools was evident in one of her first jobs at a Manor Care in Maryland, which she took as a newlywed in search of a job after moving to a new city from Minnesota. A college student at the time, Moen says she was struck for the first time by the reality that healthcare for seniors and LTC residents didn’t get nearly as much attention—and funding—as acute care treatment for children and adults with diseases did. Working in the reimbursement department, where cost reports were produced on green columnar notebooks using mechanical pencils, she realized the technology wasn’t a part of mainstream working American at this point. Frustrated by the labor-intensive paperwork, she picked up Lotus 1-2-3 and began automating much of her work.
“We would assess where they were on a quarterly basis in order to advise them that their costs were running high or that adjustments needed to be made to reimbursable cost centers. I began to experiment with keying in an entire chart of accounts to my computerized quarterly cost report analysis, and my Lotus 1-2-3 would calculate the interim cost report results. All of a sudden, I started moving faster than everybody else, and I began to experience firsthand the power of technology and how you could harness it to serve healthcare,” Moen says.
That experience helped Moen identify a “hunger” to help people realize the potential that computer systems had to move patient information from point A to point B quickly and efficiently. This led her to start a LTC EMR company with two others, Marktech Systems, followed seven years later by a consulting firm, HealthWare Consulting Services. Her consulting company allowed her team to “liaise between the providers who knew they needed technology but weren’t quite sure how to harness it effectively, and the EMR vendors who created efficient technology but couldn’t communicate with the providers exactly how to use it properly,” Moen says.
Moen’s worldview—that every action should be infused with kindness and empathy—was integral to her work implementing EMRs in LTC settings. During every implementation she worked on, she went on-site to ensure every department received some training or an understanding of how the EMR affected operations in the building, from environmental services and dietary workers to direct caregivers.
“Even if the front desk wasn’t using the core EMR because they were greeting guests or directing visitors to their location, I gave them enough familiarization of the work at hand that they understood what was happening on the floor, to involve them as part of making sure they knew they were important, that their contributions mattered. We found time after time that if there was something the front desk could do in the greeting process that would make a difference to the residents and the facility at large as part of the technology implementation, they were glad to do it. The more people we engaged in being part of a positive change for the residents, the more likely they were to contribute to making the overall effort successful. So, it was just how I saw the problem and the solution,” Moen says.
To get a sense of each building’s processes and culture, she would accompany nurses and CNAs on rounds and medication passes to watch how they operated before the software implementation began, and then she would create a workflow diagram to help visibly teach the staff how they would perform that task once the new software was implemented.
“When they looked at it the workflow diagram, they could see what they needed to do and had confidence. They knew they weren’t being replaced by a computer, and they knew that they were still doing the same job but in a slightly different, more efficient way, so their resistance melted, and they were excited to begin to do their tasks better with an easy, ‘Oh, okay. Well, this is how I do this now,’” Moen says.
Moen’s approach to implementation—involving everyone in the training and process of change—is also key to improving interoperability and overcoming information blocking in health IT in general.
“You know, if the nurse on the floor understands what the system can do and what the impact of an action in the software is, they are going be more amenable to supporting the processes that are brought to them. If they don’t understand why they need to pay special attention to a small action or function, then it gets lost in the dozens of other things they do each shift that they do understand the impact of. I believe that a lot of information blocking happens because … nobody has helped the people who send and receive information connect the dots. They’re not doing it willfully. It’s just a lack of understanding, because we haven’t involved them in the process overall—that point A and point B are cause and effect, if you will,” Moen says.
Connecting the Dots
Moen moved out of the consulting world during the 2008 global recession and repositioned herself in the market, taking a position as director of healthcare IT for the LTC operator Brookdale Senior Living while she finished her degree in organization leadership with a minor in technology. Moen had started her degree while working at Manor Care many years earlier but stepped away from school to have children and build Marktech.
It was at this later point in life that Moen found herself inadvertently becoming literally a posterchild for lifelong learning. The university where she finished her degree used her photo on billboards all over Nashville as part of an advertising campaign to recruit nontraditional adult students.
“It’s got me [the photo] standing there, and I’ve got my arms crossed because they told me what to think about in order for my face to say to the viewer. I have a look on my face, like, ‘Bring it. Just bring it.’ You know? It was amazing,” Moen says.
She graduated from her program magna cum laude and earned the respect of her professors who have begged her to come back and get a master’s degree and teach other students because they knew from talks with her that she saw technology with such depth and heart—something she thinks she might have considered had COVID-19 not happened.
“The thought of teaching young minds, to awaken students to the beauty and the power and the promise of data, I’m just drawn to that … I would absolutely get up there and tell them, ‘You’re not back-office people. You’re changing healthcare!’” Moen says.
For the last three years, Moen has been working as director of platform innovation for ADVault, a technology suite that allows individuals to upload or create, store, and share their advance directives, advance care plans, and portable medical orders. Advance directive information is one of the last vestiges of the paper world in healthcare, and as she knows from her years in LTC, they are crucial documents that frequently become lost when a patient transitions from their homes to LTC facilities, acute care settings, and hospices. They’ve also proven to be a challenge to handle for senior and end-of-life patients, but it took a pandemic to bring the realization to younger people that sudden illness or a health emergency can happen to anyone, meaning everyone needs to think about their end-of-life wishes and get them documented where they can be found when needed
In October, Moen got involved with an HL7 committee focused on improving the interoperability of advance directives in post-acute care. She was asked to lead the initiative—which is known as Advance Directive Information Interoperability (ADI) on FHIR—to examine existing standards and create brand-new FHIR standards to liberate advance directive information. While many people in her field might shy away from the technical terminology in standards development work and dealing with such a personal, emotionally charged topic, it’s ideal for Moen and her passion to put humans at the center of the conversation.
“[Advanced care planning] is a perfect subject for me to devote myself to because I can’t think of another way to extend kindness than to help someone to be present at their darkest moment, even if they’re not able to speak, to just give them a voice. I’ve certainly had a lot of people be unkind to me during the course of my career, and it left its mark on me. I don’t want to do that to others. I want leave a different mark.”
Mary Butler (firstname.lastname@example.org) is the senior editor of the Journal of AHIMA.