Majd Alwan, Senior Vice President of Technology at LeadingAge and CAST Executive Director, shared the LeadingAge/CAST perspective in two articles in the June 2017 issue of McKnight's Technology: Changing the future.
"Barriers to entry: Costs and other factors are holding back EHR implementation in this sector" addressed a recent Government Accountability Office report criticizing the U.S. Department of Health and Human Services for not measuring its interoperability efforts well or promoting them to long-term care and post-acute (LTPAC) providers.
The report found that cost was the main barrier to LTPAC health information exchange and that meaningful use incentives have not been available for LTPAC providers.
“If we really want to meet the three goals of improving care quality and improving person-centeredness while reducing costs, we really need to seriously consider long-term and post-acute providers who are touching and taking care of the sickest and most vulnerable populations,” Alwan said.
The article also addressed unique staffing challenges in LTPAC and suggested the electronic health record (EHR) selection tools that LeadingAge/CAST provides, plus its seven-stage adoption model, help solve providers’ difficulty in finding the best technology.
The tools “can help operators see which providers on the market have what they need and are certified,” Alwan was quoted as saying. “Fifty percent of the EHRs out there are offering things such as interoperability with pharmacies, e-signature portals and analytics. But we don’t even know if these are being put to full use.” However, new data from a follow-up LeadingAge Ziegler 150 (LZ 150) survey shows that EHRs being deployed now by the largest 150 LeadingAge members have more advanced functionalities, like clinical decision support systems, analytics and health information exchange, than EHRs being deployed in the long-term and post-acute care sector in general, according to a joint CAST-Ziegler press release
Alwan said that unlike larger providers who responded to competitive forces, smaller stand-alone providers, especially rural ones, are less likely to have invested in technology, like EHRs, because of the cost involved.
“Personally, I worry about those types of organizations,” he said. “In some cases, they are the only healthcare providers in certain areas. We need to ensure those types of organizations have not only the ­financial resources but also the technical assistance and support.”
The second article, “Investing in tech: Operators are spending more on infrastructure that improves information and communication,” discussed results of the Ziegler CFO Hotline survey of senior living organizations, conducted with input from LeadingAge/CAST.
The fact that providers are moving their IT spending away from capital and towards the operational side is important, Alwan was quoted as saying. “We see many providers downsizing their data centers and outsourcing the handling of applications to third-party operators who are capable of taking these things off their plate.” 

He said many vendors are offering only remote connections to health care clients, which has lowered costs and offered more robust backup and security. EHR and electronic medical record (EMR) systems were the top investment for 2016 and 2017, and providers are trying to capture more data, Alwan said. “There’s a continuing demand for improvements in quality,” Alwan told McKnight’s. “Hospitals are deciding where to send post-acute enrollees post-discharge based on data … It’s also affecting reimbursements, so there’s a double whammy.”
Alwan told McKnight’s that shared care planning and care coordination will become more popular as reimbursement initiatives and the focus on person-centered care increase and providers move away from siloed thinking. Yet to ensure success, he said, leadership is needed. “There are so many moving parts. It needs to be coordinated and someone needs to be at the helm.”

Those interested in adopting the right technology solutions, including EHRs and Shared Care Planning and Coordination technologies, should check CAST’s Technology Selection Tools.