A new report provides policy recommendations that could help the long-term and post-acute care (LTPAC) sector better exchange patient health information and promote interoperability of health IT. Ultimately, these steps would improve health care for older adults.

“Health Information Technology Adoption and Utilization in Long-Term and Post-Acute Care Settings” assesses the LTPAC sector’s current state. It looks at adoption of health IT, electronic health records (EHR), and health information exchange (HIE). After outlining factors that support and challenge the sector’s use of health IT and interoperability, the report presents policy recommendations.

RTI International prepared the report for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health & Human Services.

The research included an environmental scan, a literature review from 2011 to 2021, and subject matter expert (SME) interviews. These findings informed the policy recommendations.

Importance of Interoperability

The COVID-19 pandemic emphasized the gaps between LTPAC and other health care settings; as of June 30, 2021, nearly one-third of state-level COVID-19 deaths were in long-term care facilities, said the report. Interoperability can help LTPAC providers “better monitor signs and symptoms and coordinate responses with local and state public health departments.”

Study Finding: Lack of Interoperability

The top study finding outlines a lack of interoperability:

• LTPAC providers are adopting EHRs to support their clinical and business needs (80% for nursing homes and home health), but interoperable exchange of health information is not routine or widely used.

Last fall, the 20th Annual LeadingAge Ziegler (LZ 200) report found that the percentage of providers participating in HIEs continues an upward trend. Each year, LeadingAge partners on this report with Ziegler, a LeadingAge Gold Partner with CAST Focus and the nation’s leading underwriter of financings for not-for-profit senior living providers. The LZ 200 ranks the 200 largest not-for-profit senior living organizations in the country and outlines relevant business trends. In 2023, only 28% of respondents said they are not in HIEs. In 2021, the number was 31%; in 2020, 42% were not in HIEs.

Yet the latest LZ 200 did find increased use of Electronic Medical/Health Records (EMR/EHR) and Electronic Point of Care/Point of Service Documentation Systems. Use of both rose from 66% of providers in 2021 to 72% in 2022. See more on 2023 LZ 200 trends.

“Even though EHR systems are still very prevalent, most are still not using fully interoperable systems,” said Scott Code, senior vice president at LeadingAge CAST. “We see this situation each year when we publish results of CAST’s annual 7-Stage EHR Adoption Model survey.”

Study Finding: Resources Limit Interoperability

The research also found that many LTPAC providers face financial and workforce constraints that impede interoperability.

• Data is needed from LTPAC organizations by others, but LTPAC providers lack monetary incentives, policy requirements, or a strong business case to increase interoperability.
• LTPAC use of interoperability features available in their EHRs lags without a driver or policy lever.
• Many LTPAC providers struggle to prioritize EHR optimization, and few have available resources for training and workflow changes.

Study Finding: LTPAC Investments Support Other Technologies

Another key finding is that LTPAC providers are investing in other areas:

• Innovators in LTPAC HIT are focusing on telehealth, remote patient monitoring, medication management, functional assessment and activity monitoring, shared care planning, social connectedness and engagement, safety, and data analytics.

Data from the LZ 200 supports these findings. To assist LTPAC providers who are investing in these technologies, CAST provides a suite of 10 CAST Technology Selection Tools. The tools are intended to help providers choose the solution that best fits their organization’s needs. The tools include white papers with detailed background on each technology, online selection tools and matrices, and provider case studies.

Related Study Finds 10% of Medicare Home Health Providers Do Not Use EHRs

In related findings, this month McKnight’s Senior Living published “About 10 percent of Medicare home health providers do not use EHRs, study finds.” The research sampled more than 1,500 Medicare home health providers, finding that the providers that did not use EHRs were more likely to be smaller for-profit entities that received lower Star Ratings and lower scores on Home Health Consumer Assessment of Healthcare Providers and Systems. The research also found that the providers that use EHR systems brought patients better health outcomes at lower costs, the article said.

Barriers

Since 2011, Centers for Medicare & Medicaid Services (CMS) programs have created incentives for meaningful use and interoperability of certified electronic health record (EHR) technology, primarily among hospitals and physicians. As many LTPAC providers are aware, the sector has not been included in the CMS incentives to promote interoperability.

The report notes that today, “market forces are not driving interconnectivity between hospitals and physician offices or with public health entities and LTPAC.”

LTPAC providers and their care partners were found to exchange information regularly for care transitions, care coordination, and administrative reasons. Yet this data exchange usually happens through work-around solutions rather than through interoperable exchange, according to the report.

“We found little evidence of programs that effectively promote the widespread use of HIE by LTPAC in the same way that the Meaningful Use/Promoting Interoperability Program were effective for hospitals and physician-office settings,” wrote the report authors. “Lack of alignment with these programs or equivalent policy levers could further widen the gap between LTPAC and their care partners.”

Policy recommendations could help to drive investment in interoperability, for the sake of patient care.

Policy Recommendations

The following policy considerations and approaches were identified to advance interoperable EHR adoption and use in LTPAC:

• Understand and address the barriers that limit policy makers from including LTPAC in HIT and interoperability programs, including statutory limitations to include LTPAC in HIT policies and regulations.
• Spur adoption of interoperable HIT in LTPAC settings by considering policy options to increase adoption. Understand the effectiveness of past policies, funding, and interventions and look at future program changes to support LTPAC interoperability such as with digital quality measures (dQMs) and reporting, public health reporting modernization, and targeted payer process such as pre-claim review and prior authorization programs.
• Improve HIE across platforms, networks, and geographies by understanding the value proposition for LTPAC to participate in HIEs/health information networks (HINs), improving the ease of data sharing, and clarifying HIE/HIN vendor and provider relationships.
• Investigate telehealth policy, planning, use, and research in LTPAC, including barriers, facilitators, policies, reimbursement, and technology readiness for greater telehealth adoption in LTPAC settings.

LeadingAge Policy Team Addresses Similar Issues

Advancing interoperability, EHR, and telehealth use are also key tenets of the LeadingAge 2023 Policy Platform. LeadingAge is working to promote the adoption of interoperable electronic health records, including funding and technical support.

The LeadingAge policy team is also working to secure government funding for the Office of National Coordinator (ONC) at the U.S. Department of Health and Human Services (HHS). This funding would establish electronic health record (EHR) Interoperability Certification Criteria/Program relevant to LTPAC but aligned, where possible, with the acute care certification program.

Related to meaningful use, LeadingAge will continue to advocate for funding and payment incentives. This effort would include incentives tied to quality, to assist aging services providers in accessing EHR technology that is interoperable with that of their physician and hospital partners and peers. The effort would also encourage the bi-directional exchange of information.

The LeadingAge 2023 Policy Platform includes multiple measures to increase the use of telehealth, including advocating for permanent changes to Medicare, Medicaid, and commercial payer telehealth policy based on lessons learned from the coronavirus pandemic.

For more details on health IT adoption and interoperability, download the full report.