October 01, 2010

By Majd Alwan, PhD

Early in 2009, President Obama signed the economic stimulus package called the American Recovery and Reinvestment Act. Within that law was the HITECH (Health Information Technology for Economic and Clinical Health) act, which codified the government's push for a national health information technology infrastructure and the effective exchange of electronic health records between providers.

HITECH offers financial incentives for the adoption and meaningful use of electronic health records (EHRs) by Medicare and Medicaid providers. While nursing facilities, home health agencies, and other long-term and acute-care facilities were included in HITECH's definition of health care providers, they weren't made eligible for the incentives.

Medical directors, attending physicians, and other providers serving the LTC needs of Medicare and Medicaid patients are themselves eligible, however. Also, a section in HITECH mandated a study to determine if LTC facilities, long-term care hospitals, and rehabilitation hospitals need incentives to implement EHR technology prior to the target date of 2014.

Incentives aside, LTC providers care for a medically complex population that would be well served by EHRs that seamlessly carry health information between the many entities that care for these people in multiple settings. These patients have complex care needs stemming from functional and cognitive decline and multiple chronic conditions, they see multiple providers, and many repeatedly transition between long-term and acute care facilities, home, and other community settings.

Arguably, this population would benefit more than any other from EHRs that are interoperable across these venues. Consider the potential to avoid adverse interactions of drugs prescribed by separate physicians, each seeing the patient for a separate chronic condition but typically without access to the full list of the person's medications.

Over 40% of hospital transfers are to LTC settings, including homes in which health services are delivered. Yet hospitals often fail to exchange timely and necessary health information about these patients, and the result is an unacceptably high rate of unnecessary hospital readmissions that increase Medicare and Medicaid costs.

LTC providers are ready to embrace EHRs, as they have already embraced federally mandated electronic reporting of functional assessment information, such as Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) data. National surveys show that 20% of nursing homes had basic EHR system as early as 2004 and that 43% of home health and hospice agencies were using EHR systems in 2007.

These adoption rates favorably compare with those of acute care settings (hospital and physician practices). In the 2007 survey, about 20% of the home health and hospice-care providers had EHRs with information-sharing capability, and about half of those had actually used that capability. That was remarkable, given that standards-based interoperability of EHRs was in its infancy at the time of this survey.

Today, several recognized interoperability standards are relevant to LTC. These include:

▸ The HL7 Continuity of Care Document, which allows the exchange of patient summaries at the time of transfer between care settings.

▸ NCPDP Script 10.6, which allows physician medication order entry, e-prescribing, and the exchange of pharmacy data.

▸ The Patient Health Monitoring Report, which standardizes the exchange and integration into EHRs of home-health data such as blood pressure and glucose levels.

▸ The Patient Assessment Questionnaire Framework, which allows the capture and exchange of data for such functional assessment questionnaires as MDS and OASIS.

Moreover, the Certification Commission for Health Information Technology (CCHIT), which recently has been recognized as an authorized testing and certifying body for HIT products, developed certification criteria and testing scripts for EHRs used in skilled nursing facilities as well as home health. CCHIT published the criteria and results of several tests on its Web site and is currently accepting certification applications from EHR vendors (www.cchit.org/certify/2011/cchit-certified-2011-long-term-post-acute-care-ltpac-ehr

Much has been accomplished on the HIT front by the LTC community over the past few years, but much more remains to be done. Medical directors have the ability to influence the settings where they practice. They can pave the way for continuing improvements in quality of life and quality of care by encouraging the adoption of HIT in those settings. Some suggestions:

▸ Start by implementing a certified, interoperable EHR system in your practice, and advise the same to the LTC providers and facilities with which you work (see the toolkits developed by Stratis Health for Aging Services of Minnesota, at www.aahsa.org/section_cast.aspx?fid=1929&id=10375

▸ If you have an EHR system in place, discuss with your vendor its plans to have the product certified and to perform upgrades. Advise other providers that serve your patients to have similar discussions with their vendors.

▸ Start a dialogue about electronically exchanging your patients' health information with other physician practices, hospitals, and facilities. This will help all of you become “meaningful users” of HIT, which is a condition for receiving the financial incentives under HITECH.

▸ Partner with other providers to seek representation on health information exchange organizations, so they serve your needs and those of the elderly population you serve.

For more information, check the 2010-2012 “Roadmap for Health IT in Long Term and Post Acute Care,” developed and recently released by the LTPAC HIT Collaborative, a coalition of organizations that promotes HIT adoption among long-term and postacute-care providers (www.aahsa.org/article_cast.aspx?id=10379

DR. ALWAN is vice president of the Center for Aging Services Technologies within the American Association of Homes and Services for the Aging. A researcher on aging-services technologies, he is responsible for creating and leading a network of technology companies, providers, and research institutions focused on technological solutions for an aging society.

<- Back to: Community LTC