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11/10/2011
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EHRs Certified For Long-Term, Post-Acute Care

These EHRs can't be certified for Meaningful Use, but interoperability with hospital systems is viewed as a key advance.

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The Certification Commission for Health Information Technology (CCHIT) has certified the first batch of electronic health records (EHRs) for long-term and post-acute-care (LTPAC) in a new program designed for applications used in skilled-nursing facilities (SNFs), home health care, hospices, rehabilitation centers, and other LTPAC settings.

The initial certification criteria cover the core functionality of all EHRs used in LTPAC, as well as specific features applicable to SNFs and home care. As these certifications gain traction in the marketplace, CCHIT will consider adding specialized criteria for other care settings, said Karen Bell, MD, chair of CCHIT, in an interview with InformationWeek Healthcare.

The commission awarded the first LTPAC certifications to EHRs from:

-- AOD Software, Fort Lauderdale, Fla., which makes applications for nursing homes, assisted living facilities, and continuing care retirement communities.

-- HealthMEDX, Ozark, Mo., a vendor of software for long-term care, home care, and rehab facilities.

[Which healthcare organizations came out ahead in the IW500 competition? See 10 Healthcare IT Innovators: InformationWeek 500.]

CCHIT, a nonprofit organization, is one of six private-sector entities that certify EHRs for the government's Meaningful Use incentive program. But the government does not currently recognize certifications of LTPAC EHRs because LTPAC providers and facilities are not eligible to receive federal payments under the American Recovery and Reinvestment Act's HITECH provisions.

Nevertheless, Bell said, CCHIT is hopeful that the Office of the National Coordinator of Health IT (ONC) may recognize some of its LTPAC certifications so that SNFs located on hospital campuses and the physicians who work in them can count the use of CCHIT-certified EHRs toward the achievement of Meaningful Use. There is a precedent for such an expansion of the regulations: The Centers for Medicare and Medicaid Services (CMS) decided to allow hospitals to include emergency departments' use of computerized physician order entry (CPOE) in calculating their overall use of CPOE.

The lack of government incentives for Meaningful Use has discouraged many LTPAC facilities and agencies from acquiring EHRs, Bell noted. Partly as a result, the adoption rate in these settings continues to be quite low. But recently, because of impending changes in reimbursement that promote better coordination between inpatient and post-acute care, she said, the interest in LTPAC EHRs has picked up.

To support that coordination, LTPAC and inpatient EHRs must be able to communicate with each other. So far, little of that integration has occurred, partly because the leading LTPAC EHRs are not made by the same vendors that provide information systems to acute-care hospitals.

In fact, a recent survey by research firm KLAS showed that only 15% of home care agencies with EHRs could exchange any data with inpatient systems--despite the fact that 60% of the agencies in the sample were owned by hospitals.

Recognizing this problem, CCHIT decided to include interoperability in its LTPAC certification criteria. To be certified, an EHR vendor must show that it can generate and exchange Continuity of Care Documents (CCD) that contain clinical summaries and care plans.

Bell said some members of the commission were concerned about requiring this, because "a lot of these vendors had not baked in the ability to transmit CCDs. But we decided to keep the bar high on this, even though some vendors weren't ready. By putting it in our process, we sent a strong signal that this type of interoperability was going to be critical going forward."

The LTPAC industry seems to be on board with the final results. In a CCHIT press release, Cynthia Morton, executive vice president of the National Association for The Support of Long-Term Care, said, "This CCHIT certification offers LTPAC providers greater assurance that their EHR systems will support their individual patient care and business needs. Our association supports CCHIT’s efforts to raise the bar for EHRs used in these care settings."

John Derr, leader of strategic clinical technology, Golden Living, LLC, and a member of CCHIT's board, said in the announcement, "It's an advantage to LTPAC providers who want to form partnerships with hospitals to adopt CCHIT-certified LTPAC EHRs. CCHIT’s certification of an EHR’s integrated interoperability and security features will prove invaluable as providers seek to participate in community healthcare organizations designed to foster coordination across the spectrum of care. CCHIT certification is a win-win for all."

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