Long-Term Care Providers Release Health IT Roadmap

Clinicians in nursing homes and other LTC facilities have made significant progress, but want to work more with hospitals, physicians, and other providers to improve transitions of care.
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The long-term post-acute-care (LTPAC) community has made considerable progress in developing its health IT capabilities but must do much more, according to a roadmap released by the LTPAC Health Information Technology Collaborative at the organization's recent summit in Baltimore.

The 15-member Collaborative, which includes associations of nursing homes, assisted living facilities, and home care agencies, cited these achievements:

-- Publication of certification criteria for LTPAC electronic health records by the private-sector Certification Commission for Health IT (CCHIT) and achievement of CCHIT certification by leading EHR vendors;

-- Having the Office of the National Coordinator of Health IT (ONC) award grants to statewide health information exchanges (HIEs) in Colorado, Maryland, Massachusetts, and Oklahoma to promote the participation of LTPAC in HIEs;

-- Continuing adoption of EMR/EHR systems by LTPAC providers;

-- LTPAC exploration of health and wellness monitoring technologies; and

-- Broader recognition of LTPAC concerns and activities by ONC and other parties involved in standards and quality initiatives.

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In the short term, the report said, LTPAC providers must support the efforts of hospitals and physicians to achieve Meaningful Use, even though the legislation that established that government incentive program does not provide any funds to LTPAC providers. In addition, the Collaborative said, "LTPAC providers must become more engaged in substantial partnerships as part of accountable care and accountable payment initiatives."

At the Baltimore conference, as InformationWeek Healthcare previously reported, ONC official Judy Murphy called on the LTPAC sector to exchange data electronically with other providers and to report on clinical quality measures in order to prepare for pay for performance and value-based reimbursement programs. "It is essential for LTPAC providers to invest in technology to support these goals," she said.

John Derr, an LTPAC health IT expert who is a former CIO of Golden Living, a leading operator of long-term care and rehab facilities, agreed with Murphy's statement, but added that the same is true for hospitals. For example, he told Information Week Healthcare, "Everybody has to get better at cost accounting before we undertake financial risk."

Murphy disputes a widespread impression that LTPAC providers are far behind the curve in computerization. "Every nursing home and home care agency is computerized," he said, because they must be in order to get paid by Medicare and Medicaid, the primary revenue sources for these providers. The leading EHR systems for LTPAC, he added, are quite sophisticated and can do much more than simply meet government requirements for care assessments.

Only two LTPAC IT vendors, he said, have obtained CCHIT certification so far. The others, he explained, are waiting for the government to issue its final rules on Meaningful Use stage 2 and EHR certification. In addition, he noted, they're coping with Medicare's first major upgrade in its minimum data set (MDS) for nursing homes in 15 years.

To help hospitals meet Meaningful Use criteria for transitions of care, it would be helpful for both hospitals and LTPAC providers to belong to HIEs that could facilitate the exchange of clinical summaries. But so far, outside of the four states where the pilots are going on, relatively few LTPAC facilities and agencies have joined HIEs, Derr noted. Exceptions include some Golden Living nursing homes in Indiana and Pennsylvania, which are participating in the Indiana HIE and Keystone HIE, respectively.

Derr cited several ways in which LTPAC providers are starting to get more input into government decisions about health IT. For example, ONC has engaged them in a Standards and Interoperability Framework wiki, and LTPAC companies are also working with the Health IT Standards Committee. Derr says his community will also be involved in creating the Meaningful Use stage 3 proposals.

Derr freely admitted that LTPAC providers still have problems finding funds for EHR and HIE initiatives in the absence of government incentives. But that won't stop them from fully participating in ONC's transition of care efforts, he said.

"The greatest thing that's happened in stage 2 is that people are realizing that we're part of the healthcare system," he noted. "So we're working hard, and hopefully, some hospitals will say, 'We'll help you with your interface, because we need it to do Meaningful Use.' But we're not waiting for that."

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