Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.4.3. Facilitators and Barriers to Adoption and Use of HIE to Support Care Coordination

10/29/2013

Costs and Workforce Preparation

Key barriers to LTPAC provider participation in HIE activities include lack of funding and/or payment incentives (e.g., no HITECH EHR incentive funding for LTPAC providers), and the workforce that is not well-prepared to implement and use HIT systems (e.g., issues include staff shortages, turnover, and lack of IT skills, and training needs).14103104105106

LTPAC providers continue to have lower rates of EHR adoption than other settings such as physician practices and hospitals. LTPAC providers vary widely from small, non-affiliated providers to large networks of facilities. Acquiring and implementing EHRs by smaller providers can be disproportionately expensive. In addition, smaller facilities often lack staff resources to develop, implement, and maintain these systems. Even in larger LTPAC facilities, it can be difficult to attract and retain skilled IT workers to support the necessary systems. High staff turnover rates in LTPAC settings contribute to high staff training costs. Given privacy and security issues when exchanging health information across entities, clinical care providers and IT staff must be well trained to protect personal health information. LTPAC/LTSS providers must train their staff to use EHRs, which can be costly and time intensive.

Data Availability and Standardization

The data exchanged by the HIE initiatives surveyed by the 2012 eHealth Initiative study included inpatient data (discharge list, problem list, inpatient medication list and physician notes); outpatient/ambulatory data (clinical summaries, problem list, ambulatory medication list, physician notes and referrals summary of care record); and public health reports. Clinical summaries, discharge list, outpatient problem list, and ambulatory medication list were the top five types of inpatient and outpatient data reported to be exchanged according to the eHealth Initiative study.6

The Massachusetts IMPACT project identified 483 unique data elements as important for transitions in care. The S&I LCC LTPAC Transition Workgroup worked in collaboration with HL7, to include this data in refinements to the CCDA Implementation Guide. These data elements are available from the S&I LCC Framework.107

A technical expert panel convened by the National Quality Forum (NQF) developed a starter set of data elements based on the concept of a person-centered POC, to support coordinated care and performance measurement of the care process. NQF found that although some clinical data could be derived from EHRs, other starter data elements such as care plan steward, medical equipment, social supports, and task completions would have to come from other information systems such as case management, pharmacy, home care and financial systems.108

The need for health information to support care coordination was an important finding from the study site visits, and is discussed more completely in Section 4. One of the sites that was visited in this study had a care transition program that involved LTSS. This site collected and exchanged a wealth of EHR and other information, mostly as unstructured notes, about the patient and family situation and needs (e.g., medical, psychosocial, and financial data). The site visit discussion provides more detailed information on the types of information exchange to support persons receiving LTSS. In addition, much of the data identified as critical for care transitions and care coordination is presently not electronically exchanged. For example, it was observed during the site visits that most HIT/EHR systems lack the capacity to create, transmit, and incorporate interoperable clinical data such as functional and cognitive status and formal and informal caregiver status. In addition, current, complete medication information was often not available to reconcile medications.

Software and Vendor Issues

Some of the HIE interventions noted that using new software and interfaces with EHRs could be problematic, particularly if these products are first to market, as they may not have been completely tested. Software developers reported needing more time to create "out-of-the-box" capabilities such as discharge summaries or workaround solutions. There was also uncertainty surrounding core EMR vendor HIE interfaces and solutions. For example, vendors may not be willing to develop a customized interface, or they are willing but the cost of such interfaces may be high. There may be no vendor who will develop an interface, for example, in the case of a "home grown" technology solution, or in situations where there is no ongoing maintenance contract.

Even with available standards, interfaces are not easy to implement and smooth implementation of HIE is not guaranteed. There may be significant variability in the interpretation of the standards, for example. Standards such as a CCD do not always have the structure and content to reflect the data needed to support transitions and referrals in care to and from LTPAC/LTSS providers.

Stakeholder and Policymaker Engagement

Stakeholder engagement remains a significant barrier to successful data exchange. The eHealth Initiative survey of organizations that are planning, building, or maintaining technology to help health care entities electronically exchange health data (e.g., HIEOs, state entities, medical groups, hospitals, other types of organizations exchanging data) found that a high percent of those surveyed reported a general lack of stakeholder interest in HIE, and difficulty in engaging stakeholders such as health providers, plans, purchasers, laboratories, and hospitals.6

Another significant challenge reported by HIE initiatives is the multiple and competing programs for advancing HIE. States are coordinating numerous initiatives related to health care system transformation and and controlling rising health care costs. As a result, states have largely focused their HIE efforts on providers eligible for the EHR Incentive Programs, leaving fewer resources for ineligible providers, including LTPAC/LTSS providers and facilities.

Accountability and Incentives for HIE Related to Payment Models

Disincentives to care coordination include payment methods and sources across the care continuum which may not encourage information exchange.109 FFS payment methods, still widely used, create little incentive to coordinate and deliver high-quality care. The new payment and service delivery models (e.g., those listed in Section 3.2 such as ACOs, Medicare and Medicaid Shared Savings Programs, and capitated care models) provide incentives to improve care coordination using HIE.

Privacy, Policy, and Security Issues and Compliance

Many information privacy laws were written before the current digital world was conceptualized. The Health Insurance Portability and Accountability Act provides guidance for the exchange of health information. Many states enacted laws more stringent than HIE guidelines. Some states are adapting current laws to update them for the modern context. State laws vary widely, presenting challenges for developing unified policy solutions or solutions that work across states. This variation creates barriers to technology vendors.

Public trust in HIE is critical to ensuring participation, funding, and policymaker support. Policies that permit (or require) consumers to opt-in vs. opt-out of HIE activities is one of the first of many policy decisions the HIEOs need to make. One of the barriers identified in this study was stringent privacy laws and opt-in requirements that impact patient participation. Consumer and provider participation in HIE is higher in states and other areas that have opt-out policies (e.g., Maine) as compared to opt-in policies. Opt-in policies lower the likelihood that patients will be located when their records are queried through an HIEO. Some states such as Maryland, New York, Rhode Island, and Massachusetts have more stringent privacy laws and opt-in policies.

Maryland's HIE policy, for example, currently restricts the disclosure of protected health information through an HIEO for primary use (treatment). This means that LTPAC providers are not able to gather information from the HIEO about potential patients/residents who may be referred to a LTPAC provider upon hospital discharge, without an existing treatment relationship. The state HIE policy does not allow for HIE in this situation.

Maimonides Hospital and the Brooklyn Health Information Exchange (BHIX) experienced patient consent challenges during implementation. Because of state health privacy policies, if a patient has been admitted to Maimonides Hospital and the hospital has not secured consent from that patient, a policy filter built into the BHIX infrastructure will block an alert from going to the patient's physician(s) and the assigned care coordinator. BHIX estimated that alerts could be sent for an estimated 10,000 additional patients if consent is obtained by the various participating sites.24

Almost half of the surveyed HIE initiatives in 2012 reported that stakeholder concerns about privacy and confidentiality were identified as a moderate or substantial challenge to HIE.6

LTPAC/LTSS Engagement and Interest in HIE

Even though the CMS EHR Incentive Program does not include incentive payments to LTPAC/LTSS providers, these providers report looking forward to participating in HIE with their trading partners -- specifically pharmacies, labs, hospitals and physicians. LTPAC/LTSS providers are looking for assistance in navigating the technology and privacy and security requirements that would allow interoperable HIE with these other health care providers.110

3.4.4. Facilitators -- HIE Tools and Resources

A number of public and private sector activities/tools have been developed that support electronic HIE by LTPAC/LTSS providers.

  • The QIO Program provides technical assistance in three states to Medicare SNFs and HHAs to support their participation in electronic HIE activities.111

  • MDS and OASIS assessments can be transformed into an interoperable LTPAC Summary (into CCD format). The tool developed by KeyHIE and described above enables low-cost, interoperable HIE by nursing facilities and HHAs (http://transform.keyhie.org/).112

  • The Direct Project (discussed in Section 3.3.1) supports low-cost, standards-based exchange for sending encrypted and authenticated health information over the Internet.

  • The Massachusetts statewide HIE incorporated the LAND and SEE developed under Massachusetts' Challenge grant to accelerate LTPAC connectivity. SEE will be available to other states either under open source or through a commercial license from Lantana Consulting Group. LAND is adapter software that organizations can use to convert files or interfaces into "Direct" communications which are compatible with the state's HIE, and vice versa.113 (See Appendix A and Section 3.3.1 for more information.)

  • As described in Section 3.3.1 the SBAR identifies a change in resident condition and communicates patient information in a concise and structured format. Kaiser Permanente and SNFs participating in the Oklahoma State HIE program have implemented an electronic version of SBAR.114

  • The Continuum of Care Improvement through Information New York (CCITI NY) (http://www.ccitiny.org) was established to improve the quality, patient safety, and costs of transferring patients between acute, post-acute, and ambulatory care organizations in the greater New York metropolitan region. The CCITI NY project combines an electronic transfer form process with an automated clinical decision support tool. CCITI NY developed a UTF that provides important patient information to clinicians during transfers, including medications, problems and allergies. Key information is provided to care providers in advance of patient arrival. The UTF also contains clinical decision support functionality by providing alerts for harmful drug-drug and drug-allergy interactions. CCITI NY collects patient information by using the infrastructure and clinical messaging capabilities of participating HIEOs and hospitals.


  1. Dougherty M, Harvell J. Opportunities for engaging long-term and post-acute care providers in health information exchange activities: Exchanging interoperable patient assessment information. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy; 2011. Available athttp://aspe.hhs.gov/daltcp/reports/2011/StratEng.htm.

  2. Affordable Care Act. National pilot program on payment bundling. Public Law 111-148 and Public Law 111-152. 2010: Section 3023.

  3. Engquist G, Johnson C, Johnson W. Medicaid funded long-term supports and services: Snapshots of innovation. Center for Health Care Strategies, Inc.; 2010.

  4. Woodcock C. Long-term services and supports: Challenges and opportunities for states in difficult budget times. National Governors Association; 2011.

  5. National Alliance for Health Information Technology. Report to the Office of National Coordinator for Health Information Technology on defining key health information technology terms. Washington, DC: U.S. Department of Health and Human Services, Office of the National Coordinator of Health IT; 2008.

  6. eHealth Initiative. 2012 report on health information exchange: Supporting healthcare reform. Washington, DC: eHealth Initiative; 2012.

  7. LTPAC Health IT Collaborative. A roadmap for health IT in long term and post-acute care, 2010-2012. Available athttp://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047579.pdf. Accessed July 25, 2013.

  8. McDonald K, Schultz E, Albin L, et al. Care coordination measures atlas version 3. Rockville, MD: Prepared by Stanford University under Subcontract to Battelle on Contract No. 290-04-0020 for the AHRQ; 2010. AHRQ Publication No. 11-0023-EF.

  9. Singer SJ, Burgers J, Friedberg M, et al. Defining and measuring integrated patient care: Promoting the next frontier in health care delivery. Medical Care Research and Review; 2011; 68(1):112-127.

  10. Office of the National Coordinator for Health Information Technology policy framework RFTOP. Solicitation No 12-233-SOL-00615; 2012.

  11. Informed Medical Decisions Foundation. What is shared decision making? Available at http://informedmedicaldecisions.org/what-is-shared-decision-making/. Accessed January 12, 2013.

  12. Gruneir A, Bronskill S, Bell C, et al. Recent health care transitions and emergency department use by chronic long-term care residents: A population-based cohort study. J Am Med Dir Assoc; 2012; 13(3): 202-206.

  13. Mor V, Intrator O, Feng Z, et al. The revolving door of rehospitalization from skilled nursing facilities. Health Aff; 2010; 29(1): 57-64.

  14. Naylor MD, Kurtzman ET, Pauly MV. Transitions of elders between long-term care and hospitals. Pol. Polit. Nurs. Pract.; 2009; 10(3): 187-194.

  15. Boling  PA. Care transitions and home health care. Clin in Geriatr Med; 2009; 25(1): 135-148. 

  16. Bayley KB, Savitz LA, Rodriguez G, et al. Barriers associated with medication information handoffs. In: Henriksen K, Battles JB, Marks ES, et al., editors. Advances in Patient Safety: From Research to Implementation. Rockville, MD; 2005.

  17. Chhabra PT, Rattinger GB, Dutcher SK, et al. Medication reconciliation during the transition to and from long-term care settings: A systemic review. Res Soc Admin Pharm; 2012; 8(1): 60.

  18. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med; 2003; 138(3): 161-167.

  19. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med; 2009; 360(14): 1418-1428.

  20. Thorpe KE. The Medicare advantage experience: Lessons for reform to original Medicare. Atlanta, GA: Emory University Rollins School of Public Health; 2012.

  21. Clancy CM. Commentary: Reducing hospital readmissions: Aligning financial and quality incentives. Am J Med Qual; 2012; 27(5): 441-443.

  22. Barnsteiner JH. Medication reconciliation: Transfer of medication information across settings-keeping it free from error. J Infus Nurs; 2005; 28(2 Suppl): 31-36.

  23. Sentinel events statistics for 2011. Jt Comm Perspect; 2012; 32(5): 5.

  24. Office of the National Coordinator for Health Information Technology. Getting to impact: Harnessing health information technology to support improved care coordination. In State HIE Bright Spots Synthesis: Care Coordination Part 1. Washington, DC: ONC; 2012. Available at http://statehieresources.org/wp-content/uploads/2013/01/Bright-Spots-Synthesis_Care-Coordination-Part-1_Final_010913.pdf.

  25. Murray LM, Laditka SB. Care Transitions by older adults from nursing homes to hospitals: Implications for long-term care practice, geriatrics education, and research. J Am Med Dir Assoc; 2010; 11(4): 231-238.

  26. LaMantia MA, Scheunemann LP, Viera AJ, et al. Interventions to improve transitional care between nursing homes and hospitals: A systemic review. J Am Geriatr Soc; 2010; 58(4): 777-782.

  27. Rippen HE, Pan EC, Russell C, et al. Organizational framework for health information technology. Int J Med Inf; 2013; 82(4): e1-e13.

  28. Office of the National Coordinator for Health Information Technology. Update on the adoption of health information technology and related efforts to facilitate the electronic use and exchange of health information. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  29. Patterson ES, Roth EM, Woods DD, et al. Handoff strategies in settings with high consequences for failure: Lessons for health care operations. Int J for Qual Health Care; 2004; 16(2): 125-132.

  30. Gleason K, Brake H. Medications at transitions and clinical handoffs (MATCH) toolkit for medication reconciliation. Rockville, MD: AHRQ; 2012; 11(12)-0059.

  31. Siefferman JW, Lin E, Fine JS. Patient safety at handoff in rehabilitation medicine. Phys Med Rehabil Clin N Am; 2012; 23(2): 241-257.

  32. Lucian Leape Institute. Order from chaos: Accelerating care integration. Boston, MA; 2012.

  33. Kripalani S. Care transitions. In Perspectives on Safety. AHRQ Web M&M; 2013.

  34. Allen J, Ottmann G, Roberts G. Multi-professional communication for older people in transitional care: A review of the literature. Int J Older People Nur; 2012; 7(4).

  35. Burton R. Improving care transitions. Health Aff and Robert Wood Johnson Foundation; 2012; 10.1377/hpb2012.17.

  36. U.S. Department of Health and Human Services. Roadmap to better care transitions and fewer readmissions. Available at http://www.healthcare.gov/compare/partnership-for-patients/safety/transitions.html#BackgroundonCareTransitions. Accessed August 6, 2012.

  37. Terrell KM, Miller DK. Challenges in transitional care between nursing homes and emergency departments. J Am Med Dir Assoc; 2006; 7(8): 499-505.

  38. National Transitions of Care Coalition. Improving transitions of care: The vision of the national transitions of care coalition. Washington, DC; 2008.

  39. Brown RS, Peikes D, Peterson G, et al. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff; 2012; 31(6): 1156-1166.

  40. Bez A. Preventing unnecessary hospitalizations for nursing home residents. Podcast on Internet; 2012.

  41. Metzger J. Preventing hospital readmissions: The first test case for continuity of care. Falls Church, VA: Computer Sciences Solutions Global Institute for Emerging Healthcare Practices; 2012; WA12_0155 HCG.

  42. Rutherford P. Reducing readmissions -- First, for the patient. Cambridge, MA: Institute for Healthcare Improvement; 2012.

  43. Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med; 2013; 368(13): 1175-1177.

  44. Agency for Healthcare Research and Quality. Medication Reconciliation. Available at http://www.psnet.ahrq.gov/primer.aspx?primerID=1. Accessed January 27, 2012.

  45. Centers for Medicare and Medicaid Services. Eligible professional meaningful use menu set measures, measure 7 of 10: Medication reconciliation. Available at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/7_Medication_Reconciliation.pdf. Accessed August 28, 2013.

  46. Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc; 2012; 19(3): 328-333.

  47. Kind A, Jensen L, Barczi S, et al. Low-cost transitional care with nurse managers making mostly phone contact with patients cut rehospitalization at a VA hospital. Health Aff; 2012; 21(12): 2659-2668.

  48. Health Information Exchange Roadmap: The landscape and a path forward. ONC Grant #7U24AE000006-02. Washington, DC: National eHealth Collaborative; 2012.

  49. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: A systematic review. Ann Intern Med; 2011; 155(8): 520-528.

  50. Phillips CO, Wright SM, Kern DE, et al. Comprehensive discharge planning with post-discharge support for older patients with congestive heart failure. J Am Med Assoc; 2004; 291(11): 1358-1367.

  51. Ouslander JG, Lamb G, Tappen R, et al. Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. J Am Geriatr Soc; 2011; 59(4): 745-753.

  52. Coleman EA. The care transitions program. Available at http://www.caretransitions.org/. Accessed August 6, 2012.

  53. Boston University. Project RED. Available at http://www.bu.edu/fammed/projectred/presentations.html. Accessed August 6, 2012.

  54. Institute for Clinical Systems Improvement, Minnesota Hospital Association and Stratis Health. Reducing avoidable readmissions effectively (RARE). Available at http://www.rarereadmissions.org/resources/collaboratives.html. Accessed November 19, 2012.

  55. Boult C, Green AF, Boult LB, et al. Successful models of comprehensive care for older adults with chronic conditions: Evidence for the Institute of Medicine's "retooling for an aging America" report. J Am Geriatr Soc; 2009; 57(12): 2328-2337.

  56. Healthcentric Advisors. Safe Transitions Project. Available at http://www.healthcentricadvisors.org/safe-transitions-cp.html. Accessed August 6, 2012.

  57. Society of Hospital Medicine. Project BOOST: Better outcomes for older adults through safe transitions. Available athttp://www.hospitalmedicine.org/AM/Template.cfm?Section=Home&CONTENTID=27659&TEMPLATE=/CM/HTMLDisplay.cfm. Accessed August 6, 2012.

  58. Centers for Medicare and Medicaid Services. EHR Incentive Programs: Stage 2. Available at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html. Accessed June 14, 2013.

  59. Metzger J. Preparing for accountable care: Coordinated care. Falls Church, VA: Computer Sciences Solutions Global Institute for Emerging Healthcare Practices; 2012; WA12_0280 HCG.

  60. eCaring LLC. Preventable readmissions: A prime target for healthcare innovation. Available at http://blog.ecaring.com/preventable-readmissions-a-prime-target-for-healthcare-innovation/. Accessed July 18, 2013.

  61. McClellan M, McKethan AN, Lewis JL, et al. A national strategy to put accountable care into practice. Health Aff; 2010; 29(5): 982-990.

  62. Pioneer Accountable Care Organization Model: General fact sheet. CMS, Center for Medicare and Medicaid Innovation; 2012.

  63. American College of Physicians. What is the patient-centered medical home? Available athttp://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/understanding/what.htm. Accessed August 30, 2013.

  64. Centers for Medicare and Medicaid Services. State Demonstrations to Integrate Care for Dual Eligible Individuals. Available athttp://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/StateDemonstrationstoIntegrateCareforDualEligibleIndividuals.html. Accessed October 28, 2013.

  65. Centers for Medicare and Medicaid Services. Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. Available at http://www.innovations.cms.gov/initiatives/rahnfr/index.html. Accessed November 20, 2013.

  66. Centers for Medicare and Medicaid Services. New program to increase quality in nursing facilities. Available athttp://www.cms.gov/apps/media/press/release.asp?Counter=4454&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date. Accessed November 20, 2012.

  67. Centers for Medicare and Medicaid Services. Details for Regulation #CMS -1600-P. Available athttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1600-P.html. Accessed August 8, 2012.

  68. Colorado Foundation for Medical Care. Links/resources/tools for providers -- care transitions improvement efforts. Available athttp://www.cfmc.org/integratingcare/provider_resources.htm. Accessed July 14, 2013.

  69. Office of the National Coordinator for Health Information Technology. Meaningful use -- What is meaningful use? Available athttp://www.healthit.gov/policy-researchers-implementers/meaningful-use. Accessed July 14, 2013.

  70. Dougherty M, Williams M, Millenson M, et al. EHR payment incentives for providers ineligible for payment incentives and other funding study. Washington, DC: Prepared for Office of Disability, Aging and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services; 2013. Available athttp://aspe.hhs.gov/daltcp/reports/2013/EHRPI.shtml. Accessed July 14, 2013.

  71. LTPAC Collaborative, State HIE Toolkit Module: Vulnerable populations and HIE. 2010.

  72. Harvell J, Harr M, Hall EP, et al. Implementing health information exchange in the long-term and post-acute care community -- Perspectives for LTPAC providers and their affiliated organizations. Webinar, December 12, 2012.

  73. ECRI Institute and s2a. Crossing the connectivity chasm: Pinpointing gaps in readiness to exchange health information. Plymouth Meeting, PA; 2012.

  74. Office of the National Coordinator for Health Information Technology. Health IT Policy Committee. Available athttp://www.healthit.gov/policy-researchers-implementers/health-it-policy-committee. Accessed June 13, 2013.

  75. Office of the National Coordinator for Health Information Technology. Principles and strategy for accelerating health information exchange (HIE). Washington, DC: Office of the National Coordinator for Health Information Technology; 2013. Healthcare Information Technology Standards Panel. HITSP enabling healthcare interoperability. Available at http://www.hitsp.org/about_hitsp.aspx. Accessed August 6, 2013.

  76. Office of the National Coordinator for Health Information Technology. Federal health information technology strategic plan, 2011-2015. Washington, DC: Office of the National Coordinator for Health Information Technology; 2011.

  77. Office of the National Coordinator of Health Information Technology. Initial set of standards, implementation specifications, and certification criteria for electronic health record technology. 2010:45 CFR Part 170.

  78. LeadingAge Center for Aging Services Technology. EHR for LTPAC: A primer on planning and vendor section. Washington, DC: LeadingAge Center for Aging Services Technology; 2013.

  79. Certification Commission for Health Information Technology. CCHIT certified products. Available at https://www.cchit.org/find-cchit. Accessed June 14, 2013.

  80. HL7 International. HL7 EHR system long-term care functional profile, release 1 -- U.S. realm. Available athttp://www.hl7.org/implement/standards/product_brief.cfm?product_id=134. Accessed August 28, 2013.

  81. Alwan M. Personal communication about LeadingAge members and participation in health information exchange of electronic medical record data. LeadingAge; 2012.

  82. Metz K, Russell W. Improving transitions of care in LTPAC: An update from the theme 2 Challenge Grant awardees. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  83. Office of the National Coordinator of Health Information Technology. Beacon Community program. Available athttp://www.healthit.gov/policy-researchers-implementers/beacon-community-program. Accessed December 20, 2012.

  84. Smith L. "Direct" your attention to Mass Health Information Exchange (HIE). Massachusetts eHealth Institute (MeHI) Newsletter; 2012.

  85. Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2012. NCHS Data Brief No. 111. Hyattsville, MD: National Center for Health Statistics; 2012.

  86. King J, Patel V, Furukawa M. Physician adoption of electronic health record technology to meet Meaningful Use objectives: 2009-2012. ONC Data Brief, No. 7. Washington, DC: Office of the National Coordinator for Health Information Technology; 2012.

  87. Jha AK, DesRoches CM, Kralovec PD, et al. A progress report on electronic health records in US hospitals. Health Aff; 2010; 29(10): 1951-1957.

  88. Charles D, King J, Patel V, et al. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2012. ONC Data Brief, No. 9. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  89. Coleman EA, Bennett RE, Dorr D, et al. Report on health information exchange in post-acute and long-term care. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy; 2007. Available at http://aspe.hhs.gov/daltcp/reports/2007/HIErpt.htm.

  90. Decker SL, Jamoom EW, Sisk JE. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. Health Aff; 2012; 31(5): 1108-1114.

  91. Caffrey C, Park-Lee E. Use of electronic health records in residential care communities. Hyattsville, MD: National Center for Health Statistics; 2013; No. 128.

  92. National Center for Health Statistics. National study for long-term care providers, 2011. Available athttp://www.cdc.gov/nchs/data/nsltcp/NSLTCP_FS.pdf. Accessed August 20, 2013.

  93. Hsiao CJ, Hing E. Adoption of health information technology among U.S. ambulatory and long-term care providers. National Conference on Health Statistics. Washington, DC: 2012. Available at http://www.cdc.gov/nchs/ppt/nchs2012/SS-03_HSIAO.pdf. Accessed August 20, 2013.

  94. Richard A, Kaehny M, May K, et al. Literature review and synthesis: Existing surveys on health information technology, including surveys on health information technology in nursing homes and home health. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation; 2009. Available at http://aspe.hhs.gov/daltcp/reports/2009/hitlitrev.htm#table2.

  95. Resnick HE, Alwan M. Use of health information technology in home health and hospice agencies: United States, 2007. J Am Med Inform Assoc; 2010; 17: 389-395.

  96. Wolf L, Harvell J, Jha AK. Hospitals ineligible for federal meaningful use incentives have dismally low rates of adoption of electronic health records. Health Aff; 2012; 31(3): 505-513.

  97. Desroches CM, Charles D, Furukawa MF, et al. Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Aff (Millwood); 2013; 32(8): 1478-1485.

  98. Adler-Milstein J, DesRoches C, Jha A. Health information exchange among US hospitals. Am J Manag Care; 2011; 17: 761-768.

  99. Furukawa MF, Patel V, Charles D, et al. Hospital electronic health information exchange grew substantially in 2008-12. Health Aff (Millwood); 2013; 32(8): 1346-1354.

  100. CapSite. 2012 U.S. Health information exchange study. CapSite; 2012.

  101. Bipartisan Policy Center. Clinician perspectives on electronic health information sharing for transitions of care. Washington, DC: Bipartisan Policy Center; 2012.

  102. Adler-Milstein J, Bates DW, Jha AK. Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Aff (Millwood); 2013; 32(8): 1486-1492.

  103. Cagel JG, Rokoske FS, Durham D, et al. Use of electronic documentation for quality improvement in hospice. Am J of Med Qual; 2012; 27(4): 282.

  104. Oakes SL, Gillespie SM, Ye Y, et al. Transitional care of the long-term care patient. Clin Geriatr Med; 2011; 27(2): 259-271.

  105. Office of the National Coordinator for Health Information Technology. Health IT in long-term and post-acute care. Washington, DC: ONC; 2013.

  106. Cherry B, Carter M, Owen D, et al. Factors affecting electronic health record adoption in long-term care facilities. J Healthc Qual; 2008; 30(2): 37-47.

  107. S&I Framework. IMPACT transfer of care dataset 20OCT2012. Available at http://wiki.siframework.org/LCC+Long-Term+Post-Acute+Care+(LTPAC)+Transition+SWG. Accessed July 15, 2013.

  108. National Quality Forum. Critical paths for creating data platforms: Care coordination. Washington, DC: National Quality Forum; 2012.

  109. Folkemer D. Telephone discussion. 2013.

  110. Arizona Strategic Enterprise Technology Office. Arizona health information exchange environmental scan: Long-term care. CFDA #93.719. Phoenix, AZ: Arizona Strategic Enterprise Technology; 2012.

  111. Centers for Medicare and Medicaid Services. Current work -- what are QIOs doing? Available at http://www.cms.gov/Medicare/Quality-Initiaves-Patient-Assessment-Instruments/QualityImprovementOrgs/Downloads/10thSOWSlides.pdf. Accessed August 28, 2013.

  112. Caradigm. Low-cost health IT connectivity for skilled nursing facilities enables clinicians to provide better, more coordinated patient care. Available at http://www.caradigm.com/pages/en-us/press/2012-08-09-data-share-nursing-facilities.aspx. Accessed December 2012.

  113. Garber L. Massachusetts Technology Park Corporation: Improving long-term and post-acute care transitions. Washington, DC: Office of the National Coordinator for Health IT, State Health Information Exchange Challenge Program; 2012.

  114. SaferHealthCare. What is SBAR and what is SBAR communication? Available at http://www.saferhealthcare.com/sbar/what-is-sbar. Accessed December 2012.

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