Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. HITECH Focuses on Key Priorities for HIT

12/01/2011

To support the development and adoption of a nationwide HIT infrastructure, Congress enacted and President Obama signed the HITECH of 2009. The Act seeks to substantially expand the electronic use and exchange of health information to:

  • Improve the quality and continuity of health care, the delivery of health care services, patient health outcomes, and population health;
  • Increase efficiencies;
  • Decrease costs; and
  • Increase overall health care value.

HITECH resources to accelerate the adoption of HIT and EHRs primarily target physicians and acute care hospitals. Several HITECH programs support the electronic exchange and use of health information. These include state-level HIEs and Beacon Community initiatives. A few grantees in both programs are making a deliberate effort to engage nursing homes and home health agencies.7

The law also enables eligible professionals (primarily physicians) as well as eligible hospitals to receive Medicare and Medicaid incentive payments for the meaningful use of certified EHR technology. A core goal of meaningful use is the two-way exchange of clinical information among the spectrum of health care providers. Once providers establish electronic exchange of basic clinical information, they can progress to exchanging other clinical information like advance directives and obtaining prescription information for medication reconciliation. Accordingly, meaningful use objectives for electronic exchange become more rigorous each year. To qualify for Stage 1 meaningful use incentives, eligible professionals and hospitals must meet certain measures regarding the electronic exchange of clinical information. Objectives for electronic clinical information exchange are expected to ratchet up in Stages 2 and 3.

Even though LTPAC providers are not eligible for EHR incentive payments, their capacity to exchange health information electronically is likely to impact eligible professionals' and eligible hospitals' ability to qualify for meaningful use incentives. Figure 3 identifies meaningful use Stage 1 objectives that eligible professionals and hospitals could have trouble meeting if LTPAC providers have limited EHR and electronic exchange capabilities. These challenges will likely increase as meaningful use thresholds increase in future stages. Further, beginning in 2015, Medicare eligible professionals and hospitals that do not meet the meaningful use requirements will be subject to downward payment adjustments.

  FIGURE 3: Meaningful Use Objectives for Eligible Professionals and Hospitals Impacted by LTPAC Electronic Exchange Abilities  
  • Electronically exchange (i.e., send and receive) key clinical information among providers of care.
  • Provide a summary care record for each transition of care (ToC) or referral.
  • Perform medication reconciliation for individuals who transition into care of an eligible professional or eligible hospital.
  • Record advance directive status upon admission of patients 65 and older in an eligible hospital.

ONC recognizes the importance of including the wide array of health care providers in the emerging nationwide HIE infrastructure. A May 2011 Blog8 posted by the ONC states that:

"ONC's core mission includes promoting the meaningful use of health information technology nationwide. By one definition, "meaningful users" are those who qualify to receive funding under the Medicare and Medicaid Electronic Health Records Incentive Programs under the HITECH…. But the incentives do not apply to everyone…[including] mental health providers…[and] long-term and post-acute care providers.

For ONC, the fact that not all providers are eligible for payments under HITECH is a reminder that meaningful use is not only a financial incentive program; it is also a goal. Meaningful use is the idea that all of our nation's health care system will benefit from an IT infrastructure in which electronic health information can be collected, exchanged, and innovatively deployed to improve the safety, quality, and cost-effectiveness of American health care. ONC has several programs and resources to help providers and hospitals that do not happen to be eligible for incentive payments nevertheless use health IT to improve their patients' care."

There are several initiatives underway to engage LTPAC providers in HIT, EHR, and HIE activities at the federal, state and regional level. Some of these initiatives are described below:

  • ONC Challenge Grants: In January 2011, ONC announced an additional $16 million in "Challenge Grants" to ten states/SDEs focusing on certain clinical areas, including "improving long-term and post-acute care transitions." The funding for the Challenge Grants supplemented the $547 million in funds that ONC awarded to each state and qualifying Territories to support electronic HIE primarily by Eligible Professionals and Eligible Hospitals participating in the Meaningful Use Program. Through the Challenge Grant program, ONC awarded almost $7 million to the following four states focusing on transitions in nursing homes and/or home health.

    • Colorado: Colorado Regional Health Information Organization is focusing on connecting communities and developing tools to support the workflow for information exchange including LTPAC providers.

    • Oklahoma: Oklahoma is focusing on the technology infrastructure across the state to facilitate the HIE workflow that will avoid unnecessary transfers and coordinate advanced directives.

    • Maryland: Maryland will leverage an operational statewide HIE to share critical pieces of clinical information in real-time as residents of the state's long-term care facilities (LTCFs) transition from one care setting to another. The goal is to connect all 235 LTCFs to the statewide HIE.

    • Massachusetts: Massachusetts is leveraging its state HIE and implementing the Improving Massachusetts Post-Acute Care Transfers (IMPACT) program. The program is developing tools to support decision-making and information sharing at the point of transfer to reduce unnecessary hospitalizations. IMPACT is planning to leverage the ONC Standards and Interoperability (S&I) Framework TOC initiative to coordinate standards development for development of a universal transfer form (UTF) set and the re-use of interoperable, standards-based assessment content to engage LTPAC providers in HIE.

  • ONC Beacon Communities: Under the Beacon Community Program, ONC provided grant funding to 17 communities to support building and strengthening their HIT infrastructure and exchange for improved care coordination, quality, and economic efficiency.9 Some of the communities have specific initiatives to engage LTPAC providers.

One Beacon Community -- Keystone in Danville, Pennsylvania -- has leveraged the work of this study to engage the nursing home and home care agencies in their community. Their HIE efforts are described in the following section: Exchanging Standardized Assessment Content for Patient Assessment Summary Documents.

In summary, HITECH did not include significant support for the use of EHRs and exchange of health information by LTPAC providers, even though eligible professionals and hospitals will increasingly need electronic clinical information from LTPAC providers to qualify for meaningful use incentives and deliver high quality health care. In the very near term, an approach to accelerate LTPAC providers' adoption of more sophisticated types of information exchange and sharing capabilities could contribute to the development of the technical infrastructure that could support the more robust clinical information exchange anticipated through the meaningful use requirements.

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