Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. III. National Policy Priorities

12/01/2011

National policy promotes the use of HIT to advance health care delivery, payment and outcomes. LTPAC providers are a vital part of the health care system and an important part of the nationwide HIT infrastructure. The HITECH of 2009 and the ACA of 2010 establish important goals for the exchange and use of HIT to reform health care. This study collected and analyzed data from multiple sources to generate the findings and opportunities described in this report.

As described in this section, national policy is reforming the health care system with the goals of better quality care, health care outcomes and efficiency. The policy framework uses HIT as a tool that aids improvements in care coordination and transitions of care. National policymakers also have promoted HIT as a critical tool to support new health care delivery and payment systems that will make marked improvements in quality, safety, efficiency, population health and health outcomes. Key strategies to advance the technical HIT infrastructure in the United States include spurring adoption of EHRs, using technical standards and vocabularies, and establishing a mechanism to exchange clinical information electronically. These policies stemmed from the need to accelerate health care providers' EHR adoption and use including HIE.

In the health care system, LTPAC providers deliver specialized care to elderly, frail or disabled patients and to individuals who require ongoing treatment or care following an acute health episode. Figure 1 identifies some of the most common LTPAC providers. Typical services include rehabilitation, medical management, skilled nursing services, and assistance with activities of daily living due physical and/or cognitive impairments. This study specifically focused on two of those LTPAC providers -- nursing facilities/skilled nursing facilities and home health agencies.

  FIGURE 1. Common Types of Long-Term and Post-Acute Care (LTPAC) Providers  
  • Nursing facilities or skilled nursing facilities
  • Home health agencies
  • Hospice providers
  • Inpatient rehabilitation facilities (IRFs) " Long-term acute care hospitals
  • Assisted living facilities
  • Continuing care retirement communities
  • Home and community-based services
  • Adult day service providers

The Federal Health IT Strategic Plan lays a foundation for HHS to support adoption of HIT/EHRs in LTPAC by leveraging the 2009 HITECH and the 2010 ACA. Figure 2 provides an excerpt from the Office of the National Coordinator for Health Information Technology's (ONC's) Federal Health IT Strategic Plan.5 The next subsections review the policy goals of HITECH and the ACA and their meaning for LTPAC providers.

FIGURE 2: Federal HIT Strategic Plan Excerpt related to LTPAC

HHS will build on meaningful use to adopt electronic standards for the exchange of clinical data among facilities and community-based LTPAC settings, including, where available, standards for messaging and nomenclature. ONC will leverage the State HIE and Beacon Community grant programs in demonstrating methods for which the electronic exchange of information with LTPAC entities can improve care coordination.

In addition, HHS will identify opportunities in the ACA to support the use of HIE technologies by LTPAC and behavioral health providers to improve quality of care and care coordination.

Improving LTPAC providers' capacity to participate in HIE could contribute to the success of both the HITECH EHR Meaningful Use Incentives Program and systemic improvements envisioned in health care reform. As observed in the Federal Health IT Strategic Plan 2011-2015:6

  • The Medicare and Medicaid EHR Incentive program (under HITECH) incentivizes eligible professionals and hospitals to electronically exchange information and states that "requirements for sharing information electronically across provider settings will grow stronger in future stages [of the Meaningful Use Program]."

  • The ACA is "an even more important potential driver of provider motivation to exchange information." The delivery system reforms and quality improvements envisioned in the ACA will require richer and timelier information to provide more efficient and coordinated care. These efforts, as well as likely future stages of meaningful use, will rely on emerging HIE models. The strategic plan reflects that: "Eventually, as digital health information becomes more widely available, exchanging it will be more natural and incentives will become less relevant. Several challenges also exist to creating a national infrastructure."

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