As described earlier in this report, LTPAC providers currently use limited but not interoperable information systems for clinical and administrative processes. Further, the sector lacks widespread awareness of the need to invest in and use interoperable EHRs that can support HIE. Experts identified two significant barriers for LTPAC providers to participate in HIE (Appendix A: Stakeholder Interview Summary):
Most LTPAC providers are not ready and able to participate in interoperable electronic exchange of health information.
The absence of funding and mandates for HIT/EHR adoption and use by LTPAC providers reduces the business case for investing in HIT. Specifically, stakeholders reported insufficient capital to upgrade existing systems or acquire new products that support electronic exchange of health information. Stakeholders expressed that the exclusion of LTPAC from federal HIT funding and mandates will result in a slower uptake of technology in LTPAC settings.
An alternative approach to jump-starting LTPAC providers' use of more sophisticated, interoperable EHRs is necessary because Congress did not make HITECH EHR Incentive funding available to this sector.
A starting point could be to build upon federally required PAIs that are in an electronic format and are electronically transmitted by LTPAC providers and apply accepted HIT vocabulary and exchange standards to these instruments. The nursing home and home health assessment instruments were selected for this study. The IRF-PAI was not selected given intellectual property constraints associated with the content of the instrument (see Appendix B: Using Patient Assessments to Advance Electronic Use and Exchange of Clinical Data). A benefit of this approach is that it builds on existing capabilities and would engage the majority of LTPAC providers. Once engaged, these LTPAC stakeholders could focus on building and using the technical infrastructure to support more sophisticated types of information exchange and sharing. The technical infrastructure for standardizing assessment content and exchanging this information is discussed in Supporting an Interoperable Nationwide Health Information Infrastructure that includes LTPAC.
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