Expert interviews were conducted via conference call in May and June 2010 to gather input from stakeholder groups pivotal to advancing the use and exchange of electronic clinical information in LTPAC settings. Participants in the interviews included:
Post-acute and long-term care (LTPAC) providers.
Integrated delivery system providers.
Clinical information system software vendor representatives.
Staff from the Centers for Medicare and Medicaid Services.
Members of the federal advisory committees (FACAs) and workgroups addressing Health IT (i.e., the HIT Policy Committee and its committee workgroups and the HIT Standards Committee and its committee workgroups -- Participants did NOT speak for the FACA Committees, the Committee Workgroups, or the ONC).
Representatives of state-level health information exchange initiatives.
Staff and committee members from the National Quality Forum.
The following topics were addressed with all stakeholder groups and are detailed more fully in of this appendix:
- Meaningful Use
- Health Information Exchange
- CDA for Transfer of Care
- Data Re-Use
- CDA Tools
- Quality Measures
- Functional Status
High level themes that emerged across the stakeholder interviews include:
There is an overall lack of readiness and ability to participate in electronic exchange of health information on the part of LTPAC providers.
The exclusion of LTPAC from federal HIT funding and mandates will result in a much slower uptake of technology in this care setting. Absent funding and mandates, LTPAC providers generally do not feel they have the capital to invest in upgrading existing systems or acquiring new products that support electronic exchange of health information.
There are competing views regarding whether LTPAC providers will want to electronically exchange information if it cannot be reused in their systems. General consensus over several discussion groups was that, even if LTPAC providers are only able to view information, it is a starting point and there is value in the information exchange. However, the information must be efficiently consumable by the clinician.
LTPAC is an important component to achieving meaningful use (MU) and distributed health information exchange.
Although there are neither direct financial incentives nor MU requirements for LTPAC participation in electronic exchange of information, changing payment models (e.g., bundling, Accountable Care Organizations (ACOs)) and wider use of technology by Eligible Hospitals/Eligible Professionals will create other business drivers for HIT adoption in this care setting.
A number of LTPAC organizations operate multiple facilities located in different counties or states. When faced with exchanging electronic information with multiple HIEs, the importance of standardized information becomes critical to any scalability within these organizations.
A more detailed accounting of themes identified through the expert interview sessions are found in this appendix.
"StratEng.pdf" (pdf, 1.74Mb)
"StratEng-A.pdf" (pdf, 198.14Kb)
"StratEng-B.pdf" (pdf, 534.93Kb)
"StratEng-C.pdf" (pdf, 214.97Kb)
"StratEng-D.pdf" (pdf, 4.65Mb)
"StratEng-D1.pdf" (pdf, 12.32Mb)
"StratEng-D2a.pdf" (pdf, 3.62Mb)
"StratEng-D2b.pdf" (pdf, 3.58Mb)
"StratEng-E.pdf" (pdf, 3.66Mb)
"StratEng-F.pdf" (pdf, 162.5Kb)
"StratEng-G.pdf" (pdf, 340.24Kb)
"StratEng-H.pdf" (pdf, 173.91Kb)
"StratEng-I.pdf" (pdf, 194.52Kb)
"StratEng-J.pdf" (pdf, 311.03Kb)
"StratEng-K.pdf" (pdf, 4Mb)
"StratEng-L.pdf" (pdf, 2.33Mb)