Skilled nursing facilities lag acute care settings in EHR, HIE use

Only 7 percent of SNFs were able to simultaneously send, receive, find and integrate patient health information.

The first nationally representative survey on electronic health record adoption and health information exchange among skilled nursing facilities has found that they are lagging behind acute care settings.

While data released by the Office of the National Coordinator for Health IT shows that most SNFs (64 percent) used EHRs to manage patient health information last year and a fifth of facilities (18 percent) used both an EHR and a state or regional health information organization (HIO), a HIT gap persists with their acute care counterparts.

“The EHR adoption lag in SNFs may be in part due to their ineligibility to receive financial incentives to adopt and use EHRs under the Centers for Medicare and Medicaid EHR incentive programs,” states ONC’s data brief. “Researchers have identified barriers to EHR adoption across long-term and post-acute care settings, the most salient of which is the initial cost of EHR adoption, followed by user perceptions and implementation problems, among others.”

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Nonetheless, despite these barriers, ONC points out that EHR adoption among SNFs is higher than those of other long-term and post-acute care service providers such as adult day service centers.

“Drivers of EHR adoption for SNFs may be due to the EHR and health information exchange investments made by hospitals,” observes the agency. “The Improving Medicare Post-Acute Care Transformation Act of 2014 and efforts like the State Medicaid Directors Letter #16-003 are additional levers to facilitate interoperability among SNFs. Our findings suggest that factors like HIO participation are also important to advancing interoperability among SNFs.”

At the same time, ONC suggests that the ability of SNFs to send, receive, find and integrate patient health information—the four domains of interoperability—varied by organization category.

“For example, large SNFs integrated patient health information from outside sources at a higher rate (12 percent) than medium-sized SNFs (6 percent),”states the agency’s data brief. “Non-profit SNFs electronically exchanged patient health information at a higher rate (36 percent) than for-profit facilities (27 percent). Moreover, SNFs using both an EHR and an HIO reported significantly higher levels of interoperability across all domains than those facilities that did not use an EHR or HIO.”

In response to the ONC findings, the National Association for the Support of Long Term Care (NASL) expressed its appreciation for the agency’s survey results on the subject.

“We also appreciate ONC’s acknowledgment that—even though LTPAC was not included in the Health Information Technology for Economic & Clinical Health (HITECH) Act—LTPAC providers are major exchange partners of those who were eligible to participate in the Medicare and Medicaid Incentive Programs,” says NASL Executive Vice President Cynthia Morton. “We further welcome ONC’s recognition that ‘EHR adoption and interoperability of SNFs’ health information systems is critical to facilitating transitions of care.’”

Although the survey found that most SNFs (64 percent) used EHRs to manage patient health information in 2016, Morton references the fact that just 7 percent were optimally using health IT to send, receive, find and integrate patient health information.

“While having standards that are granular and constrained enough to facilitate exchange is important, so is encouraging bidirectional and timely exchange of data—especially around transitions of care,” observes Morton. “Requiring acute care hospitals and other incentivized providers to send information in a timely fashion—so it arrives with, or even before the patient is transferred—as well as to receive patient data from other providers certainly would help to foster greater interoperability.”

“Improving the adoption and use of health IT should be a priority as we work toward greater interoperability across the care continuum,” she adds. “NASL looks forward to working with ONC on those priorities.”

For its part, ONC concludes that “future research on the adoption and use of EHRs and other health IT (e.g. telehealth) among LTPAC providers, including hospice and home health agencies, is necessary to identify and address barriers that hinder the coordination and continuity of care for patients in these settings.”

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