The Department of Health and Human Services lacks a comprehensive plan to meet its goal of increasing the proportion of post-acute care providers electronically exchanging health information.
That’s the finding of a new Government Accountability Office audit of the use of electronic health records in post-acute care settings, such as skilled nursing and long-term care facilities.
“When patients leave the hospitals and move to post-acute care settings, electronic health records can help providers know what the patient needs and better coordinate care. However, we found that issues like increased costs and a lack of access to technology deter the use of electronic health records in these settings,” states the GAO report.
According to auditors, five key factors affect the use of EHRs and the electronic exchange of health information in post-acute care settings:
- Cost: Facilities often have limited financial resources to cover the initial cost of an EHR, and additional costs may be incurred for exchanging information and for EHR maintenance.
- Standards: There is variability in the implementation of health data standards and difficulty in finding health information relevant to post-acute care providers when this information is exchanged.
- Workflow disruptions: Implementation of EHRs requires post-acute facilities to change their daily work activities or processes, which can be disruptive.
- Technological challenges: EHRs are not capable of electronically exchanging health information.
- Staffing: A lack of staff with expertise in managing EHRs and high staff turnover result in a constant need to train staff to use the technology.
“Many patients who leave hospitals receive care in post-acute settings, such as skilled nursing facilities and long-term care hospitals,” contends the GAO. “Exchange of accurate and timely health information is particularly important in these transitions, and technology like EHRs could help to improve quality and reduce costs.”
To improve efforts to promote EHR use and electronic exchange of health information in these care settings, auditors made two executive action recommendations for the HHS Secretary:
- Direct the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health IT to evaluate the effectiveness of HHS’s key efforts to determine whether they are contributing to its goal for increasing the use of EHRs and electronic exchange of health information in post-acute care settings.
- Order CMS and ONC to comprehensively plan for how to achieve HHS’s goal related to the use of EHRs and electronic information exchange in post-acute care settings, including identifying specific actions related to post-acute care settings and identifying and considering external factors.
In a written response to the report, HHS concurred with the GAO’s recommendations and identified four key departmental efforts related to post-acute care settings. Specifically, the agency said that a first step in evaluating its efforts is to establish baseline metrics to assess the current situation. In addition, HHS stated that it intends to develop comprehensive planning to achieve its goal, including working with stakeholders to advance the use of EHRs in post-acute settings and to address barriers and external factors.
However, auditors found that the agency “has not measured the effectiveness of each of its efforts to promote the use of EHRs” and that the “lack of measurement of the effectiveness of these efforts is contrary to leading principles of sound planning” while “most of the key efforts lack specific plans for evaluating their progress.”
An ONC spokesperson declined to specifically comment on the GAO’s findings and recommendations and instead referred to the agency’s official written response published in the report, including ONC’s plans to survey providers in post-acute settings to gather baseline data on the rates of EHR adoption and activities that demonstrate ways to electronically exchange health information.
Nonetheless, GAO said the ONC surveys “are not intended to assess the effectiveness of HHS’s efforts to promote EHR use.”
Overall, auditors found that HHS planning “does not address how to overcome key external factors that may adversely affect its efforts” related to post-acute care settings. Without a comprehensive plan to address these issues, “HHS risks not achieving its goal of increasing the proportion of post-acute providers that send, receive, find, and use electronic health information by 2017,” concludes the report.
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