Hospitals began adopting electronic health records (EHRs) more than 15 years ago, using them to document the care delivery inside their own walls. Back then, EHRs were viewed greatly as electronic versions of paper records, with a few juicy extras built in, like clinical decision support and medication alerts. Later, acute care marveled as the EHR shifted from being a virtual filing cabinet to becoming an interactive part of the healthcare enterprise. These days, long-term care needs EHRs to do the same for them.
Some larger, well-moneyed long-term and post-acute care (LTPAC) chains have had some sort of EHR technology for years. Others are only beginning to research its potential. Everybody’s trying to figure out how to pay for it. Meanwhile, a vast disparity currently exists between the haves and have-nots.
“Forward-thinking providers recognize that EHRs and technology are becoming a business incentive rather than a luxury,” says Majd Alwan, executive director, LeadingAge Center for Aging Services Technologies (CAST). Continuing-care retirement communities (CCRCs) tend to be the early leaders, partly because their multiple service lines made EHRs and transition of care documentation an in-house business priority long ago, he adds.
Then there’s the funding issue. Long-term care didn’t get invited to the Centers for Medicare & Medicaid Services (CMS) “meaningful use” party, and therefore, doesn’t benefit from the federal funding for EHR adoption. However, since meaningful use Stage 2 includes transitions of care, hospitals are being incentivized to work with LTPAC, explains Judy Murphy, RN, FACMI, FAAN, deputy national coordinator for programs and policy, Office of the National Coordinator for Health Information Technology. “Transitions of care is now a core criterion under Stage 2,” she says. “[Those applying for Stage 2 reimbursement] are expected to be able to exchange data with someone who has an EHR other than their own. It has to be open, transparent and based on national standards.”
EHRs: LTC’s new competitive edge
LTC facilities with EHRs that can communicate data with local acute-care sites can adopt a new marketing slogan: We’re ready to work with you. Unfortunately, although the spirit may be willing, the vendor offerings for LTPAC-ready EHRs can be frustratingly slim and can include extensive interfacing tasks to link up care sites and service lines.
Fast-growing providers like Harden Healthcare, Austin, Texas, also are preparing to navigate the new waters of health insurance exchanges (HIEs) says Diane Kenyon, senior vice president of information technology at Harden. Among Harden’s 225 offices in 13 states, including 51 skilled nursing/assisted living facilities, the company probably touches at least 30 different HIEs, Kenyon figures.
For many in the LTPAC industry, transitions of care documentation may be where the dollars hit the road. The National Transitions of Care Coalition (NTOCC) views interoperable EHRs as the game-changers in documenting patient transfers, allowing all partnered entities in the care chain to track patient conditions accurately at intake, in situ and at transfer. Even if the patient is simply being moved from one service line to another within the same LTC community, EHR documentation should be a quality imperative toward the patient-centric care continuum rather than a “hand-off” between care silos, noted NTOCC’s Executive Director Cheri Lattimer, RN, BSN, at a recent NTOCC summit. Yet, she admits, “We can put all the systems and processes in place, but the hardest thing will be for us to change our [siloed] culture.”
The Vendors: Building the LTC features for the future
With the prompting of several CMS initiatives in the past two years, LTPAC has gradually become aware of what features it needs in an EHR, and why it should have an EHR in the first place. Until recently, EHR vendors have had little reason to pay attention to the LTC market, but that’s changing now—and fast.
Most legacy EHRs were, quite frankly, built for acute care. The CAST EHR selection tool database, first introduced in June 2012, was a loud call to arms for vendors, especially concerning the types of EHR features LTPAC facilities need—which are vastly different from the EHR features employed by acute care. But even systems that have moved into LTPAC are still greatly siloed, making it difficult to find a system that can handle the range of service lines, says Harden Healthcare’s Kenyon. “Our four core businesses are SNFs, skilled home health, community home health (personal care attendant service) and hospice. There isn’t one solution that meets all my needs.”
Moving EHR functionality beyond the enterprise walls and into data exchange with acute care is also a challenge, notes Kenyon, whose organization has been crafting its own pilots to connect its LTPAC service lines with local care partners. “We need to be able to interact with our hospital partners.” Kenyon says. “I was telling vendors seven years ago, ‘your product isn’t interoperable, and it has to be. I need to share information.’ And that was before I had eight EHRs that had to talk to each other internally.”