According to its authors, whose work was based on a 2009 AHA survey, while 12% of ARRA-eligible acute-care hospitals had at least a “basic EHR,” among ARRA-ineligible organizations, just 6% of long-term acute-care hospitals, 4% of rehabilitation hospitals and 2% of psychiatric hospitals had basic EHR systems. No more than 2% had full-featured, “comprehensive EHRs” and “very few” had the IT capacity to meet federal meaningful-use standards under the ARRA.
Congress excluded long-term-care providers from the ARRA “primarily because of funding constraints and uncertainty about their readiness to adopt EHR systems,” the authors say. But ignoring these providers' IT needs will have negative “spillover effects,” they say. “If large segments of the healthcare system remain paper-based, then investments to support EHR adoption and use by eligible hospitals and physicians might not produce the expected quality and efficiency gains.”
There is no similar, current, nationwide survey of EHR adoption in nursing homes, according to Michelle Dougherty, director of research and development at the AHIMA Foundation, which acts as the convener of the annual Long-Term and Post-Acute Care Health IT Summit.
The common perception is that long-term care is totally bereft of IT, “and that's not the case,” Dougherty says. Most nursing homes and home-care agencies have some electronic record-keeping capability to compile and file electronically minimum data sets and outcome and assessment information reports with the CMS, she says, while many “are expanding their repertoire” to include clinical systems. Meanwhile, ONC-funded challenge grant programs are making some progress in connecting hospitals with nursing homes and other long-term-care and post-acute providers, she says.
In its recent proposed rule, the ONC asked for public comments on whether it would be “prudent” for it to approve testing and certification programs—as it does with such programs for EHRs for ARRA-eligible providers—for IT systems for ARRA-ineligible providers in long-term care, post-acute and mental and behavioral health, or leave such testing to the private sector.
Last year, the not-for-profit Certification Commission for Health Information Technology launched its own testing and certification programs for IT used in long-term care and behavioral health. So far, however, only handful of vendors have sought certification, according to C. Sue Reber, a CCHIT spokeswoman.
David Whitlinger, executive director of the New York eHealth Collaborative, which oversees New York's ARRA-supported statewide health information exchange, says he's all in favor of federal support for testing and certifying systems in the long-term-care market where IT capabilities are “rudimentary.”
“Anything that the government can do to set the bar on standards in interoperability is a good thing,” Whitlinger says.
The Colorado Regional Health Information Organization, one of the four ONC challenge grant recipients, seeks to connect its 18 member hospitals statewide with 160 long-term-care providers in four target communities, says Phyllis Albritton, CoRHIO's executive director.
Only a few of CoRHIO's targeted long-term-care providers have EHRs, Albritton says. Most will access hospital data through CoRHIO's package of Web-based services, where “they can share and view all the information they need,” she says. “The discharge summary, immunizations, lab test, notes are all available.”
“We went live a couple of weeks ago,” says Scott Buck, a Pueblo, Colo.-based registered nurse and branch director of home health provider Gentiva Health Services, which serves 150 patients a day in Pueblo, and was CoRHIO's first long-term-care customer under the challenge grant. Gentiva also added a CoRHIO connection in its Colorado Springs office and plans to link its Denver office soon.
“We've always been able to get a history and physical,” Buck says, but now, “there is so much more—a lab report, a radiology report, whether they've had a swallow study, a supplemental report that really rounds out what happened to a patient in a hospital.”
According to Buck, Congress missed an opportunity by not providing IT incentives to skilled-nursing providers.
“I think a lot of what happened was the legislators didn't understand healthcare,” Buck says. “When you think healthcare, you think hospital. You think doctor—even though home care costs less. One day in the hospital can cost you more than 60 days on home health. I think this is the track that this has to go. We have to get strongly into the care-transition process.”