Guest Columns

GAO gets it right with need for more IT

Cynthia Morton
Cynthia Morton

It's good to have a "big dog" recognize that the long-term and post-acute care sectors should be given more help with information technology and exchange.

The Government Accountability Office recently released a fascinating report entitled, “Electronic Health Records: HHS Needs to Improve Planning and Evaluation of Its Efforts to Increase Information Exchange in Post-Acute Care Settings (GAO-17-184).” NASL was glad to contribute to the report, which examines the state of health information technology adoption and use in the long term and post-acute care sector.

Health IT in LTPAC is hard to measure. What I mean is, we do not have a national study that can tell us how many long-term care providers have deployed electronic health records. That is what makes the GAO study such an interesting read. 

While it's an unscientific report, NASL does agree with the GAO's overall findings that cost; standards implementation; workflow disruptions; technological challenges; and staffing are key factors affecting the adoption and use of electronic health records and exchange of health information. While we in LTPAC know very well that these factors influence the adoption and use of health IT, it is good that the GAO has captured a snapshot of today's environment with this high-profile report. 

It faults the U.S. Department of Health & Human Services for doing little to promote health IT adoption in LTPAC, even though there are means to do so.

Like it or not, HHS had resources — in the form of the enormous infusion of funds from the Health Information Technology for Economic & Clinical Health (HITECH) Act — to help fuel health IT adoption and use in the acute and ambulatory sectors. That infusion of funds prompted a sea change in getting physicians and hospitals to embrace health IT and electronic exchange of health information.

With a clear lack of parity with hospitals and others in primary care in terms of eligibility for HITECH Act inventive funding and no comparable funding on the horizon for LTPAC, why would anyone be astonished that LTPAC and behavioral health providers have yet to adopt health IT in record numbers? 

The fact is there is no financial incentive or federal mandate for providers to purchase, adopt and implement health IT. LTPAC providers, who often struggle under staffing shortages and margin pressures, have been more reticent to invest in health IT because the return on such an investment needs to be significant in order to offset not just the dollars to acquire health IT systems, but the human capital necessary to implement its use.

Many LTPAC providers have minimal IT staff, if any at all. With a relatively high staff turnover rate and a highly regulated operational environment, there are added demands and costs associated with training new and existing staff that may make such investments seem almost insurmountable. 

Nonetheless, the environment has changed since NASL first sat down with the GAO analysts who worked on this report.

LTPAC, behavioral health and other providers left out of Meaningful Use funding now are looking at how health IT might help them to manage emerging requirements under the IMPACT Act and the revised “Requirements of Participation for Long Term Care Facilities,” as well as deliver other efficiencies needed to fully participate in a value-based world. These are important developments for providers. In addition, the emergence of cloud technology and other secure, hosted software deployment options are helping to increase affordability and require fewer staff implementation resources. 

We believe in the carrot approach — offering some level of assistance or incentive for LTPAC and behavioral health providers to adopt these needed technologies and to continually train and support the sustained use of health IT and electronic exchange of health information.

We believe that would return benefits to our nation's healthcare system. If Congress won't provide funding, we suggest that HHS consider constructing quality metrics under the IMPACT Act that encourage health IT adoption by giving LTPAC providers “extra points” on a metric if they utilize an electronic health record. 

NASL has shared other such recommendations on how the federal government might incentivize this sector's use of health IT through public comment and in discussions with policymakers.

Just what is the state of health IT in LTPAC? Well, it's changing. More work needs to be done to include developing more granular and constrained standards that can be used for voluntary certification of health IT used by LTPAC providers participating in accountable care and other emerging payment models.

LTPAC probably will never be offered the kind of funding that went to hospitals and doctors, and our sector might not receive explicit mandates to deploy health IT. Still, savvy LTPAC providers know that without health IT, they will have difficulty partnering with upstream and downstream partners and complying with quality metrics yet to come from the IMPACT Act and the Requirements for Participation.

The state of health IT is changing across the healthcare system. NASL is attuned to those changes as we look for opportunities to advance interoperability and, ultimately, to realize the reward of improving care for some of our most vulnerable citizens.

Cynthia Morton is the executive vice president for the National Association for the Support of Long Term Care (NASL).

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