Let's get connected: the challenges of coordinating care

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John F. Derr, R.PH
John F. Derr, R.PH
One of the greatest healthcare challenges today is coordinating care for patients treated in long-term and post-acute care (LTPAC) settings. They may be cared for in a wide variety of environments, including skilled nursing, nursing and assisted living facilities; home, independent and adult care environments; rehabilitation facilities; long-term acute care hospitals; and hospice.

Today's clinical environment requires caring for an individual in the right care setting, at the right time, for the right medical condition and at the right cost. We now see LTPAC patients move from care setting to care setting, depending on their individual and changing care requirements.

This new world demands that our industry create a person-centric, integrated electronic health record (EHR). The Centers for Medicare & Medicaid Services has recognized this need with the demonstration of the Continuity Assessment Requirement Evaluation (CARE) tool, which will follow patients and their outcomes across multiple transitions of care and settings.

The state of EHRs

Today, LTPAC is siloed and there are few, if any, LTPAC standardized electronic health records on the market. When a patient or long-term care resident moves to a new provider, it is usually with a paper medical record that is often incomplete. All too often, the result is less-than-optimal healthcare delivery that is fragmented and duplicative.

In 2004, a group of representatives from the LTPAC community formed the HIT LTC Collaborative in response to the presidential executive order to establish the National Coordinators Office under the Secretary of Health and Human Services to develop the national EHR program and infrastructure.

In 2008, the collaborative approached the Certification Commission for Health Information Technology (CCHIT®) to consider developing a certification program for LTPAC EHR technologies. The CCHIT Certified® mark indicates that an EHR meets a standards-based, consistent benchmark. The certification criteria help ensure that products provide necessary functionality, will evolve to be interoperable with other systems and include security features that protect the privacy of personal health information. As of today, CCHIT is the only federally recognized EHR certifying organization, with a five-year track record of developing and testing criteria for certification and certifying EHR technologies.

Timeline for certification

The Certification Commission placed long-term care certification on the commission's certification “road map” for 2010, and an advisory task force was formed to provide direction and set priorities for the commission.

Among its recommendations, which were approved unanimously by the CCHIT Board of Commissioners: a strong focus on the EHR technology requirements of the American Recovery and Reinvestment Act (ARRA), and identification of core certification criteria for four settings for use in the initial EHR certification. The four settings are:

• Skilled nursing facilities (SNFs) and nursing facilities

• Medicare-certified home health agencies

•Inpatient rehabilitation facilities (IRFs)

• Long-term acute care hospital (LTAC) facilities

The final recommendations of the Task Force are available at http://www.cchit.org/about/atf/ltpac.
In July, a work group began developing criteria for certification of LTPAC EHRs. Preliminary criteria eventually will address privacy, security, interconnectivity and interoperability. EHR certification for skilled nursing facilities and certified home healthcare is expected to be available in 2010.

Why certification matters

Today, very few LTPAC providers are electronically connected with each other or with hospitals and physician offices. Without the standards required for certification, how will providers know when purchasing an application that they will be able to connect to and exchange information with other providers and a patient's EHR?

The ARRA legislation offers incentives for providers that can demonstrate meaningful use of certified EHRs, such as measuring quality and exchanging information. As of the writing of this article, LTPAC providers are not included under the ARRA program. But this is bound to change as hospitals and physicians discharge some 40% of their patients to LTPAC settings.

I and others on the HHS Federal Advisory Committee on HIT Standards are preparing for the future as we work together on LTPAC quality measurements. LTPAC providers need certification and standards to avoid isolation and the inability to connect with other providers. Most importantly, we need to embrace certified EHRs because it's the right thing to do.

With certified standards-based EHR interconnectivity and interoperability there will be a higher quality of care and a higher quality of life for the individuals we serve. For more information, visit www.cchit.org


John Derr is chief technology strategic officer and senior vice president of Golden Living, and commissioner of the Certification Commission for Health Information Technology.