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GAO: HHS Needs Comprehensive Plan to Improve EHR Use in Post-Acute Settings

March 1, 2017
by Heather Landi
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Issues such as increased cost and lack of access to technology often deter the use of electronic health record (EHR) systems in post-acute care settings, such as rehabilitation and skilled nursing facilities, according to a study by the U.S. Government Accountability Office (GAO), which recommend that the Department of Health & Human Services (HHS) develop a comprehensive plan to increase electronic information exchange in these care settings.

According to the GAO report, despite the potential benefits of EHRs, available evidence suggests the use of EHRs is limited in post-acute settings, such as nursing facilities and long-term care hospitals. The Office of the National Coordinator for Health Information Technology (ONC) reported in its 2013 Issue Brief “that there are no national data on EHR adoption and the electronic exchange of health information across the different types of post-acute care settings. At that time, ONC noted that a survey of some post-acute settings—specifically long-term acute care hospitals and rehabilitation hospitals—conducted in 2009 showed adoption rates for EHRs of six percent and four percent, respectively,” the report stated. “Furthermore, a 2014 survey of post-acute care providers in New York found that only one-quarter reported receiving an electronic document when a patient transitioned to their care. In contrast, ONC has reported that most acute care hospitals possessed EHRs in 2015,” the GAO researchers wrote in the report.

HHS has set a goal to increase the use of EHRs and the electronic exchange of information in post-acute care settings, and the GAO researchers examined the federal agency’s efforts to promote EHR use and electronic information exchange. According to the GAO report, HHS has fallen short of its goal by failing both to assess the effectiveness of its efforts thoroughly and to have a comprehensive plan in place to meet its own goals for post-acute care EHR use and health data exchange.

The GAO researchers recommend that HHS evaluate the effectiveness of its key efforts to increase the use of EHRs and electronic information exchange and comprehensively plan for how to achieve the department’s goal regarding the use of EHRs and electronic information exchange in post-acute care settings.

According to the report, industry stakeholders that GAO interviewed, including experts on EHRs in post-acute care settings, described five key factors that affect the use of EHRs and the electronic exchange of health information in these settings.

  • Cost: Stakeholders stated that facilities often have limited financial resources to cover the initial cost of an EHR and noted that additional costs may be incurred for exchanging information and for EHR maintenance.
  • Implementation of standards: Stakeholders expressed concerns with the variability in implementation of health data standards and the difficulty of finding health information relevant to post-acute care providers when this information is exchanged.
  • Workflow disruptions: Stakeholders stated that implementation of EHRs requires post-acute facilities to change their daily work activities or processes, which can be disruptive.
  • Technological challenges: Stakeholders stated that they face technological challenges, such as having EHRs that are not capable of electronically exchanging health information
  • Staffing: Stakeholders noted that a lack of staff with expertise to manage EHRs and high staff turnover result in a constant need to train staff to use the technology.

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