- A new proposed rule released this week in conjunction with the White House Conference on Aging would require long-term care (LTC) facilities and nursing homes to participate in health information exchange, CMS says. During a patient transfer or discharge, long-term care facilities would be required not only to document an event in the patient’s clinical record, but also to transmit that information to the receiving facility in order to promote continuity of care.
During the first stages of the EHR Incentive Programs, long-term care providers and skilled nursing facilities (SNFs) lagged behind their primary care and hospital counterparts in the race for widespread EHR adoption, due in part to being largely ineligible for meaningful use payouts. In 2010, only 17 percent of residential care communities used some degree of EHR technology, the CDC found, though that percentage has jumped significantly as LTC providers recognize the importance of becoming integrated members of the care continuum.
Still, just as in primary care and hospital settings, health information exchange has been slow to follow EHR adoption. In 2013, less than 20 percent of long-term care providers could exchange electronic summary reports, including discharge and transfer information, with an unaffiliated organization, stated a survey by LeadingAge.
The wide-ranging quality improvement proposal would update many of CMS’ current requirements to reflect ongoing changes in technology adoption, said HHS Secretary Sylvia Burwell, in addition to providing more stringent guidelines for staff training, encouraging the reporting of crime or elder abuse, and improving infection control procedures within communal settings. LTC providers would also be required to develop and implement a comprehensive patient-centered care plan for each resident within 48 hours of admission.
“This proposal is just one part of the administration’s overall commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way,” Burwell said in a press release. “Today’s measures set high standards for quality and safety in nursing homes and long-term care facilities. When a family makes the decision for a loved one to be placed in a nursing home or long-term care facility, they need to know that their loved one’s health and safety are priorities.”
Long-term care and skilled nursing facilities will be required to participate in the industry’s growing health information exchange ecosystem to ensure that quality improvements and patient safety gains can be distributed to the increasingly complex populations served by these facilities.
“Our revisions to this rule are intended to recognize the advent of electronic health information technology and to accommodate and support adoption of ONC certified health IT and interoperable standards,” the proposed rule says. “We believe that the use of such technology can effectively and efficiently help facilities and other providers improve internal care delivery practices, support the exchange of important information across care team members (including patients and caregivers) during transitions of care, and enable reporting of electronically specified clinical quality measures (eCQMs).”
“We propose to require not only that a transfer or discharge be documented in the clinical record, but also that specific information, such as history of present illness, reason for transfer and past medical/surgical history, be exchanged with the receiving provider or facility when a resident is transferred.”
However, LTCs will have significantly more flexibility in the way they implement this requirement than providers and hospitals do under Stage 2 meaningful use. While the EHR Incentive Programs mandate that participating organizations demonstrate their ability to use the Continuity of Care Document (CCD) format to transmit a summary of a patient’s medical record to other providers, this proposed rule specifically states that CMS is “not proposing to require a specific form, format, or methodology for this communication.”
“Ensuring that individuals and care providers can send, receive, find, and use a basic set of essential health information across the health care continuum will enhance care coordination and enable health system reform to improve care quality,” the proposed rule continues. “While current Medicare and Medicaid EHR Incentive programs have focused on providers other than SNFs and NFs, certified health IT possesses capabilities that can assist any health care provider to improve the quality, safety and efficiency of the care they deliver.”
“Electronic health records could simplify the process of extracting necessary information when a resident is transferred from a nursing home and electronic summary of care documents provide a standardized way to exchange critical information between providers.”