One of the things I learned from Holly Jarek at Seven Hills Pediatric Center is that pediatric nursing homes are not eligible for federal funding support for electronic health records (i.e, for "meaningful use.") The problem this raises is that the patient information systems between this kind of nursing homes (and adult ones, too) are therefore not integrated with the hospitals and physicians that serve these patients. The patients with the severe complex conditions found at Seven Hills are quite likely to need emergency or other treatment at Children's Hospital or other facilities. Holly pointed out that the lack of a common EHR interfered with management of patient care.
Using the crowdsourcing capability of Twitter, I asked my followers how this exclusion came to pass. Ashish @ashishkjha Jha quickly answered: "MU $ not available to nursing homes etc. A financial call when HITECH put together. Not enough $ to go around."
When I responded that this was a shame, he expanded on the thought: "We wrote a paper about ineligible providers and potential implication for fragmentation. It's a challenge."
Indeed. Here's a link to the paper. Here's the abstract, with emphasis added:
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.
Using the crowdsourcing capability of Twitter, I asked my followers how this exclusion came to pass. Ashish @ashishkjha Jha quickly answered: "MU $ not available to nursing homes etc. A financial call when HITECH put together. Not enough $ to go around."
When I responded that this was a shame, he expanded on the thought: "We wrote a paper about ineligible providers and potential implication for fragmentation. It's a challenge."
Indeed. Here's a link to the paper. Here's the abstract, with emphasis added:
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.
There is no question this should be a goal. Perhaps, if meaningful use eventually fulfills its promise of reducing expenditures, Medicare will save enough $$ to add these facilities as another expansion phase. On the other hand if it doesn't work, then some $$ has been saved, eh?
ReplyDeletenonlocal
Dr Levy
ReplyDeleteYou are absolutely correct. The problem is actually worse than you describe. I've gone into well over a dozen hospitals and LTACHs (who also don't get MU money) that have nursing homes attached. The culture, attention to technology, and overall organizational integration is abysmal. The disparate IT systems promote a culture of us vs them. Resources aren't shared, and nothing talks.
All of post-acute care has been left out of this. Nursing homes, home health, Hospice, etc...
ReplyDeleteThen they wonder why transitions of care are difficult...!