HHS: Hospice, Post-Acute Providers Lag on EMR Interoperability

Hospices and other post-acute health care providers lag behind hospitals and ambulatory settings when it comes to electronic health record (EMR) interoperability.

More than 85% of ambulatory practices and 95% of hospitals have adopted and use some form of EMR to document patient care and share data to varying degrees, according to a new report from the U.S. Department of Health and Human Services (HHS).

Conversely, while long-term and post-acute providers (LTPAC), about 80%, are adopting EMRs for clinical and business operations, interoperable exchanges of information are not routine or widely used, the report indicated. This is largely due to a lack of monetary incentives, worker training, policy requirements or a strong business case for interoperability, HHS reported.


“This has led to capability gaps between the LTPAC settings and other parts of the United States health care system, resulting in missed opportunities to share patient data and coordinate care among providers and caregivers in LTPACs, primary care, and hospitals,” the report indicated. “These gaps are becoming increasingly apparent due to a multitude of factors that include the general trend of an aging population and a health care system that is increasingly asked to deliver care for older adults with multiple chronic conditions.”

Interoperable technology is designed in part to improve care coordination, transitions of care and administrative functions like quality reporting. Definitions of interoperability can vary, but the term most often refers to the ability of different IT systems and software applications to communicate, exchange data and use the information that has been exchanged.

But currently, few interoperable solutions are used to support these exchanges of information, with providers often relying on workaround processes. Also, while post-acute providers use EMR data for quality measurement and public health reporting, few are using interoperable systems to do so, according to the report.


HHS researchers relied on an “environmental scan” and interviews with subject matter experts to develop the report, which was prepared for HHS’ Office of Behavioral Health, Disability and the Aging Policy Office of the Assistant Secretary for Planning and Evaluation.

Gaps in public policy are a contributing factor. Standards do exist that require some level of interoperability from agencies like the U.S. Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC), a federal agency designed to foster greater health care interoperability.  

CMS and ONC developed the interoperability rules pursuant to provisions of the 21st Century Cures Act, passed by Congress in 2016. This requires public and private organizations to share health information between patients and other parties while ensuring the privacy and security of those data.

However, to date those standards and efforts have been focused primarily on hospitals and ambulatory settings.

“We found little evidence of programs that effectively promote the widespread use of [health information exchange]by LTPAC in the same way that the Meaningful Use/Promoting Interoperability Program were effective for hospitals and physician-office settings,” HHS reported. “Lack of alignment with these programs or equivalent policy levers could further widen the gap between LTPAC and their care partners.”

HHS listed a number of considerations and potential approaches to move the needle on interoperability in the post-acute space:

  • Understand and address the barriers that limit policy makers from including LTPAC in HIT and interoperability programs including statutory limitations to include LTPAC in HIT policies and regulations.
  • Spur adoption of interoperable HIT in LTPAC settings by considering policy options to increase adoption.
  • Understand the effectiveness of past policies, funding, and interventions and look at future program changes to support LTPAC interoperability such as with digital quality measures (dQMs) and reporting, public health reporting modernization, and targeted payer process such as pre-claim review and prior authorization programs.
  • Improve HIE across platforms, networks, and geographies by understanding the value proposition for LTPAC to participate in HIEs/health information networks (HINs), improving the ease of data sharing, and clarifying HIE/HIN vendor and provider relationships.
  • Investigate telehealth policy, planning, use, and research in LTPAC, including barriers, facilitators, policies, reimbursement, and technology readiness for greater telehealth adoption in LTPAC settings.

Forward movement on expanded interoperability is essential in a health care system that is increasingly tech-enabled, according to HHS.

“The United States health care system is progressing incrementally toward an electronically connected ecosystem with the goals of delivering high-quality health care, lowering costs and enabling digital health …” the report said. “Lessons from the COVID19 pandemic are highlighting the challenges of this approach and the need for seamless interconnectivity not only between hospitals and physician-offices, but also with public health entities and LTPAC.”

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