In the drive for adoption of electronic health records, the post-acute sector has been overlooked. That’s slowly changing as the CMS begins to shift its attention that way.

As part of its long-awaited interoperability proposed rule released last month, the CMS issued a request for information seeking industry feedback on how it can give post-acute providers incentives to adopt interoperable health information technology systems. The agency has largely attributed the sector’s lag in EHR adoption to lack of federal incentives, since providers in the post-acute setting weren’t eligible for the Medicare and Medicaid EHR Incentive Programs.

“We are asking for comments on how CMS can ensure that post-acute care providers adopt health technology, allowing for a more seamless flow of data,” CMS Administrator Seema Verma said during a speech in February at HIMSS19.

That’s important, suggested Neal Reizer, chair of the Home Care Technology Association of America, an affiliate of the National Association for Home Care & Hospice, since care settings no longer work in isolation.

“You can probably run your own agency on paper, but I think where it really hurts you is when you’re a referral partner,” added Reizer, who also serves as senior vice president of product management at Homecare Homebase, a home health software provider.

There’s more than 90% adoption of EHRs in acute-care hospitals and 85% of office-based physicians have them. By contrast, just 19% of post-acute providers surveyed had EHRs in place as of 2017, according to a market research survey by Black Book. And just 64% of skilled-nursing facilities had implemented EHRs in 2016, according to the most recent data from HHS’ Office of the National Coordinator for Health Information Technology.

How post-acute providers access patient records from other facilities

Even as EHR adoption among post-acute providers rises, the majority still access patient records from outside organizations using fax machines

“I consistently hear that post-acute organizations are about 10 to 15 years behind acute-care organizations when it comes to technology adoption and sophistication,” said Erik Bermudez, vice president of emerging healthcare markets at KLAS Research.

The majority of post-acute providers—66%—still access patient records from referring facilities via fax machines, according to a 2018 report from KLAS Research. While the market research firm’s sample size was small—based on just 160 interviews—it is reflective of an ongoing industry trend. In 2017, the Government Accountability Office called on HHS to boost its efforts to increase electronic health data exchange among post-acute providers.

Organizations that aren’t live on an EHR system most often cite not having the budget and lack of inclusion in federal incentive programs as reasons for not adopting the technology, KLAS found. Colin Buckley, director of customer insights at the firm, suggested the CMS offer federal subsidies similar to existing EHR incentive programs to post-acute providers on a voluntary basis.

Programs like the Medicare and Medicaid EHR Incentive Programs may prove to be an effective first step to addressing lack of electronic data exchange capabilities in the post-acute sector, according to John Kunysz, CEO of Intrepid USA, a home healthcare agency that operates in nearly two dozen states. But it only starts to get at the cost problem.

“The post-acute setting is really fragmented, so (the CMS) really has to provide some of these incentives or support for the super small and extremely localized home healthcare agencies that are out there,” he said.

To date, the federal government has spent more than $35 billion under the Medicare and Medicaid EHR Incentive Programs to encourage EHR adoption in the acute-care setting.

“Maybe there’s a smaller, but meaningful, number to drive adoption for EHRs in the post-acute setting,” said Bill Miller, CEO of healthcare software provider WellSky.

Still, EHR adoption doesn’t always go hand-in-hand with interoperability.

“Much of the market has felt like meaningful use focused too much on EHR adoption, and didn’t incorporate enough provider adoption and vendor EHR technology common standards at the onset that would make eventual interoperability easier to achieve,” Bermudez said.