- A new ONC data brief exploring EHR adoption, use, and interoperability in skilled nursing facilities (SNFs) found 64 percent of facilities used EHRs to manage patient health data in 2016.
The data brief marks a first at ONC in measuring SNF EHR adoption rates.
Authored by Alvarado et al., the brief used data from a 2016 nationally representative census by private healthcare reference information provider QuintlesIMS. Respondents included 1,000 facilities offering long-term post-acute care (LTPAC) services. Of the participating facilities, 831 identified as SNFs, and 96 percent of SNFs were CMS Medicare-certified skilled nursing or nursing facilities.
SNFs serve patients that often have complex chronic conditions and care needs, resulting in frequent transitions between home, acute, post-acute, and long-term care settings. These transitions require care coordination between providers — collaboration that becomes easier with efficient EHR use, health data exchange, and interoperability.
According to the study, almost one-fifth of SNFs used both an EHR system and a regional health information exchange organization (RHIO) to share health data in 2016. Additionally, three out of ten SNFs exchanged key clinical data.
“SNFs that used an EHR and an HIO could send, receive, find, and integrate patient health information at higher rates than those facilities that used an EHR alone,” noted authors.
Furthermore, the majority of SNF providers leveraged this data to improve patient care: 62 percent of SNFs had electronic health data available from outside sources at the point of care, according to the brief.
Ultimately, the brief found SNFs that used both an EHR and an RHIO used electronic health data at higher rates than facilities using EHRs only. SNFs using EHRs and RHIOs exchanged patient health data at five times the rate of facilities that did not use either.
SNF EHR adoption rates did not vary significantly by facility size or location, giving no clear indication as to the motivations behind SNF EHR system adoption.
Whereas rural hospitals lag significantly behind their urban counterparts in EHR adoption and health IT use, rural SNFs pulled slightly ahead of urban facilities in 2016. Specifically, 67 percent of rural SNFs adopted EHRs in 2016, while adoption rates for urban facilities peaked at 62 percent.
Whether a practice is for profit or non-profit also did not make a significant difference in EHR adoption rates: 70 percent of non-profit SNFs adopted EHR technology last year compared to 62 percent of for-profit facilities.
While ONC officials stated the data were “promising,” ONC Director of Office Planning, Evaluation, and Analysis Seth Pazinski noted SNFs still lag behind acute-care settings in EHR adoption and HIE use.
“Prior research identified barriers to EHR adoption across long-term and post-acute care settings, the most salient of which is the initial cost of EHR adoption, followed by user perceptions, and implementation problems among others,” he wrote in a Health IT Buzz blog post.
Additionally, EHR use at SNFs is not as widespread as it is in hospital-owned practices. One-third of responding SNFs did not use an EHR or an RHIO at all in 2016, which could be the result of their ineligibility to qualify for federal EHR incentives in the past.
“It is important to note that SNFs were not eligible to participate in programs such as the Medicare and Medicaid Electronic Health Record Incentive Programs,” noted Pazinski. “However, today, federal and state efforts are underway to advance interoperability among these settings of care.”
Clinical efficiency with health IT at these facilities is also slow. While about half of SNFs currently use EHR technology, 91 percent are still manually entering or scanning patient health data into their systems. Less than ten percent stated they are able to easily integrate patient health data into their EHRs without manual entry.
Unlike EHR adoption rates, rates at which SNFs easily integrated health data into EHRs did vary significantly by facility size. Twelve percent of large SNFs were able to integrate health data into their EHRs without manual entry, compared to only six percent of medium-sized SNFs.
Overall, ONC officials determined a lot of work needs to be done before SNFs catch up to other care settings in health IT adoption and use.
“Eliminating these gaps will be critical to ensuring that all healthcare providers, including those in institutional and long-term and post-acute care settings, can leverage health IT to deliver coordinated care with data that follows the person across care settings,” wrote Pazinski.