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GAO Calls for Improvements to HHS Post-Acute EHR Use Plans

Limited progress in improving and promoting EHR use in post-acute care at HHS has prompted GAO to suggest a reevaluation of the federal agency’s efforts.

GAO Recommendations

Source: Thinkstock

By Kate Monica

- Earlier this week, the Government Accountability Office (GAO) issued recommendations for the Department of Health & Human Services (HHS) to improve EHR use and health data exchange in post-acute care settings.

Despite the federal agency’s own goal to promote EHR use in post-acute settings (e.g., nursing facilities, long-term care hospitals), GAO found that HHS has fallen short in achieving its own goal in two ways: failing both to assess the effectiveness of its efforts thoroughly and to have a comprehensive plan in place to meet its own goals for post-acute care EHR use and health data exchange.

 “Despite the potential benefits of EHRs, available evidence suggests the use of EHRs is limited in post-acute settings,” GAO noted in the report citing an 2013 issue brief published by the Office of the National Coordinator for Health Information Technology (ONC) in which the division of HHS indicated that “are no national data on EHR adoption and the electronic exchange of health information across the different types of post-acute care settings.”

‘At that time, ONC noted that a survey of some post-acute settings — specifically long-term acute care hospitals and rehabilitation hospitals — conducted in 2009 showed adoption rates for EHRs of six percent and four percent, respectively,” GAO continued.

Increasing health data exchange in post-acute care settings is particularly important when patients transfer between facilities. Transitions of care pose challenges to patient safety unless a dependable, accurate, and time-efficient way to transfer a patient’s health information from one setting to another is available.

While HHS has established ONC financial awards, Medicaid matching funds, ONC EHR certification for post-acute care, and a CMS data mapping and data element library, the federal agency has not measured the effectiveness of any of these initiatives in a quantifiable way, according to GAO.

Through interviews with stakeholders and EHR experts specifically in post-acute care facilities, GAO concluded there are five factors affecting EHR use and health information exchange in this part of the care continuum:

GAO determined that HHS is not on track to achieve its EHR technology goals as a result of limited specificity in outlining concrete action steps to increase EHR use. With a keener awareness of which areas of EHR use require improvements and a reasonable, actionable plan laying out the steps to achieve this goal, HHS will be in a much better position to fulfill its objectives.

“HHS officials indicated that while achieving the goal of the Roadmap depends in part on actions by post-acute care vendors and providers, the Roadmap does not address how to facilitate or encourage vendor and provider actions,” stated GAO. “Furthermore, in its certification program, HHS has not outlined specific action steps for post-acute care vendors or providers to take.”

HHS has reviewed these recommendations and agreed to take the listed steps to improve its approach to post-acute EHR use and health data exchange. Outlining exactly how vendors, providers, and initiatives promoting EHR use should focus their efforts to increase health information exchange will set the industry on a steadier path toward achieving optimal post-acute care. 

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