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Is meaningful use widening the digital divide?

November 14, 2014 | Erin McCann, Contributing Editor


The federal government’s electronic health record incentive money appears to be working well for hospitals and physician practices, both of whom have seen double-digit growth in EHR adoption. But how are those care providers who didn’t qualify for incentives faring with digital health? Not so great, it turns out.

The Centers for Medicare & Medicaid Services’ EHR Incentive Programs, which have paid out some $25.4 billion to hospitals and eligible providers as of September, have done great things for health IT, but they’ve also created a “digital divide” between those who qualify and those who don’t, according to a new white paper.

The study, published by interoperability software company Inofile, underscores the challenges most long-term and post-acute providers – think nursing homes, hospice, behavioral health and home care – are facing as they still predominantly lack the health IT infrastructure necessary for health information exchange. And there’s a significant number of them: As of 2012, there were some 58,500 long-term care providers in the U.S., serving some 8 million people.

Adoption rates for long-term acute care hospitals, rehabilitation hospitals and psychiatric hospitals – all of which don’t qualify under the meaningful use program – showed “dismally low” rates of EHR adoption, a 2012 Health Affairsstudy pointed out. In fact, adoption rates were half the rates seen at qualifying hospitals – a paltry 6 percent of long-term acute care hospitals had adopted at least a basic EHR, 4 percent for rehabilitation hospitals had done so, and 2 percent of psychiatric hospitals had done this.

The big issue with this, as the white paper pointed out, is that transitions of care and subsequent care coordination can be a real nightmare, as crucial patient data cannot be seamlessly exchanged. “Today there are several weak links across the healthcare spectrum where patient information is involved,” the paper read. “This is especially true when a patient’s care is transitioned between acute care and long-term care providers.”

Consider the fact that an estimated 60 percent of medication errors happen during care transition. The need for accurate, real-time information proves crucial.

Indeed, even the Office of the National Coordinator for Health IT has acknowledged this, launching workgroups that identify issues and establish standards and solutions for long-term care providers. Grant programs and new payment policies that incentivize data exchange have been among the ways to facilitate EHR adoption among LTCPs, ONC suggested in a 2013 brief.

The standards will certainly help, the white paper pointed out, but there also needs to be a “a technological leap from a world of manila folders, physician phone calls and outdated fax technology.”

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