The Office of the National Coordinator for Health Information Technology Health IT Playbook

Section 8

Care Settings

An organization’s approach to health IT varies by care setting and related care delivery needs. Although the Health IT Playbook primarily targets ambulatory care practices, this section includes tools and resources to support a variety of care settings with unique considerations for health IT implementation and adoption.

This section offers resources for:

  • Long-term and post-acute care (LTPAC)
  • Rural practices and
  • Underserved care settings

As the U.S. population continues to age, the number of people 65 years and older will more than double from 40 million to 89 million by 2050 — and the demand for long-term post-acute care (LTPAC) services will grow.

LTPAC covers a wide array of services and settings — including complex medical care in long-term care hospitals, rehabilitative services in skilled nursing facilities, and supportive services in home- and community-based settings. Transitions across LTPAC settings are common and can be costly.

Patients who receive LTPAC services often have a wide range of health conditions and more complex, chronic care needs. These patients frequently receive care from multiple care settings and require ongoing communication and coordination between each service point.

How health IT helps LTPAC

Health IT gives LTPAC providers the opportunity to share essential health information:

  • Quickly and securely
  • Across care settings
  • To improve clinical decision making
  • To increase patient and family engagement

Health IT supports patient-centered care — particularly during transitions from one care setting to another. Ultimately, health IT can help LTPAC providers improve patient health outcomes and reduce health care costs.

As electronic health record (EHR) adoption and interoperability continues to advance in both acute and ambulatory care settings, it’s increasingly important for LTPAC providers to adopt EHR systems capable of exchanging interoperable clinical data that can improve the quality of care. For more information on actionable tools to assist in planning for and optimizing the use of health IT, check out the Health IT Toolkits for nursing homes, home health and care coordination.

EHRs for LTPAC: A Primer on Planning and Vendor Selection 2016

EHRs for LTPAC: A Primer on Planning and Vendor Selection 2016

Overview
Helps aging-services organizations plan for and choose the best EHR system for their needs

Who it’s for
LTPAC providers and LTPAC practice managers

When it’s used
To plan for and select an EHR system

Download EHRs for LTPAC: A Primer on Planning and Vendor Selection 2016 [PDF - 351 KB]

Factors Contributing to the Use of Health Information Exchange in Health Care Organizations (LTPAC)

Factors Contributing to the Use of Health Information Exchange in Health Care Organizations (LTPAC)

Overview
Study of factors influencing and contributing to health information exchange use in LTPAC organizations; includes references to research on health information exchange in the LTPAC setting

Who it’s for
Providers working in LTPAC facilities, LTPAC health IT implementers, health IT professionals

When it’s used
To learn about health information exchange in the LTPAC setting

Download Factors Contributing to the Use of Health Information Exchange in Health Care Organizations (LTPAC) [PDF - 435 KB]

Long-Term and Post-Acute Care (LTPAC) Providers and Health Information Exchange

Long-Term and Post-Acute Care (LTPAC) Providers and Health Information Exchange

Overview
Information on the value of health information exchange for LTPAC providers, health information exchange success stories, and steps providers can take to adopt health information exchange

Who it’s for
LTPAC providers and LTPAC practice managers

When it’s used
To plan or advocate for health information exchange adoption in the LTPAC setting

Download Long-Term and Post-Acute Care (LTPAC) Providers and Health Information Exchange [PDF - 627 KB]

Electronic Health Record (EHR) Clinical Decision Support, Interoperability, and Health Information Exchange

Electronic Health Record (EHR) Clinical Decision Support, Interoperability, and Health Information Exchange

Overview
Four case studies designed to help LTPAC providers understand the benefits of EHR systems

Who it’s for
LTPAC providers and LTPAC practice managers

When it’s used
To plan or advocate for EHR adoption in the LTPAC setting

Download Electronic Health Record (EHR) Clinical Decision Support, Interoperability, and Health Information Exchange [PDF - 996 KB]

Almost 20% of the U.S. population lives in a rural area. Critical Access Hospitals (CAHs) and other small, rural hospitals provide vital services and often serve as the foundations of rural health-care delivery systems.

People living in rural areas face barriers to accessing health care services, such as traveling long distances. Rural hospitals — often the only local source for patient care — typically offer additional services that residents couldn’t otherwise access.

Rural hospitals are expected to:

  • Improve access to services — including urgent care services — and meet health needs in isolated communities
  • Engage communities in rural health-care system development
  • Develop collaborative delivery systems as hubs of rural health care
  • Create transitions of care coordination to align with urban health care systems
  • Serve as subject matter experts and coordinators for providers, patients, and staff

How health IT helps rural providers

Health IT holds great potential for rural communities. Providers benefit especially from EHR systems, which can transform how they collect, manage, store, use, and share health information.

Better care coordination and instant access to patient information can improve health care quality and patient outcomes.

For example, health IT can help rural communities:

  • Access and coordinate care
  • Improve disease surveillance
  • Target health education
  • Compile regional data

An EHR also creates an improved mechanism to complete specialty referrals, which is valuable when communities have limited access to specialists.

In rural areas with long distances between clinics, and where specialists are few and far between, health IT can also:

  • Give health care providers instant access to information to make timely, vital decisions, and to save lives
  • Decrease travel time for patients and their familie
  • Help rural hospitals use remote clinicians, pharmacists, and staff to improve and extend access
  • Simplify efficient transfer to other facilities for vital services
  • Facilitate post-hospitalization care close to patients’ families and primary care providers

Rural Health Resources

Overview
Provides resources for CAHs and small rural hospitals to learn more about the benefits of health IT, and to take the first step toward implementation and attaining Meaningful Use; also includes information about implementation support and funding opportunities

Who it’s for
CAHs, small rural hospitals, and health IT implementers

When it’s used
To plan for — and to use during — an EHR implementation

Visit the Rural Health Resources website

EHR Implementation Issues Unique to Rural Settings

Overview
Provides information about barriers unique to EHR implementation in rural health; also presents, in tabular form, the implementation issues and corresponding rural-related health IT resources

Who it’s for
Rural practices and health IT implementers in rural settings

When it’s used
To plan EHR implementation in a rural setting, or to assist with issues related to EHR implementation in rural settings

Visit the EHR Implementation Issues Unique to Rural Settings website

As defined and designated by the Health Resources and Services Administration (HRSA), medically underserved communities consist of:

  • Medically Underserved Areas (MUAs)
  • Medically Underserved Populations (MUPs)
  • Health Professional Shortage Areas (HPSAs)

MUAs and MUPs refer to areas or populations that have insufficient primary care providers, high infant mortality, a high poverty rate, and/or a large older-adult population.

MUAs may include:

  • An entire county
  • A group of contiguous counties
  • A group of county or civil divisions
  • A group of urban census tracts with a shortage of personal health services

MUPs may also include groups of people within an area who face barriers to health care including:

  • Economic
  • Cultural
  • Linguistic

HPSAs lack sufficient primary medical care, dental, or mental health providers and may be:

  • Geographic (a county or service area)
  • Demographic (low-income population)
  • Institutional (comprehensive health center, federally qualified health center, or other public facility)

In short, HPSAs may be urban or rural areas, population groups, or medical or other public facilities.

Medically underserved communities aren’t just very remote or deeply rural. Many areas throughout the country, including inner-city urban areas, qualify as MUAs, MUPs, and HPSAs.

The Office of the National Coordinator (ONC) 2015 Edition for Health IT Certification Criteria, Base EHR Definition, and Certification Program Modifications describe in detail the various criteria to help providers determine the best EHR for their needs.

2015 Edition Final Rule: Addressing Health Disparities

2015 Edition Final Rule: Addressing Health Disparities

Overview
Criteria for capturing patient health information to help providers better identify the populations they serve

Who it’s for
All providers, practice staff, and EHR vendors

When it’s used
To learn more about capturing health disparities data

Download 2015 Edition Final Rule: Addressing Health Disparities [PDF - 627 KB]

Content under development

We plan to expand this section over time, so check back periodically for additional resources for other care settings. Do you have suggestions to improve this section? Please share your feedback.

Section 8 Recap

  • Support long-term and post-acute care
  • Improve care in rural areas
  • Reduce health disparities

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Content last updated on: May 31, 2017