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

Care Settings

All care settings can greatly impact an organizations approach to health IT. Although this Playbook is targeted for use by ambulatory care practices, this section includes – and will be expanded – to provide tools and resources to support a variety of care settings with unique considerations for health IT implementation and adoption.

This section currently provides resources for long-term post-acute care (LTPAC), rural, and underserved care settings. Check back for additional care settings and resources. Have a care setting health IT tool or resource that should be considered for the Playbook? Please follow the feedback link below to contact us.

The population of those aged 65 and older will more than double from 40 million to 89 million by 2050. As the U.S. population ages, the demand for LTPAC services is expected to grow. LTPAC services cover a wide array of services ranging from institutional services provided in specialty hospitals and nursing homes, to a variety of home and community based services. Transitions across acute, post-acute, and long-term care settings are common and can be costly.

Patients who receive LTPAC services typically have co-occurring health conditions, such as diabetes or high blood pressure. These patients are likely to encounter multiple care settings, requiring ongoing communication to and from each service point. Health IT provides an opportunity for LTPAC providers to share health information in a timely and secure manner across care settings to support patient-centered care, particularly during transitions from one care setting to another. Innovations in health IT can facilitate transitions across provider settings and ultimately improve the health outcomes for this patient demographic and reduce cost to the health care system.

Stage 2 of the EHR Incentive Program will take an important first step in supporting the needs of persons who receive LTPAC services by requiring eligible providers to send care summaries during transitions of care, which may include LTPAC providers. As EHR adoption and interoperability requirements continue to advance in the acute care and ambulatory care sector, it will be increasingly important for LTPAC providers to adopt EHRs that have the capability of exchanging standardized clinical data with care partners.

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

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

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
EHR planning and selection

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

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

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

Study of the factors influencing and contributing to the use HIE in LTPAC organizations

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

When it’s used
When educating about HIE in the LTPAC setting and references to research on HIE in the LTPAC setting

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

Almost one fifth of the US population lives in a rural area. Critical Access Hospitals (CAHs) and other small, rural hospitals provide vital services in rural areas and often serve as the foundations of rural health care delivery systems. Residents of rural areas face barriers to accessing health care services that include traveling long distances to seek care. Since rural hospitals are often the sole local source for patient care in rural communities, they are more likely to offer additional services that otherwise would not be accessible to residents. To improve care for patients residing in rural areas, rural hospitals are expected to:

  • Improve access to services, including urgent care services, and meet unmet community health needs in isolated rural communities
  • Engage rural communities in rural health care system development
  • Develop collaborative delivery stems in rural communities as the hubs of rural health care
  • Create transitions of care coordination with urban health care system alignment
  • Be the subject matter experts and coordinators for the health care environment of providers, patients and staff

The use of health IT holds much potential for rural America. Not only does health IT enable better care coordination, but instant access to patient information can improve health care quality and patient outcomes in rural communities.

The benefits of electronic health records are well documented, and rural providers are uniquely positioned to benefit from the use of EHRs. Health IT has the potential to transform how rural health care providers collect, manage, store, use and share health information. Health IT also helps rural communities access and coordinate care, improve disease surveillance, target health education, and compile regional data – all activities aimed at improving health care quality and patient outcomes. An EHR also creates an improved mechanism to complete specialty referrals which is valuable when access to specialists is often limited in rural communities.

Health IT will be especially beneficial to rural America. In rural areas where distances between clinics are great and specialists are often few and far between, health IT can:

  • Give health care providers instant access to information they need to make timely, vital decisions and save lives
  • Decrease travel time for patients and their families
  • Enable rural hospitals to utilize remote clinicians, pharmacists, and staff members to improve and extend access
  • Facilitate efficient transfer to other facilities for vital services not offered locally
  • Facilitate efficient local care after intense care in a tertiary hospital by enabling patients to get care near their families and primary care providers

EHR Implementation Issues Unique to Rural Settings

Provides information about barriers unique to electronic health record (EHR) implementation in rural health; also presents in tabular form the implementation issue and corresponding rural related Health IT resources

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

When it’s used
When planning to implement EHR in a rural setting and/or requiring assistance with issues related to EHR implementation in the rural setting

Visit the EHR Implementation Issues Unique to Rural Settings site

Rural Health Resources

Provides resources for critical access and small rural hospitals to learn more about the benefits of health IT and take the first step toward implementation and attaining meaningful use; also includes information about implementation support and funding opportunities

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

When it’s used
When planning for and during an EHR implementation

Visit the Rural Health Resources site

Summary: Areas where individuals do not have ready access to health services due to shortages of various types of healthcare professionals and organizations and / or economic and other factors.

Medically underserved communities are defined by a combination of factors. They include Medically Underserved Areas (MUAs), Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs), which are defined and designated by the Health Resources and Services Administration (HRSA) in the U.S. Department of Health & Human Services.

MUAs and MUPs are areas or populations that have too few primary care providers, a high infant mortality, high poverty, and/or high older adult population. MUAs may include an entire county, a group of contiguous counties, a group of county or civil divisions, or a group of urban census tracts where residents have a shortage of personal health services. MUPs may include groups of persons within an area of residence who face economic, cultural, or linguistic barriers to health care.

HPSAs have shortages of primary medical care, dental, or mental health providers and may be geographic (a county or service area), demographic (low-income population), or 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 rural. Many areas throughout the country, including inner-city urban areas, fall into MUAs, MUPs, and HPSAs. The ONC 2015 Edition for Health IT Certification Criteria, Base EHR Definition, and Certification Program Modifications describes in detail the various criteria to help providers determine the best EHR to suit their needs.

2015 Edition Final Rule: Addressing Health Disparities

2015 Edition Final Rule: Addressing Health Disparities

Criteria for the capture of patient health information to help providers better identify the populations they serve

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

When it’s used
When seeking guidance on how to capture health disparities data

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

Content under development - We envision this section to contain helpful resources that address the specific challenges faced by LTPAC, rural and other underserved communities when configuring health IT systems to meet their organizational needs. This section currently contains material to support LTPAC, rural and other underserved providers to showcase the design functionality and demonstrate possibilities for future expansion to other care settings with similar challenges. We invite your organization to submit feedback, suggestions and ideas so that we can continue to build the health IT playbook into a truly useful resource for all care settings. Please follow the feedback link below to contact us.

Join the conversation.

Let us know how we can improve and expand on Care Settings.