Electronic Health Records: HHS Needs to Improve Planning and Evaluation of Its Efforts to Increase Information Exchange in Post-Acute Care Settings
Fast Facts
Many patients who leave hospitals receive continuing care from places like rehab facilities (called post-acute care settings). When patients leave the hospitals and move to post-acute care settings, electronic health records can help providers know what the patient needs and better coordinate care.
However, we found that issues like increased costs and a lack of access to technology deter the use of electronic health records in these settings.
We recommended that the Department of Health and Human Services comprehensively plan its efforts to increase the electronic exchange of health information in these settings, and evaluate these efforts.
Possible Ways That Health Information Can Be Exchanged Electronically With a Post-Acute Care Provider
Possible ways that post-acute care providers exchange information with hospitals, pharmacies, others.
Highlights
What GAO Found
Stakeholders that GAO interviewed, including experts on electronic health records (EHR) in post-acute care settings, described five key factors that affect the use of EHRs and the electronic exchange of health information in these settings.
- Cost: Stakeholders stated that facilities often have limited financial resources to cover the initial cost of an EHR and noted that additional costs may be incurred for exchanging information and for EHR maintenance.
- Implementation of standards: Stakeholders expressed concerns with the variability in implementation of health data standards and the difficulty of finding health information relevant to post-acute care providers when this information is exchanged.
- Workflow disruptions: Stakeholders stated that implementation of EHRs requires post-acute facilities to change their daily work activities or processes, which can be disruptive.
- Technological challenges: Stakeholders stated that they face technological challenges, such as having EHRs that are not capable of electronically exchanging health information.
- Staffing: Stakeholders noted that a lack of staff with expertise to manage EHRs and high staff turnover result in a constant need to train staff to use the technology.
The Department of Health and Human Services (HHS) has not measured the effectiveness of each of its efforts to promote the use of EHRs, and it lacks a comprehensive plan to meet its goal of increasing the proportion of post-acute care providers electronically exchanging health information. HHS identified four key efforts related to post-acute care settings; however, the lack of measurement of the effectiveness of these efforts is contrary to leading principles of sound planning. The Office of the National Coordinator for Health Information Technology (ONC) is planning to survey providers in post-acute settings to gather baseline data on the rates of EHR adoption and activities that demonstrate ways to electronically exchange health information. However, these surveys are not intended to assess the effectiveness of HHS's efforts to promote EHR use. In addition, most of the key efforts lack specific plans for evaluating their progress. Therefore, HHS cannot determine if its efforts are contributing to its goal, or if they should be adjusted. In addition, although HHS's goal depends in part on actions by post-acute care providers and EHR vendors, HHS lacks a comprehensive plan with specific action steps to achieve this goal. HHS's planning also does not address how to overcome key external factors that may adversely affect its key efforts. Without a comprehensive plan to address these issues, HHS risks not achieving its goal of increasing EHR use and the electronic exchange of health information in post-acute care settings.
Why GAO Did This Study
Many patients who leave hospitals receive care in post-acute settings such as skilled nursing facilities and long-term care hospitals. Exchange of accurate and timely health information is particularly important in these transitions, and technology like EHRs could help to improve quality and reduce costs.
GAO was asked to review issues related to the use of EHRs in post-acute care settings. With regard to post-acute settings, GAO (1) described factors that affect EHR use and electronic exchange of health information and (2) examined HHS efforts to promote EHR use and electronic information exchange. GAO reviewed HHS planning and related documents and best practices for planning identified in prior GAO work. GAO also interviewed HHS officials, and through those interviews and background research identified and interviewed a non-generalizable selection of individuals representing 20 relevant stakeholder groups, including experts, vendors, and professional associations.
Recommendations
GAO recommends that HHS (1) evaluate the effectiveness of its key efforts to increase the use of EHRs and electronic information exchange, and (2) comprehensively plan for how to achieve the department's goal regarding the use of EHRs and electronic information exchange in post-acute care settings. HHS concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To improve efforts to promote EHR use and electronic exchange of health information in post-acute care settings, the Secretary of Health and Human Services should direct the Centers for Medicare & Medicaid Services (CMS) and ONC to evaluate the effectiveness of HHS's key efforts to determine whether they are contributing to HHS's goal for increasing the use of EHRs and electronic exchange of health information in post-acute care settings. |
CMS concurred with this recommendation and in December 2019, described ONC's efforts to promote EHR use and evaluate the effectiveness of its efforts. CMS described analyses that ONC has conducted based on surveys to skilled nursing facilities and home health agencies about rates of interoperability. ONC presented the results of the surveys at various conferences in 2018 and 2019 and on its website. In addition, ONC evaluated the efforts of 10 states that received cooperative agreements to increase interoperability in long term and post acute care settings. These efforts help to evaluate the extent to which CMS's and ONC's efforts are contributing to the goal of increasing the use of EHRs and electronic exchange of health information in post-acute care settings.
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| Department of Health and Human Services | To improve efforts to promote EHR use and electronic exchange of health information in post-acute care settings, the Secretary of Health and Human Services should direct CMS and ONC to comprehensively plan for how to achieve the department's goal related to the use of EHRs and electronic information exchange in post-acute care settings. This planning may include, for example, identifying specific actions related to post-acute care settings and identifying and considering external factors. |
HHS concurred with this recommendation. In August 2020, HHS provided additional information on steps that ONC has taken to address the recommendation. ONC released the 2020-2025 Federal Health IT Strategic Plan in October 2020, based on information from 25 federal organizations. The plan included an objective related to the access of electronic health information through the Post-Acute Care Interoperability (PACIO) Project . They also noted that they are working to map CMS data to health IT standards. Another goal in the plan has as an objective to advance the development of health IT capabilities. Further, interoperability standards relevant to post-acute care settings have been added to the Interoperability Standards Advisory.
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