Skilled Nursing Facilities Lag Acute Care Settings in EHR Adoption, HIE Use

According to data from the Office of the National Coordinator for Health IT (ONC), a majority (64 percent) of skilled nursing facilities (SNFs) used an electronic health record system in 2016, and 18 percent used both an EHR and a state or regional health information organization last year.

The ONC data present key measures on EHR adoption and interoperability from a 2016 sample of SNFs. About one-third (31 percent) of SNFs did not use an EHR or an health information organization (HIO) last year, and almost half (46 percent) of the facilities used only an EHR.

SNF patients may have complex chronic care needs that result in frequent transitions between their homes, acute, post-acute, and long-term care settings, which makes patient care coordination and continuity of care paramount in the SNF setting where transitions of care are common.

The ONC data indicates that EHR adoption rates among SNFs lag compared to acute care settings as do rates of engagement in the different interoperability domains. Consistent with hospitals and office-based physicians, SNFs are more likely to electronically send and receive patient health information than to find and integrate electronic health information. “The EHR adoption lag in SNFs may be in part due to their ineligibility to receive financial incentives to adopt and use EHRs under the Centers for Medicare and Medicaid EHR incentive programs. Researchers have identified barriers to EHR adoption across long-term and post-acute care settings, the most salient of which is the initial cost of EHR adoption, followed by user perceptions, and implementation problems among others,” the ONC report authors wrote.

In spite of the barriers, SNFs’ EHR adoption is higher than those of other long-term and post-acute care service providers such as adult day service centers, ONC found. “Drivers of EHR adoption for SNFs may be due to the EHR and health information exchange investments made by hospitals. The Improving Medicare Post-Acute Care Transformation Act of 2014 and efforts like the State Medicaid Directors Letter #16-003 are additional levers to facilitate interoperability among SNFs,” the ONC report authors wrote.

Further, the ONC report authors wrote, “Our findings suggest that factors like HIO participation are also important to advancing interoperability among SNFs. Future research on the adoption and use of EHRs and other health IT (e.g. tele-health) among LTPAC providers, including hospice and home health agencies, is necessary to identify and address barriers that hinder the coordination and continuity of care for patients in these settings.”

The data indicates that three out of 10 (29 percent) SNFs electronically exchanged, specifically sent or received, key clinical information with outside organizations. However, only 20 percent reported they could find clinical information from outside sources, for example via web portals, through remote access to another facility or through an HIO. Almost one in 10 (9 percent) of SNFs reported that they were able to integrate patient health information into their EHR without manual entry or scanning, and only 7 percent were able to simultaneously engage in the four domains of interoperability (send, receive, find and integrate patient information).

ONC data also indicates that SNFs that used an EHR and an HIO in the four domains of interoperability at substantially higher rates than SNFs that used an EHR alone. Large SNFs were able to integrate, without manual entry or scanning, patient health information electronically received into their respective EHRs at a higher rate (12 percent) than medium-sized (6 percent) SNFs. And, non-profit SNFs exchanged key clinical information at higher rates (36 percent) than for-profit facilities (27 percent). What’s more, SNFs located in urban areas were able to integrate patient health information at a higher rate than those located in rural areas (11 percent versus 7 percent).

Sixty-two percent of SNFs had clinical information from outside encounters electronically available at the point care in 2016, ONC data reported, but 28 percent reported that they never have clinical information from outside encounters electronically available at the point of care. Using both an EHR and HIOs significantly impacted an organization’s ability to electronically access patient health information at the point of care, as 86 percent of SNFs that used both technologies had patient data electronically available from outside sources at the point of care.