Post–Acute Care 2018
Providers' Simple Request: "Help Me Connect"

According to homecare and long-term care providers, post–acute care interoperability is well behind the modest gains found with acute care and ambulatory EMRs. Without the compelling incentive of past meaningful use requirements, homecare and long-term care providers remain in a world where fax machines and remote logins are the unchallenged norms for data sharing.

Common Interoperability Experiences in Acute Care/Ambulatory versus Post–Acute Care Settings

Area

Electronic Access to Outside Data

Ability to Locate Individual Patient Records

Ability to View Received Data Inside EMR Workflow

Acute Care/Ambulatory

Most organizations have some basic document exchange through Direct messaging or HIEs.

When available, public, private, and vendor-supported HIE connections allow querying across multiple provider organizations.

Clinicians often view received documents inside EMR tabs. Some can import selected data elements directly into EMR data fields.

Post–Acute Care

Most organizations rely on faxes and logging directly in to the EMRs of referral partners.

Patient-specific records are delivered as part of referral and admittance process. Missing data results in phone calls, faxes, and delays.

Manual effort is often required to scan, download, upload, and hand-enter patient information into EMRs.

Impact on Patient Care

Neither setting has resolved usability issues with scanned or CCD-based documents. Manual data entry in post–acute care settings sidesteps usability challenges, but frustration may grow as interoperability spreads.

Provider feedback says no one vendor can claim triumph in the race to interoperability. Customers who gave higher-than-average interoperability ratings sometimes did so even when not using interoperability tools from their vendor. With little else to go by, some based interoperability satisfaction on their broader vendor relationship. Customers indicated that Thornberry has proven themselves as a proactive partner and thus earned confidence in meeting future interoperability needs. Higher ratings from some MatrixCare and PointClickCare customers reflect hope for new interoperability tools still in development. Epic’s success in helping customers with integration inside their health systems often contributed to more positive perceptions around interoperability in general.

Overall, providers rate their own preparation and willingness to move forward higher than they rate the interoperability support from their vendors. Customers of Epic, MatrixCare, and Thornberry suggest they have greater alignment between their readiness and their vendors’ capabilities. Early feedback from Casamba, Netsmart, and MEDITECH customers suggests wider gaps, representing an interoperability vacuum unfilled by their vendors. In many cases, provider demands are not complicated. Many wish their vendor would simply take the initiative to inform them of their options. Too often the provider experience is similar to that of one Change Healthcare client, who said, “They tend to just drop a project in our lap and walk away instead of sitting down at the table with our partners and their vendors.”

Thornberry and Epic Most Likely to Limit Added Interoperability Costs

Preliminary feedback from respondents suggests that vendors’ widespread strategy of charging incremental fees for interoperability represents a barrier to progress. Customers of Brightree, Netsmart, American HealthTech, and Homecare Homebase were most likely to say interoperability costs (often in the form of interfaces) were prohibitive. In contrast, Thornberry users described costs as “reasonable,” and Epic customers described formal efforts to minimize added costs.

Post–Acute Care Vendors Not Yet Following Acute Care/Ambulatory Lead in Removing Barriers

Post–acute care vendors that most want to distinguish themselves might follow the lead of major acute care/ambulatory vendors by embedding interoperability tools and governance into their EMRs. CommonWell and Carequality represent untapped potential for delivering widespread “plug-and-play” connectivity through nationwide networks. Nine of the vendors in this report officially participate in one initiative or the other, but in 160 interviews, providers mentioned CommonWell only once (by a Change Healthcare customer) and Carequality only once (by a Netsmart customer).

CommonWell

A multivendor health information exchange network

Participants

American HealthTech (CPSI)

BrightTree

Cerner

Change Healthcare

MEDITECH

PointClickCare

Carequality

A framework of interoperability standards that enable sharing between different HIE networks

Participants

Cerner

Epic

MatrixCare