Results of the LeadingAge NY Health IT Survey
Sixty percent of respondents to the LeadingAge New York Health Information Technology Survey have fully or partially adopted Electronic Health Records (EHRs), while only 31 percent are engaged in Health Information Exchange (HIE) with a Regional Health Information Organization (RHIO). LeadingAge NY conducted this survey of its long-term/post-acute care members and the members of its affiliate, the Adult Day Health Care Council, to assess their digital readiness for cross-continuum collaborations and valued based payments. A complete report on the survey results is available here.
EHR adoption was concentrated among nursing homes and home care agencies (73 percent and 68 percent respectively reported full or partial adoption). Rates of full or partial adoption were lower among managed long term care plans/PACE programs (56 percent), assisted living facilities (46 percent) and adult day health care programs (24 percent). Based on other studies and anecdotal evidence, it appears that there may have been a higher survey response rate among EHR adopters and that these results may be skewed in favor of providers that have adopted EHRs.
The rate of HIE between respondents and other providers lags well behind EHR adoption. Most of the HIE appears to be occurring independent of the RHIOs. Only 31 percent of respondents reported health information exchange with a RHIO. The State’s RHIOs serve as regional hubs that facilitate the secure exchange of clinical information among multiple providers in a region and ultimately statewide. By connecting with a RHIO, a provider can avoid the cumbersome and costly process of setting up unique connections with each of its health care partners. Moreover, connecting with a RHIO is a key deliverable of many of the State’s DSRIP projects. Yet, respondents’ use of RHIOs to exchange information was lower than rates of HIE with health care providers.
Even though 53 percent of respondents indicated that they exchange or view information with a hospital, only 30 percent actually receive information from, or transmit information to, a hospital. The remaining 23 percent merely view the health information in the hospital record. Only 26 percent of respondents receive electronic transfer documents when a patient transitions to their care, and only 13 percent generate such a document when a patient is transferred from their care. Only 7 percent receive electronic alerts when a patient or resident presents in an emergency room, is admitted to a hospital or is treated by another provider.
Costs associated with EHR adoption and HIE varied significantly among respondents and included not only the initial outlays for purchasing an EHR and building the HIE connections, but also annual expenses for maintenance and upgrades. Two-thirds of the respondents that estimated the initial cost of EHR adoption spent more than $100,000 on their EHR. Eighteen percent spent more than $500,000. One-third of the respondents that estimated the initial and annual cost of building and maintaining HIE infrastructure reported initial costs in excess of $10,000. Forty percent reported annual maintenance and upgrade expenses in excess of $1,000, with 14 percent estimating annual expenses in excess of $10,000.
New York State and the Centers for Medicare & Medicaid Services are trying to reduce fragmentation in care and advance the Triple Aim through new models of care and payment that bring together providers along the health care continuum and pay them based on quality and outcomes rather than volume of services. These efforts include the State’s ambitious program, known as the Delivery System Reform Incentive Payment (“DSRIP”) program, to reduce avoidable hospitalizations by 25 percent over five years. They also include federal initiatives, such as the Medicare Shared Savings Program (“MSSP”) and Bundled Payments for Care Improvement (“BPCI”). They demand that providers communicate and coordinate with each other, implement evidence-based practices, measure and analyze clinical and financial performance and engage in continuous quality improvement.
LTPAC providers are poised to play a key role in the New York’s efforts to reduce avoidable hospitalizations and advance the Triple Aim of better health and better care at a lower overall cost. Widespread adoption of EHRs and engagement in health information exchange among LTPAC providers are essential to the State’s success in achieving these goals. While progress is being made on both fronts, there is still a great deal of work to be done, especially with respect to health information exchange.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124