ONC Data Brief ■ No. 41■ November 2018
ONC Data Brief No. 41|Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities and Home Health Agencies in 2017 8
Summary
The nation’s aging population is projected to grow by 80 percent in the next 25 years (4). As a result, interoperability will
be important to ensure care coordination between acute care, post-acute care and other providers of care. A majority of
SNFs and HHAs have adopted EHRs. However, EHR adoption rates were higher among HHAs than SNFs. Among HHAs with
an EHR, a majority used their EHRs for both reconciling and recording medications. HHAs were also more likely to engage
in the use of these functions compared to SNFs.
HHAs and SNFs differed in their rates of engaging in the four interoperability domains: sending, receiving, finding, and
integrating health information received from outside sources. HHAs are more likely, than SNFs, to engage in each domain
of interoperability. Over half of HHA electronically sent or received health information; compared to 41 percent of SNFs.
However, both HHAs and SNFs had lower rates of electronically finding and integrating patient health data. Only 18
percent of SNFs report that they integrate patient health information electronically received from outside sources. Like
HHAs and SNFs, hospitals have a similar pattern related to interoperability; while a large proportion are electronically
sending and receiving health information fewer possess the capability to electronically find or integrate data from outside
sources.
Having patient health information electronically available from outside sources varied by the methods HHAs and SNFs
used to exchange information. An EHR was the most common method used to exchange information for both facility
types. Yet, at least 43 percent of HHAs and 29 percent of SNFs used more than one method for electronic exchange of
health information. Facilities that used multiple methods of electronic exchange, were more likely to engage in the four
interoperability domains. These facilities were also more likely to have information electronically available at the point of
care. For example, SNFs that use an EHR, HIO, and read-only access are twice as likely to have information available at
the point of care; compared to SNFs that use an EHR alone. Although using multiple methods increases the availability of
information, it also may increase the complexity and cost of of data exchange.
HHAs need to use technology during in home patient visits and to monitor patients between visits. Three-fourths of HHAs
(72 percent) used mobile technology. Among HHAs that used this technology, 85 percent used it during patient visits to
directly enter data into their EHR. About four in 10 HHAs (37 percent) used telehealth. There was no variation in the use
of telehealth technology by HHAs ownership status (private vs. not) or location (urban vs. rural).
Unlike hospitals and office-based physicians, SNFs and HHAs are not eligible to participate in the Medicare and Medicaid
Promoting Interoperability Programs, formerly known as the Medicare and Medicaid EHR Incentive Programs (5, 6).
However, implementation of federal policies, like the IMPACT Act, and the availability of interoperability standards for
standardized patient assessment data through resources such as the CMS Data Element Library
provide important
building blocks to advancing health information exchange. Policies that advance interoperability in the post-acute care
settings, are critical to ensuring that HHAs and SNFs are able to meet future demand for services and the complex health
needs of their patient population.
CMS Data Element Library (https://del.cms.gov/)