ADVANCE for Executive Insight 1 ADVANCE for Executive Insight

Healthcare IT
By Cara Babachicos, MHA, CHCIO
Will Post-Acute Sites
Ever See Meaningful Use?
When I speak with my acute care colleagues,
they are often surprised to learn
that meaningful use (EHR incentives)
doesn’t include the post-acute sector. Some think
it’s strange that meaningful use (MU) doesn’t consider
electronic health records (EHR) systems for
rehabilitation, long term care and psychiatric hospitals,
home care, hospice or nursing homes, while
these facilities care for some of our sickest patients.
Successful care transitions from acute to postacute
are predicated on effective communication
and coordination of the treatment plan with the
next care provider. In facilities lacking the proper
electronic coordination systems, a patient may be
transported from the acute care facility to a postacute
setting on a stretcher with a paper medical
record attached to their jonnie, while they await
an admissions person on the other side. This is by
no means a well-coordinated transition.
Keeping Pace
With the focus on cutting cost and improving
quality, it puts a healthcare provider at a huge
disadvantage if they cannot keep up with the
communication and documentation systems in
place at the referring hospitals, not to mention
the fact that they put themselves at a huge disadvantage
in the Accountable Care Organization
(ACO) marketplace. It is equally challenging for
post-acute to afford this technology when they
are significantly impacted by rate cuts.
Some organizations like mine have made the
investment in technology for post-acute, but other
facilities are light years away. I worry about the
many organizations that haven’t kept pace with
technology because the lack of standardization
and coordination of care will ultimately impact
how healthcare is delivered. As a healthcare CIO,
I know that MU and EHRs are by no means a
panacea, but lack thereof could be a game changer
for a patient if a significant note, medication
order, or a specialist consult is missed in the coordination
of care across the continuum.
Some have suggested that a HIE would solve
this problem, but without an electronic system
at the receiving site it would be very difficult to
have two-way sharing of patient data. The inefficiencies
of rekeying the information from a
paper chart would be time consuming and burdensome,
and a secondary process outside of the
clinician workflow. In addition, scanned documents
can have much variation.
Regulatory Issues
Maybe the key to integration with acute care is
regulatory simplification? At present post-acute
care requires different clinical documents and
billing codes than acute care. FIM, MDS, HHRG,
IRF-PAI are some of the terms you quickly become
familiar with in the post-acute world. By
simplifying and standardizing coding and documentation
for post-acute it would make it far
easier to extend the acute care products to the
post-acute settings. Post- acute looks forward to
the day that there will be a common care tool, but
at present the post-acute settings use different
clinical documentation coding and billing mechanisms,
making it difficult to even share tools/
systems across post-acute. If we were to move
away from the specialty codes and to a common
care tool across all levels of care it would not only
simplify the implementation of systems for postacute,
but it would also allow organizations to
truly understand the total cost and the quality of
care delivery across the continuum.
Predictions
Will MU ever see the light of day in post-acute?
Some are skeptical and have suggested that the
MU dollars would be exhausted before it gets to
post-acute sector. Others suggest that we will
see some incentives in MU stage 3. I’m inclined
Cara Babachicos is the CIO/corporate director of Community and Non Acute Sites at Partners Healthcare System.
As a healthcare
CIO, I know that
MU and EHRs are
by no means a
panacea, but lack
thereof could be
a game changer
for a patient if a
significant note,
medication order,
or a specialist
consult is missed
in the coordination
of care across
the continuum.
Healthcare IT is sponsored by
the College of Health Information
Management Executives
(CHIME). Contact CHIME at www.
cio-chime.com
10 ADVANCE for Executive Insight