Care Settings

An organization’s approach to health IT varies by care setting and related care delivery needs. Although the primary audience for the Health IT Playbook is ambulatory care practices, this section includes tools and resources to support a variety of care settings with unique considerations for health IT implementation and adoption.

This section offers resources for:

• Long-term and post-acute care (LTPAC)
• Rural practices
• Underserved care settings

As the U.S. population continues to age, the number of people 65 years and older will more than double from 40 million to 89 million by 2050 — and the demand for long-term post-acute care (LTPAC) services will grow.

LTPAC covers a wide array of services and settings — including complex medical care in long-term care hospitals, rehabilitative services in skilled nursing facilities, and supportive services in home- and community-based settings. Transitions across LTPAC settings are common and can be costly.

Patients who receive LTPAC services often have a wide range of health conditions and more complex, chronic care needs. These patients frequently receive care from multiple care settings and require ongoing communication and coordination between each service point.

How health IT helps LTPAC

Health IT gives LTPAC care teams the opportunity to share essential health information quickly and securely — particular during patient transitions from one care setting to another.

Health IT supports patient-centered care and increases patient and family engagement. By sharing information, care teams can improve clinical decision making. And ultimately, health IT can help those providing care to LTPAC patients improve health outcomes and reduce healthcare cost.

As electronic health record (EHR) adoption and interoperability continues to advance in both acute and ambulatory care settings, it’s increasingly important for LTPAC care teams to adopt EHR systems capable of exchanging interoperable health data that can improve the quality of care. For more information on actionable tools to assist in planning for and optimizing the use of health IT, check out the Health IT Toolkits for nursing homes, home health and care coordination.

Almost 20% of the U.S. population lives in a rural area. Critical Access Hospitals (CAHs) and other small, rural hospitals provide vital services and often serve as the foundations of rural healthcare delivery systems.

People living in rural areas face barriers to accessing healthcare services, such as traveling long distances. Rural hospitals — often the only local source for patient care — typically offer additional services that residents couldn’t otherwise access.

Rural hospitals are expected to:

• Improve access to services — including urgent care services — and meet health needs in isolated communities
• Engage communities in rural healthcare system development
• Develop collaborative delivery systems as hubs of rural healthcare
• Create transitions of care coordination to align with urban healthcare systems
• Serve as subject matter experts and coordinators for clinicians, patients, and staff

How health IT helps rural clinicians

Health IT holds great potential for rural communities. Clinicians benefit especially from EHR systems, which can transform how they collect, manage, store, use, and share health information.

Better care coordination and instant access to patient information can improve healthcare quality and patient outcomes.

For example, health IT can help rural communities:

• Access and coordinate care
• Improve disease surveillance
• Target health education
• Compile regional data

An EHR system also creates an improved mechanism to complete specialty referrals, which is valuable when communities have limited access to specialists.

In rural areas with long distances between clinics — and where specialists are few and far between — health IT can also:

• Give healthcare clinicians instant access to information to make timely, vital decisions and save lives
• Decrease travel time for patients and their families
• Help rural hospitals use remote clinicians, pharmacists, and staff to improve and extend access
• Simplify efficient transfer to other facilities for vital services
• Facilitate post-hospitalization care close to patients’ families and primary care clinicians

As defined and designated by the Health Resources and Services Administration (HRSA), medically underserved communities consist of:

• Medically Underserved Areas (MUAs)
• Medically Underserved Populations (MUPs)
• Health Professional Shortage Areas (HPSAs)

MUAs and MUPs refer to areas or populations that have insufficient primary care clinicians, high infant mortality, a high poverty rate, or a large older-adult population.

MUAs may include:

• An entire county
• A group of contiguous counties
• A group of county or civil divisions
• A group of urban census tracts with a shortage of personal health services

MUPs may also include groups of people within an area who face barriers to healthcare including:

• Economic
• Cultural
• Linguistic

HPSAs lack sufficient clinicians for primary medical, dental, or mental health services and may be:

• Geographic (a county or service area)
• Demographic (low-income population)
• Institutional (comprehensive health center, federally qualified health center, or other public facility)

In short, HPSAs may be urban or rural areas, population groups, or medical or other public facilities.

Medically underserved communities aren’t limited to very remote or deeply rural areas. Many areas throughout the country, including inner-city urban areas, qualify as MUAs, MUPs, and HPSAs.

The Office of the National Coordinator (ONC) 2015 Edition for Health IT Certification Criteria, Base EHR Definition, and Certification Program Modifications describe in detail the various criteria to help clinicians determine the best EHR system for their needs.