Long-Term and Post-Acute Care

As the U.S. population ages the demand for long-term and post-acute care (LTPAC) services are expected to grow. While LTPAC services are generally attributed to the elderly, these services also include younger persons with disabilities. LTPAC services cover a wide array of services ranging from institutional services provided in specialty hospitals and nursing homes, to a variety of home and community based services. Transitions across acute, post-acute, and long-term care settings are common and can be costly. Health information technology can support advancements in care coordination and sharing of essential health information as individuals transition across care settings such as LTPAC. Improved communication across settings and with the interdisciplinary team enabled by health IT can create efficiencies that lead to reductions in hospital readmissions, shorter lengths of stay, decreased costs and improved health outcomes.

Adoption and Implementation

LTPAC providers are increasingly adopting health IT to improve continuity of care and care delivery.  In 2017, ONC published data on EHR adoption and Interoperability in Skilled Nursing Homes.

LTPAC Data Exchange

Interoperable exchange of essential health information is a key enabler to improved communication during transitions in care and to inform longitudinal, person-centered care planning.  The Interoperability Roadmap, Interoperability Standards Advisory, ONC 2015 Certification, and IMPACT Act of 2014 can support LTPAC progress with interoperability.

The CMS Data Element Library, an online resource, developed in collaboration with ONC, allows users to search and obtain reports on CMS post-acute care assessment contents, including mapping to nationally recognized health IT standards.

Medicaid HIE Federal Funding

Although LTPAC was not eligible to receive funding as part of the Medicare and Medicaid EHR Incentive Program, there are now opportunities through Medicaid to support states in their initiatives to expand interoperability and data sharing across settings.

Education Module for Long-Term and Post-Acute Care

To help demonstrate the value of health IT, ONC developed an educational module that contains resources and information for LTPAC providers. In addition, the Health IT Playbook has implementation resources for LTPAC providers.

Community Based Services

As states continue to expand home and community based alternatives to institutional long term care, there is recognition in the value of sharing person centered data to better integrate health care and humans services to support an individual’s independence and quality of life.

Learn more about toolkits and standards work underway to advance these goals.