As more provisions outlined in the Affordable Care Act (ACA) take effect, many senior living providers are ramping up their adoption efforts of electronic healthcare records (EHRs). But only some providers are actually going a step further to connect those EHRs to larger networks in the interest of electronically sharing information with doctors, hospitals or other clinicians.

Interoperability, or participating in the secure exchange of patient data across systems and organizations, is achieved by connecting to a State-Certified Health Information Exchange (HIE) Service Provider. It’s only a matter of time before mounting state and federal pressure to connect EHRs to HIEs becomes too difficult for senior living providers to ignore, experts say.

The pressure right now to implement interoperable EHR technology is largely focused on those eligible for Centers for Medicare & Medicaid Services’ reimbursement, but providers across the spectrum of pay models run a serious risk of losing out on key partnerships should they choose not to adapt.

“Whether it’s a nursing home sharing information with a home health agency, or between the hospital and long-term post acute care provider, creating shared care plans and following up on the execution of those plans to optimize outcomes, reduce length of stay, or eliminate unnecessary hospital admissions via HIE will be key,” says Majd Alwan, senior vice president of technology and executive director of the LeadingAge Center for Aging Services Technologies (CAST).

In fact, grant programs, such as from the Office of the National Coordinator for Health Information Technology, are even targeting those non-eligible for CMS EHR adoption incentives to help them incorporate interoperability into their existing workflow.

The case for interoperability

Providers who use uncertified or incompatible EHRs as of 2018 could face reduced Medicare reimbursements under a bill introduced March 19 in both houses of Congress. And some states are already getting tough on providers to ramp up their interoperability efforts.

Minnesota has a 2015 interoperable EHR mandate for all hospitals and health care providers, effective the first of this year. While the state’s definition of health care providers excludes nursing homes, it applies to health care or medical care service providers who charge a fee and are eligible for reimbursement under the their medical assistance program.

The benefits of EHRs and interoperability compliance are “increased efficiency and quality outcomes, improved ability to avoid adverse events and timely access to information from your patients’ other providers,” according to the Minnesota Department of Health.

A recent case study from LeadingAge Center for Aging Services Technologies (CAST) demonstrates reduced readmission rates and an increase in referrals as a result of implementing an interoperable EHR and engaging in an HIE.

Since implementing the Vision Electronic Medical Record (EMR) platform from HealthMEDX in 2013, Illinois-based Lexington Health System has reduced readmission rates from more than 20% to 9.5% across all of its care settings, data show. In addition, some of Lexington’s skilled nursing settings have seen up to a 500% increase in referrals.

The increasing attention to interoperability is a sign of things to come, says Lori Alford, chief operating officer at Avanti Senior Living. The Woodlands, Texas-based assisted living and memory care provider is working with senior housing software management company Eldermark to launch an integrated electronic health care record-keeping system. The system will allow EHRs to be shared via HIE.

Implementing this technology from the get-go gives new providers, like Avanti, a leg up.

“We’re going to see more and more states set up health care exchanges,” Alford says. “The technology is here. The data is here. It’s just a matter of connecting and sharing it. With our partnership with Eldermark we are ahead of the game.”

Eldermark is certified in HIE, complies with standards set by the ACA, and will launch the new program this year. This system is focused exclusively on senior care providers and state vendors.

“The new day for senior housing will be how well you’re connected to the hospital and clinics — it’s all about readmission rates and everyone is being tracked,” says Craig Patnode, CEO for Eldermark. “This is intended to help assist the evolution of quality care that the ACA has laid out.”

Avanti has point of care systems streamlined with EHRs and Electronic Medication Administration Record and Scheduling (eMARS) at all of its six communities — four in the Lone Star State and two in Louisiana and more in the development pipeline.

“Unfortunately senior housing has been slow to the game — but that’s not stopping us,” she says. “Our residents often require frequent doctor visits and they have multiple doctors, diagnosis and medications. Being able to integrate information to the health care systems means our residents will have better care coordination.”

The challenge for smaller providers

For some smaller providers, the cost and technical expertise needed to implement EHR systems may be too much, Alwan says.

While 74.7% of the largest 150 not-for-profit senior living communities have adopted electronic medical records (EMR) and/or EHRs, according to the latest Technology Adoption Report released by LeadingAge Gold Partner Ziegler and CAST, the same trend is not seen among smaller providers, Alwan says.

“When you look at different, nationally representative surveys, you realize a general trend is that adoption of EHR technology is less among smaller providers who are not affiliated with a larger organization,” he says. “If you’re small and rural the chances of you having any EHR system is very low.”

While access to technology is an important part of connecting EHRs to a HIE, people sometimes focus too much on the technology aspect and overlook that what makes a HIE effective is having communication with care partners.

“That’s where it starts — agreeing on what type of data they would be interested in, what types of procedures/workflows health care partners expect,” he says. “When we have that part nailed down providers can find ways to exchange those pieces of information using the available technology today.”

Written by Cassandra Dowell