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“Do not wait for leaders; do it alone, person to person.”

-Mother Teresa

OBJECTIVES

  • Discuss various non-acute settings and their challenges for informaticists.

  • Review obstacles to adoption of health information technology within non-acute settings.

  • Understand the health IT industry's priorities for action with long-term post-acute care settings.

INTRODUCTION

Much of the attention surrounding health information technology (IT) focuses on the acute care setting; however, the healthcare industry serves a population that predominantly needs ongoing, chronic care. Patients requiring chronic care make up a significant percentage of the healthcare costs today, seeking care in many of the non-acute care settings discussed in this chapter. According to the Centers for Disease Control (2009), about 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness, and more than 75% of healthcare costs are due to chronic conditions. Many of these adults living with chronic conditions are Medicare beneficiaries, and significant gaps exist in care coordination within the traditional Medicare fee-for-service (FFS) payment structure. These gaps occur because of fragmented care, poor communication among providers in a variety of settings, and the lack of financial incentives to coordinate care (MedPac, 2012).

Payment reform driving the shift to paying for quality versus FFS will require all healthcare providers to have a fundamental change in mindset, culture, and attitude about volume and practice to eliminate redundant or unnecessary care and drive patients into the lowest possible cost setting in which quality care can be delivered. Managing a population's health across the entire continuum of care, keeping patients healthy through preventive and primary care services and out of acute care facilities whenever possible is the ultimate goal (York, Kaufman, & Grube, 2013).

If true healthcare reform is to be achieved, all settings where patients receive care must be connected and coordinated. One of the key requirements for the success of healthcare reform requires that the silos that exist across the healthcare settings be abolished. These silos lead to fragmented and redundant care that very frequently lowers the quality and increases the cost of care. Interoperability of health information technology, along with clinical informatics, plays a significant role in the removal of these silos and continues to show promise to revolutionize the way care is provided in all areas (Brailer, 2005).

The usage of Long-Term and Post-Acute Care (LTPAC) services is expected to grow rapidly as the population of the United States ages. LTPAC settings can range from complex care in long-term acute care hospitals (LTACH), inpatient rehabilitation facilities (IRF), or skilled nursing facilities (SNF) to simple supportive services in a community from assisted living facilities and home-based care. Patients receiving services from LTPAC providers typically are more complex, with multiple comorbidities resulting in frequent transitions between these settings. The frequent transitions of these patients require the sharing of relevant data in a timely fashion in ...

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