Plan to Improve Electronic Health Record Use Needed, Watchdog Says

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By Mike Stankiewicz

The HHS should develop a comprehensive plan to improve the use of electronic health records for post-acute care patients, a government watchdog said.

The Government Accountability Office said in a report made public Feb. 27 that issues like increased costs and lack of access to technology deter the use of electronic health records in some post-acute settings. EHRs contain a patient’s clinical data and treatment information. The records allow post-acute care patients to receive quicker, more precise care, but are not always used.

“Using electronic health records is important when patients transfer facilities, which happens when they leave the hospital and are moved to a post-acute care facility,” Thomas M. Leary, vice president of government relations at HIMSS North America, a not-for-profit organization focusing on health IT, told Bloomberg BNA. “EHRs allow better safety and time efficiency when transferring patients. As more Americans make their way to post-acute care, more EHRs are needed.”

There are several factors that deter EHR usage among post-acute care settings, which is where patients sometimes go after leaving a hospital, the GAO report found. Some facilities don’t have the financial resources to implement and maintain an EHR system and lack staff expertise to manage the system. Implementation of EHRs can also cause disruptions and changes to daily work activities.

According to the GAO, the Department of Health and Human Services has established four efforts related to improving post-acute care settings: Medicaid matching funds, Office of the National Coordinator for Health Information Technology electronic record certification for post-acute care, financial awards and a CMS data mapping and data element library.

Not Measuring Effectiveness

Despite making EHR promotion in post-acute services a goal, GAO’s report (GAO-17-184) found the HHS failed to assess the effectiveness of these efforts. The report also determined the HHS will not achieve its electronic health record goals because the agency has not laid out specific actions and steps to increase EHR use.

“They do not have a long-term, comprehensive plan, which our report suggests they implement,” Carolyn L. Yocom, director of health care at the GAO, told Bloomberg BNA Feb. 28. “They will not be able to reach their goals until they have more specifics on how to get EHRs into more providers.”

The GAO recommended HHS Secretary Tom Price direct the Centers for Medicare & Medicaid Services and the ONC to develop and implement a comprehensive plan to increase EHRs and other electronic exchange of health information usage in post-acute settings, and to assess those attempts.

HHS Response

In a written response to the report, the HHS agreed with the GAO’s recommendations and said the agency was beginning to evaluate problems in EHR implementation.

The HHS said the first step in making an evaluation plan is to establish baseline metrics to assess the current situation.

“It is important to understand how physicians and hospitals are exchanging information with post-acute care providers.” the HHS’s response said. “To meet this need, HHS is conducting surveys to examine the extent to which hospitals and office-based physicians exchange electronic health information with providers in post-acute care settings.”

The ONC is planning to survey post-acute providers to obtain baseline data on the rates of EHR adoption this year. The survey will estimate how many post-acute care providers have a certified EHR, can use electronic health information and have health information electronically available.

However, the GAO said those surveys will not assess the effectiveness of the HHS’s efforts to promote electronically exchanged health information and that most efforts lack specific plans for evaluating their progress.

The agency said it does not have adequate funding to expand the survey and ask providers what prevents them from adopting EHRs.

The HHS also said it intends to develop comprehensive planning to achieve its goal, including working with stakeholders to advance the use of EHRs in post-acute settings and to address barriers and external factors.

Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.), along with four other GOP senators, requested the report by GAO, which began the evaluation in February 2016.

Alexander has been a vocal proponent of making the federal government require doctors and hospitals to create electronic health records systems.

To contact the reporter on this story: Mike Stankiewicz in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

The GAO's report is at

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