Interoperability in healthcare is achieved when all providers are connected and able to securely share patient information. While hospitals and physician practices continue to make progress—supported by federal incentives to implement electronic health record (EHR) systems—long-term and post-acute care (LTPAC) providers often remain at the margins. LTPAC Providers Include: Skilled nursing facilities (SNF) Nursing homes… Read More » Author information Rebecca McGavin Research Health Information Technology Scientist at RTI International Rebecca McGavin, MA, is a research health IT data scientist and program manager at RTI Internation, an independent scientific research institute. With 10+ years of experience in clinical and private/public health informatics and data policy. She specializes in data analytics and data visualization for multiple sectors including complex electronic health record (EHR) data, geospatial and site suitability analysis, data management, mixed-methods research, focusing on primary care, long-term and post-acute care and behavioral health sectors. She strives to make a difference through data, policy, informatics and planning. Her focus areas include health policy, care delivery, community health programs and intersections of data, engagement, and policy through visualization. | The post Interoperability Can Help Long-Term Care Bridge the Information Divide appeared first on The Medical Care Blog.

Interoperability in healthcare is achieved when all providers are connected and able to securely share patient information. While hospitals and physician practices continue to make progress—supported by federal incentives to implement electronic health record (EHR) systems—long-term and post-acute care (LTPAC) providers often remain at the margins.

LTPAC Providers Include:

• Skilled nursing facilities (SNF)
• Nursing homes
• Inpatient rehabilitation facilities (IRF)
• Long-term care hospitals (LTCH)
• Assisted living and senior living communities
• Home health and hospice agencies
• Continuing care retirement communities (CCRC)
• Adult day services
• Programs of All-Inclusive Care for the Elderly (PACE)

Skilled nursing facilities, nursing homes, assisted living, home health, and hospice agencies may use EHRs, but they still face obstacles to fully adopt and effectively use interoperable health information technology (HIT). Despite their crucial role in coordinating care for complex patients across settings, LTPAC organizations encounter persistent barriers to joining the broader, connected healthcare ecosystem.

EHRs are digital versions of patient’s medical history, aggregating diagnoses, medications, treatments, and test results over time to support comprehensive, coordinated patient care. Health IT is broader. EHRs are a component of health IT, but the scope of health IT encompasses an ecosystem of software, hardware, telehealth, mobile apps, health information exchange infrastructures, etc., all dedicated to creating, storing, analyzing, and sharing health information.  For LTPAC, both are essential, yet policies, market forces, and a compelling business case have not aligned to incentivize full-scale interoperable EHR and HIT adoption.

In 2010, Congress enacted the HITECH Act, which provided funding to hospitals and clinicians (e.g., physician practices) to adopt certified EHR technology and invest in health IT to improve interoperability – the sharing of electronic health record information electronically between providers and other entities. Yet, LTPAC providers were excluded from these incentives. Without policy levers, financial support, or statutory requirements, LTPAC settings took a patchwork approach to HIT, relying on business needs rather than mandates or support.

While nearly all LTPAC providers have some form of EHR capabilities, interoperability is limited. This digital divide between LTPAC and their care partners in hospitals and physicians matters and has the potential to widen. As medically complex and often vulnerable populations move between care settings, barriers to interoperable data exchange grow. LTPAC providers may recognize the importance of health IT but prioritize resources for immediate needs like staffing, compliance, and operations. The result is frustration and missed opportunities in care coordination, particularly for high-risk and medically fragile patients who rely most on seamless transitions.

Current State of Interoperable HIT

The COVID-19 public health emergency highlighted the shortcomings of the current fragmented health IT infrastructure. Limited interoperability hinders patient placement, timely patient assessment, data exchange, and coordinated care across sectors. Lessons from the Covid-19 pandemic highlight the challenges of the current approach and the need for seamless interconnectivity not only between hospitals and physician-offices, but also with public health and LTPAC.

Health IT and access to interoperable data via EHRs would benefit LTPAC and related settings with tools to better monitor signs and symptoms and coordinate responses with local and state public health departments. Telehealth and EHR-based clinical decision support tools are emerging to support LTPAC staff—often less trained and highly mobile—but broader, bidirectional exchange remains elusive. There are efforts to create a standardized assessment, but there are legislative limitations and tensions associated.

Technology is present, but not always implemented to its full potential; many rural and under-resourced sites lack even basic broadband or connectivity. Hospitals and physician practices benefitted from past EHR incentives, leaving LTPAC organizations struggling to make the business case for costly upgrades. incentives for adoption by LTPAC settings. Overall, the challenges and opportunities of adopting EHRs are complex, and cost and burden need to balance against the potential benefits for patients.

Barriers to Adoption

Over the past fifteen years there have been consistent themes on barriers and facilitators of adoption and use of health IT and electronic data sharing. However, little has moved the needle toward widespread use of interoperable health information exchange by LTPAC providers. The value proposition and business model for LTPAC data sharing do not organically exist today. Many LTPAC providers struggle to prioritize EHR optimization, and few have available resources for training and workflow changes that utilize interoperability features.

Primary barriers discussed across researchers, providers, technology vendors, payers, consultants, health information networks, and policy leaders fall into three categories:

• Structural Barriers: LTPAC organizations often face significant obstacles to advance interoperability. The absence of strong regulatory mandates and financial incentives for these settings compared to acute and ambulatory care results in limited prioritization of health IT investments. High costs for acquiring, implementing, and maintaining technology can be prohibitive, especially for organizations operating with tight margins. As a result, technology adoption tends to vary greatly and is often driven by immediate local needs rather than by coordinated, system-wide strategies, leading to a fragmented landscape that hinders widespread connectivity.
• Operational Barriers: Operational challenges play a key role in limiting interoperability within an LTPAC organization. Many providers struggle with inadequate or unreliable broadband access, especially in rural areas, and with fragmented EHR systems that lack seamless integration across clinical support modules. Additionally, organizations frequently lack standardized workflows and best practices to maximize the potential of their health IT systems, resulting in inconsistent and often suboptimal use of available technology for health information exchange.
• Human Resource Challenges: Human resource issues further complicate improving interoperability. Persistent high staff turnover impacts workforce stability, while limited training opportunities leave front-line staff unprepared to fully use and optimize health IT systems. Additionally, the lack of leadership committed to championing health IT initiatives means many lack the organizational will and guidance necessary for sustained progress in interoperability adoption.
• Market and Policy Issues: Market dynamics and policy limitations also create significant barriers in LTPAC. The lack of validated models demonstrating return on investment for health IT adoption makes it difficult for organizations to justify expensive technology upgrades. Few payer incentives exist for LTPAC providers under current reimbursement and managed care models, and siloed regulatory requirements create complexity and administrative burden without increasing interoperability. These factors limit the pace of HIT advancement in LTPAC. Without clear policy drivers and market incentives, LTPAC organizations have not seen widespread movement toward full interoperability.

Progress toward interoperability is possible if key facilitators are addressed. Stakeholders—including policy makers, public health leaders, HIE networks, and LTPAC providers—consistently point to targeted policy incentives, increased federal funding, and the establishment of dedicated working groups as drivers for advancing health IT and EHR upgrades. Effective communication strategies are needed to raise awareness and educate providers on interoperability standards, benefits, and best practices. Progress also hinges on the creation of interoperability standards tailored for LTPAC, as well as the implementation of digital quality measures, modernization of public health reporting requirements, and deployment of interoperable data sharing with payers.

There are multiple tangible steps that LTPAC organizations can take. Participation in trust frameworks like the Trusted Exchange Framework and Common Agreement (TEFCA) and Carequality will increase information sharing with HIEs. Adopt and use The PACIO (Post-Acute Care InterOperability) Project implementation guides for sharing information with care partners using the HL7 FHIR interoperability technical standard. This standard is increasingly used by hospitals, physician practices and in the future payers. Building comprehensive care coordination models with care partners is another effective approach as transitions between care settings grow more frequent and complex.

Despite broad agreement about the importance of interoperable EHR adoption for LTPAC, incentives are rare, and the sector remains constrained by a lack of standardization and specific regulatory requirements. Challenges around data ownership and willingness to share persist. Increased use of information-sharing standards and targeted requirements will be essential for moving the needle toward broader interoperability in LTPAC.

Conclusion and Next Steps

Interconnectedness is essential for high-quality, efficient care. When LTPAC providers cannot send or receive critical health information, care gaps widen for vulnerable patients—older adults, those with chronic illness or disabilities, and individuals at social risk. The COVID-19 pandemic demonstrated how access to interoperable data is instrumental to monitor symptoms, coordinate with public health entities, and respond effectively.

As the healthcare system increasingly moves toward value-based care and data-driven decision-making, including LTPAC in interoperability priorities is crucial. LTPAC providers sit at the intersection of complex policy and market forces. Disparities in HIE participation and capability will not close without intervention. Addressing the information divide will require coordinated action:

• Convene cross-sector working groups to identify and build consensus on interoperability priorities for LTPAC
• Expand financial and policy incentives to spur adoption and optimization of interoperable HIT systems, beyond the hospital/ambulatory setting
• Modernize public health reporting requirements to integrate LTPAC data and workflows
• Strengthen broadband infrastructure to support all LTPAC settings, regardless of geography
• Promote professional development and workforce retention strategies to empower staff with health IT proficiency

It is clear that LTPAC must be part of the interoperability conversation. Without strategic interventions, market forces alone will not overcome the entrenched barriers. Policy, leadership, and investments are needed to bridge the information divide and ensure that LTPAC providers and patients reap the benefits of 21st-century health information technology.

Vulnerable populations deserve seamless, safe, and coordinated care. By bringing together people, processes, and technology, stakeholders can transform the patchwork of LTPAC health IT into a solution for efficiency and improved outcomes for all.

Author information

Rebecca McGavin

Research Health Information Technology Scientist at RTI International

Rebecca McGavin, MA, is a research health IT data scientist and program manager at RTI Internation, an independent scientific research institute. With 10+ years of experience in clinical and private/public health informatics and data policy. She specializes in data analytics and data visualization for multiple sectors including complex electronic health record (EHR) data, geospatial and site suitability analysis, data management, mixed-methods research, focusing on primary care, long-term and post-acute care and behavioral health sectors. She strives to make a difference through data, policy, informatics and planning. Her focus areas include health policy, care delivery, community health programs and intersections of data, engagement, and policy through visualization.

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