At the turn of the 20th Century, the USA was classified as the country with the highest healthcare costs and ranked the lowest in results. We were stuck in a fee for service (FFS) Healthcare Delivery system somewhat controlled by a “Get Sick; Get fixed; Get Paid” mentality. The population was increasing in number and aging in general. The system required change. And, technology was improving with leaps and bounds, especially in the field of Healthcare Software.  

On January 4, 2004 in President George W Bush’s State of the Union Speech he announced an ambitious goal: “Within the next 10 years, electronic health records will ensure that complete health care information is available for most Americans at the time and place of care, no matter where it originates. Participation by patients will be voluntary.”  

Four short months later, on April 27, 2004, health care leaders gathered at the Hubert H. Humphrey Federal Building in Washington DC for the HHS Secretary Thompson Press Conference to announce the intent to implement President’s Bush’s Executive Order (EO) 13335 to digitize healthcare. The audience was made up of representatives of Acute Care Hospitals and Physician Practices, and two individuals from long-term-care; Larry Lane, a representative from AARP, and John Derr, RPh, FASCP, Executive VP of the American Health Care Association (AHCA)/National Center for Assisted Living(NCAL).

 At the end of the presentation and during Q&A, John went to the microphone and asked Secretary Thompson: “This Press Conference has had a Hospital and Physician focus, what about Long-Term Care?We want to be involved.” His answer was: “John, you coordinate Long-Term Care IT.”

 Although his answer could not be considered official, John took the challenge and enlisted Newt Gingrich and the Center for Transitions of Care to form the Long-Term Care Living Task Force. They recruited many top LTC Executives, knowing that all Providers of LTC had to have a role in bringing Information technology (IT) to the LTC sector. 

In 2005 John met with representatives from The American Association of Homes and Services for the Aging (AAHSA now titled LeadingAge)[1] and American Health Information Management Association (AHIMA)[2] Together these three organizations formed the LTC Health IT Collaborative. The Collaborative is an informal organization with the objective to represent all Providers, Vendors, and Ancillaries in LTC[3]. The Collaborative membership quickly expanded to include all the Provider and Ancillary Associations in LTC plus representatives from ONC and CMS. This is a slide from2015 Summit of the Collaborative members.

 As the US Population ages and we look at achieving Person Centric Care the full Spectrum of care must be considered. There is a lack of understanding of the Providers of care especially in Aging and Chronic Care. For this reason, I put together a graphic (see below) of the LTPAC market segment in early 2005. It was used to educate legislators and regulators.

 On February 17, 2009 President Obama’s Administration expanded and funded EO 13335 by passing the HITECH Act. The HITECH Act was part of his American Recovery and Reinvestment (ARRP) Act.

“The HITECH Act supports the concept of meaningful use (MU) of electronic health records (EHR),an effort led by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). HITECH proposes the meaningful use of interoperable electronic health records throughout the United States’ health care delivery system as a critical national goal.”

LTPAC was left out of the ‘meaningful use’ funding provided within the HITECH Act. Why this valuable sector of healthcare was omitted from any financial support is uncertain. In subsequent years this legislative omission has had many negative ramifications.

 LTPAC was still brought into discussions by those elected to implement HITECH, including within the wonderful members of the Federal Standards Committee. This committee was chaired by Dr. John Halamka, MD and Dr. Johnathan Perlin, MD.  I was a member of the original Federal Standards Committee for 7 years. Although I could not bring up LTPAC issues in open forum, these were discussed outside of public hearings. During this time and since then, the Collaborative has actively pursued LTPAC involvement with the ONC. We understand the story of interoperability and the role of LTPAC within healthcare.

In early 2015at one of the Federal Standards Committee meetings I was asked by ONC Director Karen DeSalvo, MD (Currently Medical Director at Google) to provide a brief on LTPAC. I asked the members of the LTPAC Health IT Collaborative to assist me inwriting the paper: “Health Information Technology Use and Value Delivered by the Long-Term and Post-Acute Care (LTPAC) Sector[4]”.In this paper, we outlined the five distinct categories of Valued Quality Care Coordination (VQCC) that differentiated the LTPAC sector and highlight how our holistic approach to care benefits the individual.  

On April 29, 2022, on the 18th anniversary of EO 13335 and the formation of the Office of National Coordinator for Health IT (ONC), Deputy National Coordinator Steven Posnack released a statement reflecting on the agency’s past achievements that advanced health IT[5].“In the last 18 years, the agency has accomplished its fair share of remarkable events, Posnack added. One of the agency’s most notable achievements was introducing the 2009 Health Information Technology for Economic and Clinical Health (HITECH) act. “This dramatic change in what is arguably the most complex sector of our economy is a mammoth achievement,” Posnack stated.

As Steve said, the ONC made a major impact on Interoperability and the Electronic Health Record. This was accomplished in LTPAC in spite of not receiving any funding from the 2009HITECH Act. The gains were due, in large part, to the LTPAC Health IT Collaborative and its member Organizations and Individuals working together with ONC to do what is right for the Spectrum of Care and the Person.

 In 2022 the National Academies of Science, Engineering, and Medicine (NASEM) released a 500+ Page Report Titled: The National Imperative to Improve Nursing Home Quality[6]. There are 7 Committees in this two-year project. The Seventh Committee is chaired by two Collaborative members: Dr. Terry O’Malley, MD and Greg Alexander, RN, PhD.

 From the day of the release of EO 13335 some 18 years ago, the LTPAC Health IT Collaborative has worked to provide CMS/ONC with input on the role of LTPAC Providers, Vendors, and Ancillaries in the Person’s Spectrum of Care. The Collaborative and its members have written quantifiable documents to Legislators, CMS, and ONC encouraging incentive legislation with no funding result. Even so, we continue to lead and encourage the improvement of the technology infrastructure within LTPAC Sector of Care. Already, there is secure interoperability in partnership with acute care hospitals and physicians, within many of the LTPAC settings.  

 Since the formation of the LTPAC Health IT Collaborative in 2005, and with 4 changes in Whitehouse administration during this time, the Collaborative has accomplished much. We continue to work in cooperation with Congress, ONC/CMS and the Providers, Vendors, and Ancillaries of the LTPAC Sector of Care. We are experts collaborating on health IT issues for improved coordinated quality care in LTPAC. We will continue to be the Collaborative voice of health IT experts and we will continue to incorporate the five VQCCs that make the LTPAC sector both different, and very important.

[1] Peter Kress, CIO Acts Living Communities

[2] Michelle Dougherty, RTI

[3] The acronym LTC, which was synonymous with Skilled Nursing Facilities (SNFs) was changed to Long-Term & Post-Acute Care (LTPAC) by my CCHIT Committee to recognize all of the Providers of LTC.

[4] https://netforum.avectra.com/public/temp/ClientImages/NASL/f5082efa-0e8a-4a54-a032-d6a09f2252f4.pdf

[5] https://ehrintelligence.com/news/onc-celebrates-18-years-of-advancing-health-it

[6] https://nap.nationalacademies.org/read/26526/chapter/1

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