The Office of the National Coordinator for Health Information Technology Playbook

Section 9

Care Settings

In this section

Learn how to:

An organization’s approach to health IT varies by care setting and related care delivery needs. Although the primary audience for the Playbook is ambulatory care practices, this section includes tools and resources to support a variety of care settings with unique considerations for health IT implementation and adoption.

This section offers resources for:

  • Long-term and post-acute care (LTPAC)
  • Rural practices
  • Underserved care settings

As the U.S. population continues to age, the number of people 65 years and older will more than double from 40 million to 89 million by 2050 — and the demand for long-term post-acute care (LTPAC) services will grow.

LTPAC covers a wide array of services and settings — including complex medical care in long-term care hospitals, rehabilitative services in skilled nursing facilities, and supportive services in home- and community-based settings. Transitions across LTPAC settings are common and can be costly.

Patients who receive LTPAC services often have a wide range of health conditions and more complex, chronic care needs. These patients frequently receive care from multiple care settings and require ongoing communication and coordination between each service point.

How health IT helps LTPAC gives LTPAC care teams the opportunity to share essential health information quickly and securely — particular during patient transitions from one care setting to another. supports patient-centered care and increases patient and family engagement. By sharing information, care teams can improve clinical decision making. And ultimately, health IT can help those providing care to LTPAC patients improve health outcomes and reduce health care cost.

As electronic health record (EHR) adoption and interoperability continues to advance in both acute and ambulatory care settings, it’s increasingly important for LTPAC care teams to adopt EHR systems capable of exchanging interoperable health data that can improve the quality of care. For more information on actionable tools to assist in planning for and optimizing the use of health IT, check out the for nursing homes, home health and care coordination.

Educational Module for Long-Term and Post-Acute Care Providers

Long-term and post-acute care clinicians can use health information exchange to address patient engagement challenges and improve accuracy of patient data. This module will help you understand the value of integrating health IT and health information exchange in your setting.

Go to the Educational Module for Long-Term and Post-Acute Care Providers [PDF - 3.2 MB]

Educational Module for Long-Term and Post-Acute Care Providers

EHRs for LTPAC: A Primer on Planning and Vendor Selection

EHRs for LTPAC: A Primer on Planning and Vendor Selection 2016

Helps aging services organizations plan for and choose the best EHR system for their needs and includes a vendor selection tool

Who it’s for
LTPAC clinicians and LTPAC practice managers

When it’s used
To plan for and select an EHR system

EHR Case Studies in LTPAC

Electronic Health Record (EHR) Clinical Decision Support, Interoperability, and Health Information Exchange

Case studies that describe real-world examples and best practices of EHR implementation in LTPAC

Who it’s for
LTPAC clinicians and LTPAC practice managers

When it’s used
To plan and implement EHRs in the LTPAC setting

Almost 20% of the U.S. population lives in a rural area. Critical Access Hospitals (CAHs) and other small, rural hospitals provide vital services and often serve as the foundations of rural health care delivery systems.

People living in rural areas face barriers to accessing health care services, such as traveling long distances. Rural hospitals — often the only local source for patient care — typically offer additional services that residents couldn’t otherwise access.

Rural hospitals are expected to:

  • Improve access to services — including urgent care services — and meet health needs in isolated communities
  • Engage communities in rural health care system development
  • Develop collaborative delivery systems as hubs of rural health care
  • Create transitions of care coordination to align with urban health care systems
  • Serve as subject matter experts and coordinators for clinicians, patients, and staff

How health IT helps rural clinicians holds great potential for rural communities. Clinicians benefit especially from EHR systems, which can transform how they collect, manage, store, use, and share health information.

Better care coordination and instant access to patient information can improve health care quality and patient outcomes.

For example, health IT can help rural communities:

  • Access and coordinate care
  • Improve disease surveillance
  • Target health education
  • Compile regional data

An EHR system also creates an improved mechanism to complete specialty referrals, which is valuable when communities have limited access to specialists.

In rural areas with long distances between clinics — and where specialists are few and far between — health IT can also:

  • Give health care clinicians instant access to information to make timely, vital decisions and save lives
  • Decrease travel time for patients and their families
  • Help rural hospitals use remote clinicians, pharmacists, and staff to improve and extend access
  • Simplify efficient transfer to other facilities for vital services
  • Facilitate post-hospitalization care close to patients’ families and primary care clinicians

Rural Health Resources

Provides resources for CAHs and small rural hospitals to learn more about the benefits of health IT, and to take the first step toward implementation and attaining Meaningful Use; also includes information about implementation support and funding opportunities

Who it’s for
CAHs, small rural hospitals, and health IT implementers

When it’s used
To plan for — and to use during — an EHR implementation

Download Federal Resources to Help Rural Providers Achieve Meaningful Use [PDF - 245 KB]

EHR Implementation Issues Unique to Rural Settings

Provides information about barriers unique to EHR implementation in rural health; also presents, in tabular form, the implementation issues and corresponding rural-related health IT resources

Who it’s for
Rural practices and health IT implementers in rural settings

When it’s used
To plan EHR implementation in a rural setting, or to assist with issues related to EHR implementation in rural settings

Visit the EHR Implementation Issues Unique to Rural Settings website

As defined and designated by the Health Resources and Services Administration (HRSA), medically underserved communities consist of:

  • Medically Underserved Areas (MUAs)
  • Medically Underserved Populations (MUPs)
  • Health Professional Shortage Areas (HPSAs)

MUAs and MUPs refer to areas or populations that have insufficient primary care clinicians, high infant mortality, a high poverty rate, or a large older-adult population.

MUAs may include:

  • An entire county
  • A group of contiguous counties
  • A group of county or civil divisions
  • A group of urban census tracts with a shortage of personal health services

MUPs may also include groups of people within an area who face barriers to health care including:

  • Economic
  • Cultural
  • Linguistic

HPSAs lack sufficient clinicians for primary medical, dental, or mental health services and may be:

  • Geographic (a county or service area)
  • Demographic (low-income population)
  • Institutional (comprehensive health center, federally qualified health center, or other public facility)

In short, HPSAs may be urban or rural areas, population groups, or medical or other public facilities.

Medically underserved communities aren’t limited to very remote or deeply rural areas. Many areas throughout the country, including inner-city urban areas, qualify as MUAs, MUPs, and HPSAs.

The Office of the National Coordinator (ONC) 2015 Edition for Certification Criteria, Base EHR Definition, and Certification Program Modifications describe in detail the various criteria to help clinicians determine the best EHR system for their needs.

2015 Edition Final Rule: Addressing Health Disparities

2015 Edition Final Rule: Addressing Health Disparities

Criteria for capturing patient health information to help clinicians better identify the populations they serve

Who it’s for
All clinicians, practice staff, and EHR vendors

When it’s used
To learn more about capturing health disparities data

Download 2015 Edition Final Rule: Addressing Health Disparities [PDF - 627 KB]

Content under development

We plan to expand this section over time, so check back periodically for additional resources. Have suggestions for making the Playbook better? Please share your feedback with us.

Section 9 Recap

Use health IT to support a variety of care settings.

  • Support long-term and post-acute care
  • Improve care in rural areas
  • Reduce health disparities

Join the conversation.

Do you have a tip or suggestion for using health IT to support a variety of care settings that's worked well in your practice? Share it here!

Content last updated on: May 31, 2019