Addressing the digital divide in post-acute and long-term care
While hospitals and primary care benefited from massive federal investments and incentives to adopt electronic health records (EHRs), post-acute and long-term care (LTPAC) providers were left out.
As a result, these essential care settings are stuck trying to interoperate in a world that was never built with them in mind. And that’s a problem for everyone.
Skilled nursing facilities, home health agencies, hospices, assisted living communities, and other LTPAC care settings serve millions of older adults and people with complex needs. Yet many still rely on paper records, faxes, and manual workarounds because the policies and technology haven’t given them a viable alternative.
If we want to deliver high-quality, patient-centered, integrated care, we need a digital health strategy that’s built for all care settings. One that recognizes the diversity of provider types, reduces administrative burden, prevents fraud, and accelerates smarter technology adoption.
In this blog, we explore how we can get there.
Expand the definition of digital health inclusion
Healthcare interoperability isn’t just about hospitals and primary care clinics anymore. True interoperability means enabling seamless, secure data exchange across every setting a patient or resident might touch, including post-acute and long-term care.
But LTPAC providers weren’t included in the original HITECH Act incentives, and that exclusion has had lasting effects. Today, many skilled nursing facilities and home-based care providers operate with fragmented systems that don’t speak the same digital language. Some lack EHRs altogether. Others have invested in technology but still struggle due to outdated certification requirements.
A more inclusive digital health strategy would level the playing field. It would extend funding, support, and policy incentives to all care settings. It would empower LTPAC providers to use digital tools that fit their workflows and workforce tools, not force them to adopt systems that were never designed for their needs.
Consider FHIR-based solutions
The current system prioritizes certified EHR technology (CEHRT), but that framework was never conceived with post-acute provider settings in mind. CEHRT requirements are often rigid, costly, and misaligned with the day-to-day operations of LTPAC organizations. For example, the quality measure module does not include or even align with the LTPAC quality instruments like the OASIS and MDS.
The answer? Shift the focus from heavy-handed module requirements that can stymie innovation to API-first, FHIR-based solutions.
FHIR APIs support flexible, real-time data sharing without forcing providers to rip and replace existing tools. This approach reduces costs, opens the door to innovation, and allows organizations to adopt purpose-built apps and platforms that enhance care.
Technology adoption should be practical, scalable, and fit-for-purpose. A flexible, standards-based approach makes that possible.
Support TEFCA as the national framework for data exchange
The Trusted Exchange Framework and Common Agreement (TEFCA) is designed to create a unified network for health information exchange across the country. But for it to deliver on that promise, LTPAC providers must be part of the conversation.
Unlike traditional regional health information exchanges (HIEs), which are often siloed and difficult to navigate, TEFCA offers a scalable, plug-and-play model that can simplify connectivity across care settings. It gives providers of all sizes access to the same national infrastructure, no matter where they’re located.
To truly unleash its potential, TEFCA needs to incorporate tools like FHIR API directories that enable easier access for app developers, small vendors, and non-traditional provider types. Without this, innovation will remain bottlenecked by access barriers and complex activation processes.
Done right, TEFCA could finally enable seamless, secure data sharing between hospitals, skilled nursing facilities, home health agencies, and more.
Expanding engagement with LTPAC providers, health IT vendors, and industry experts early in the policy-making process is key.
When policy is built in partnership with the people who will actually use the tools, the result is more relevant, more adoptable, and more impactful.
Take innovation mainstream
There are plenty of exciting pilot programs, like the PACIO Project, that demonstrate how FHIR-based standards can streamline documentation, reduce burden, and improve care transitions in skilled nursing and home-based care. But without regulatory backing, these pilots never scale.
Innovation needs to be introduced into mainstream use by potentially creating incentives, removing barriers, and making it easier for providers to say “yes” to smarter digital tools.
Build flexibility into alternative payment models
New payment models like GUIDE (Guiding an Improved Dementia Experience) are a step toward value-based, resident- and patient-centered care. But if they’re built on outdated assumptions about technology, they risk excluding the very providers they aim to support.
Requiring full CEHRT participation in GUIDE, for example, could disqualify home health agencies and other non-traditional providers that don’t have certified systems but do deliver critical care.
Instead of imposing rigid requirements, CMS should allow fit-for-purpose solutions that meet the intent of the program without unnecessary complexity. If the goal is better outcomes and coordinated care, let’s prioritize the tools that get us there.
Reduce fraud, cut costs, and improve care
A more inclusive digital health exchange doesn’t just benefit providers. It helps reduce fraud concerns by creating clearer digital trails. It cuts administrative burden by automating manual tasks. And it improves resident and patient outcomes by enabling coordinated, connected care across the continuum.
Smart use of digital tools and workforce tools can streamline documentation, flag inconsistencies in billing, and surface actionable insights for care teams. Artificial intelligence trends in healthcare, such as predictive analytics and smart triage, are making it easier to target resources where they’re needed most.
But none of this works without a solid, interoperable foundation.
MatrixCare is committed to shaping the future of connected care
We believe the digital exchange should include every provider regardless of size, setting, or certification status.
We’re empowering providers across post-acute and long-term care with flexible, interoperable solutions that help them interoperate more easily, share data securely, and improve patient outcomes. From skilled nursing to home health and hospice, our tools are built to fit the needs of real-world care delivery.
As we move toward a more connected, more interoperable healthcare system, we’re committed to working with CMS, ONC, and ASTP to help ensure that post-acute and long-term care providers are not left behind.
If you’re a provider, technology partner, or policymaker interested in shaping the future of digital care, we welcome the opportunity to collaborate.
Request a demo today for a closer look at MatrixCare.
Chris Pugliese
Chris Pugliese, Director of Product Interoperability, ResMed SaaS. Chris has spent the last decade working with post-acute technology and EMRs, and the last 5 years focused on interoperability. His strength is enabling technology, as well as educating on the growing importance of interoperability and its benefits to the post-acute care settings. In a short time, Chris has become a leader, spearheading integration and interoperability initiatives within and outside of MatrixCare. Recent industry committee roles and responsibilities include: Leadership Team Member for the Post Acute Interoperability Work Group (PACIO), Technical Lead for the Functional Status Subgroup for the PACIO initiative – developing FHIR Profiles for Functional Status, CommonWell Health Alliance Use Case Committee member, CommonWell Health Alliance Specification Workgroup member
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