On April 27, 2004, the President signed Executive Order 13335 [1] announcing his commitment to the digitation of health information technology (IT) to “improve efficiency, reduce medical errors, improve quality of care, and provide better information for patients and physicians.” As the Executive VP of AHCA/NCAL, I attended the Press Conference where Secretary of HHS Tommy Thompson’s announced this groundbreaking Executive Order. [1] announcing his commitment to the digitation of health information technology(IT) to “improve efficiency, reduce medical errors, improve quality of care, and provide better information for patients and physicians.” As the Executive VP of AHCA/NCAL, I attended the Press Conference where Secretary of HHS Tommy Thompson’s announced this groundbreaking Executive Order.
As far as I know, there was only one other long-term care association representative in attendance. He was from AARP. After about an hour of Secretary Thompson discussing how digitizing healthcare would benefit Hospitals and Physicians, there was a Q&A period. I went up to the floor microphone and made the following comment: “Mister Secretary, we appreciate what you and your department have done for Long-Term Care. I do understand the focus on Acute Care but, Long Term Care (LTC) would like to participate in the Program to digitize healthcare.” He replied: “Okay John, you coordinate Long-Term Care.” I responded with a thank you and started to return to my seat. He then said: “John, did you hear what I said?” I returned to the microphone and answered: “Yes sir, I am a Retired Navy Captain and when the boss asks for me to do something, I just say Aye Aye and do it.” The audience laughed and I sat down.
This was an informal request to make an assignment because the HHS Secretary cannot establish a group without Congressional approval. At the time, within AHCA/NCAL we were working with the ex-Speaker of the House, Newt Gingrich, and his Center for Health on a Strategic Plan. Ex-Secretary Gingrich and I met after the Press Conference, and we decided that I could not coordinate LTC Health IT alone. Together we formed the Long -Term Living Task Force. After a year of working on forming the Task Force we determined that politics had entered into the forming of the Task Force. An additional complication was that the Bird Flu Pandemic had been identified. This led to dropping the idea of a task force. Secretary Gingrich and the Center for Health Transformation took a leading Think Tank role during that Pandemic.
In implementing the EO, David Brailer, MD was appointed the first Director of the Office of the National Coordinator (ONC) leading the new Program. Shortly after the Press Conference I visited with Dr. Brailer to determine how Long-Term Care could assist in achieving ONC Objectives. Dr. Brailer was very supportive of our initiative but concluded that he first had to get the Hospitals and Physicians on Board with digitation before he could focus on LTC. I told him: “Although we are disappointed, I cannot disagree with your priorities.” I went on to say: “When you are ready to work with LTC we will be ready to work with you and ONC’”
At that time (2004) Congress and the Regulatory Agency-Center for Medicare and Medicaid Services (CMMS) were using the initials “LTC” to connote “Long-Term Care”. This term was routinely used in reference to the care of a licensed Skilled Nursing Home (SNF). At the time, I concluded that our Government did not understand the full extent of what it meant to provide Long-Term Care. The sector was not made up of just SNFs and we had to train the agencies and other influencers on LTC to ensure everyone knew that LTC was not hospitals and physicians.
It was important for them to recognize that LTC did more than Acute Care and that we were Person holistic, longitudinal, and we didn’t provide just a Continuum of Care (A start and finish) but a full Spectrum of Care.
In 2005 I approached LeadingAge/CAST (Peter Kress, CIO ACTS Retirement-Life Communities) and AHIMA (Michelle Dougherty now of RTI) to assist me (AHCA/NCAL) in forming an organization that would work together with CMS/ONC to oversee LTC Health Information Technology. That year, we formed what is now titled the LTPAC Health IT Collaborative (see www.LTPACHIT.org Website for more information). In the first year the Membership was expanded to a Policy Representative from the majority of the LTC Providers, Vendors, Medical Directors, Consultant Pharmacists, Therapists, PACE, Home Care, etc. Present day membership is over 20 Associations and with listening representation from CMS, ONC and other Government Agencies.
Since the formation of the Collaborative in 2005 Members meet regularly on a weekly basis In 2005, we held our first of 16 Annual Summits.
In Subsequent years when I was a Member of the Certification for Healthcare Information Technology (CCHIT) and then on the Board of Trustees of CCHIT I formed a committee of LTC Health Information Collaborative Members to examine what we should call our sector of care in order to obtain a better understanding of the care we provide to a Patient Person. There are at least three major Sectors of care besides LTPAC. There is the Acute Sector (Hospitals) and Ambulatory Sector (Physicians). The result of this CCHIT sub-Committee was to change from Long-Term Care (LTC) to amore descriptive term of Long-Term and Post-Acute Care (LTPAC). This would embrace the Spectrum of Care described in the Illustration.
From 2005 until the passing of the 2009HITECH ACT, the LTPAC Health IT Collaborative worked in parallel with CMS/ONCs Staffs on including LTPAC in the interoperability strategies. In 2009 the HITECH Act was passed as part of the American Recovery and Reinvestment Act. The HITECH ACT created the term of “Meaningful Use” for Hospitals and Physicians and left LTPAC Providers out of the Legislation and funding program.
Omitting LTPAC from the HITECH Act will continued in Part 2 of this BLOG
January 1, 024 John F. Derr, RPh, FASCP
[1] https://www.healthit.gov/buzz-blog/health-it/onc-turns-18#:~:text=On%20April%2027%2C%202004%2C%20President,United%20States%20health%20IT%20history.
