NATIONAL CENTER FOR HEALTH STATISTICS

Is EHRs Data Extraction for 

Select Long-Term Care Settings Possible?

Christine Caffrey, Manisha Sengupta 

Division of Health Care Statistics

Angela Greene, Michelle Dougherty

RTI International

FCSM 2023 Research and Policy Conference

October 24, 2023
Disclosure

 None of the authors have any conflicts of interest to disclose.

 The findings and conclusions in this presentation are those of the authors 

and do not necessarily represent the official position of the National Center 

for Health Statistics, Centers for Disease Control and Prevention, 

Department of Health and Human Services, or RTI International. 

National Post-acute and Long-term Care Study 

(formerly National Study of Long-Term Care Providers)
EHR Environmental Scan – 2022 NPALS

Overall Goal 

– To assess whether NPALS data elements can be extracted from 

commercial EHR platforms or systems for residential care communities 

(RCCs) and adult day service centers (ADSCs).
EHR Environmental Scan – 2022 NPALS

Specific Goals

1. Understanding EHRs characteristics and usage

– Identify existing EHR platforms/systems that may serve as alternative sources of data 

– Determine what information may be available on these EHR platforms.

2. Assessing state regulations and data collection/reporting requirements 

– Whether EHRs data are available on a consistent basis across geographic areas and 

provider types.

3. Determining if EHRs data available 

– Whether the data are aggregated, or do they have identifiable information that can be 

used to link these data to the NPALS respondents.

– Whether the data are collected on a regular basis and how often the data are 

collected/updated (including lag time).
EHR Environmental Scan – 2022 NPALS

Study Design

1. Literature scan

2. Subject matter expert interviews 

• Provider associations 

• EHR vendors 

3. High-level analysis of EHR data suitable for extraction or reporting
Results of Literature Scan

17 vendors serving the broad long-term and post acute care sectors

Challenges:

 Finding information on EHR market share proved quite difficult. 

 Vendors are often hesitant to share proprietary information regarding their market 

share.

 Vendors do not adhere to the specific categorization of RCCs and ADSCs 

 One vendor was able to quantify their market share for Continuing Care 

Retirement Communities (CCRCs) since this sector is distinctly defined
Insights from SME Interviews

 Significant difference in adoption by facility size; Smaller providers often do not 

see the return on investment for implementing EHRs that larger providers do. 

 Rural RCCs also have lower adoption due to greater barriers for internet access. 

 More sophisticated providers use EHRs to manage staffing and workflow, 

regulatory compliance around documentation and record retention, invoicing, and 

data collection for quality measures. 

 Medication management is most common for EHR usage amongst RCCs. Other 

services that are often utilized are incident reporting and customizable 

assessments depending on state. 
Findings from the High-Level Analysis

State Regulations and Reporting for EHRs
Does the state require electronic reporting of 

infection control and/or public health data?
Does the state licensure agency require reporting via 

an EHR?
Beyond infection control data, does the state require 

collection of health content or adoption of an EHR?
Findings from the High-Level Analysis
Findings from the High-Level Analysis

Crosswalk of NPALS Items to EHR Vendor Data

There are measures in both

• Demographics, diagnoses, medications, functional status, health outcomes, select 

organizational characteristics 

Variable level of effort to align the two 

• Demographics and diagnoses lower level of effort

• Organizational-level characteristics higher level of effort—would need to infer

Some limitations....

• Not required, so not all providers included

• No standardization (customization common)

• Little data integration and harmonization (e.g. diagnoses)

• Available software varies (small vs large providers)
Conclusions

There is potential for using EHR data to support the survey 

process, but... 

– Not much regulation and data from states

– Commercial EHRs data may require a high level of effort and will not 

be nationally representative

– Programming and automating capture would be required as well as 

the creation of a database for storage
Recommendations

 Work to align survey content with data elements and standards for EHRs 

found in the US Core Data for Interoperability (USCDI). 

 Build on Data Already Collected and Reported

 Evolve Survey Questions on EHR and Health IT Use

 Test Different Approaches for Data Extraction and Reporting

• Data extraction by vendors for survey respondents to complete the survey

• Respondents generate their own EHRs reports to complete the survey

• Vendor-supported queries of EHR data to obtain reports to complete 

survey

• Development of standardized approaches to report survey data 

• Explore testing with HIE organizations that includes NPALS settings data
Thank you!

More information about NPALS...

Visit: https://www.cdc.gov/nchs/npals/index.htm

Email: ltcsfeedback@cdc.gov