Adoption of Electronic Medical/Health Records (EMR/EHRs) is on the rise among the nation's largest nonprofit senior living organizations, and recent survey results show that these larger multi-site, multi-state organizations are leading the way, adopting EHRs at a higher rate and using more-sophisticated EHRs than long-term and post-acute care (LTPAC) providers in general.

The findings come from two recent studies by LeadingAge CAST, a technology research and resource center at the nation’s largest association of nonprofit aging service providers, and Ziegler, the nation’s top ranked underwriter of nonprofit senior living tax-exempt municipal bond financings and a LeadingAge Gold Partner.

The 13th annual LeadingAge Ziegler 150 (LZ 150) survey, released at the end of 2016, found an 80% rate of adoption of EMR/EHRs across all respondents' operations, an increase of 5% over the past two years. The LZ 150 ranks and analyzes the nation’s largest 150 nonprofit senior living providers of multi-site systems, single-site campuses, and government-subsidized multi-site housing. LeadingAge CAST partnered with Ziegler to update the technology adoption and staffing portion of the annual survey this past year.

In a recent follow-up survey, LeadingAge CAST and Ziegler asked LZ 150 participants who had EHRs to classify the sophistication of their current EHRs using CAST’s 7-Stage EHR Adoption Model.

The survey yielded a 98% response rate, with 117 organizations responding. Of LZ 150 members, nearly 30% are in the upper tiers of EHR adoption (Stages 6 and 7, at 12% and 17.9% respectively), compared to only 23% of LTPAC providers in general (Stages 6 and 7, at 18.09% and 5.24% respectively).

Similarly, approximately 20% of LTPAC providers in general are in the lower, less-sophisticated stages of adoption (Stages 1 and 2, at 6.25% percent and 14.10% percent respectively) , compared to just about 4% among LZ 150 members (Stages 1 and 2, at 1.7% and 2.6% respectively).

These results reaffirm that larger nonprofit organizations are ahead of their smaller peers, not only in terms of EHR adoption but also the level of sophistication, advanced functionalities, and health information exchange capabilities deployed.

The stages in CAST’s 7-Stage EHR Adoption Model are as follows:

  • Stage 1 - A Basic Information System (only has resident demographics, regulatory assessments, service delivery record, and billing)
  • Stage 2 - A Basic EHR/EMR (in addition to the above, it has resident history; lists including diagnoses, problems, allergies, and medications; clinical notes; charting; and care plans)
  • Stage 3 - A Basic EHR/EMR with Ancillary and Clinical Administration (including Orders (radiology, lab. and medication); eMAR/eTAR (not at Point of Care); and Point of Care Documentation)
  • Stage 4 - An Advanced EHR/EMR (in addition to the above, it has Clinical Decision Support; eMAR/eTAR at the point of care; and Quality Reports, Analytics Tools, and Dashboards)
  • Stage 5 - An Advanced EHR/EMR with External Ancillary Services Integration (has Pharmacy Integration, CPOE, and ePrescribing)
  • Stage 6 - An Advanced EHR/EMR with Engagement and Basic Information Exchange capabilities (has Physician Portal and eSignature, Sending & Receiving documents electronically (not fax) directly to/from other providers)
  • Stage 7 - An Advanced EHR/EMR with Interoperability and Health Information Exchange capabilities (has capability of Sending & Receiving documents electronically (not fax) to/from other providers through a Health Information Exchange (HIE)).

Overall, the data revealed that these larger multi-site multi-state nonprofit providers have higher percentages of sophisticated EHRs than the EHRs deployed in long-term and post-acute care (LTPAC) in general, based on sector-wide vendor data. Full survey results of providers’ stage in the adoption process are:



Percentage of Providers

at each Stage

Stage 1



Stage 2



Stage 3



Stage 4



Stage 5



Stage 6



Stage 7



N = 117



“I am excited to share these first data points about the sophistication of EHRs and stage of EHR adoption among this segment of LeadingAge members, and very pleased to see this high level of adoption of advanced EHRs,” said Dan Hermann, senior managing partner, head of investment banking at Ziegler. “This shows the value of CAST’s 7-Stage EHR Adoption Model in gauging the sophistication of EHRs among LeadingAge members, and in this sector in general, and tracking it over time.”

“The results did not surprise me at all knowing the quality-driven mentality of these organizations and role advanced EHR functionalities play in driving care quality both within an organization and across the care continuum,” said LeadingAge Senior Vice President of Technology, Majd Alwan. “We are pleased to partner with Ziegler on this first of its kind follow-up survey to gain in-depth knowledge and valuable insights about senior living providers and their technology.”