Optimizing Data Flow in Senior Care: The 2025 Vision for Excellence by LeadingAge

November 6, 2025

Healthcare Embraces Data-Driven Care Coordination

Healthcare Providers across the United States are rapidly adopting a more connected approach to patient care, prioritizing a comprehensive continuum of services. This shift centers on leveraging accessible and relevant data to improve outcomes, particularly for individuals with complex health needs. The goal is to move beyond isolated care settings and foster collaboration across primary care physicians, specialists, pharmacies, and even social services that impact overall well-being.

National and state-level programs are emerging to modernize health facts exchange.These include California’s Data Exchange Framework (DxF) and the federal Trusted Exchange Framework and Common Agreement (TEFCA). These initiatives aim to streamline data access and promote interoperability between healthcare systems.

The Impact on Senior care

The importance of seamless data sharing was recently highlighted at the 2025 LeadingAge Annual Meeting in Boston. Industry experts emphasized the critical need for improved data exchange, especially considering that 93% of adults aged 65 and over have at least one chronic condition, and 79% manage two or more, according to the centers for Disease Control and Prevention’s recent findings.

Keith Kasin, Chief Operating Officer at Hillcrest, a continuing care retirement community in California, explained how participation in the state’s DxF program has enhanced their ability to provide personalized care. He noted that the DxF provides a deeper understanding of a resident’s medical history than traditional electronic health records, which often offer only a limited snapshot of a hospital stay.

“It fundamentally changes how we approach discharge planning,” Kasin stated. “Our priority is to prevent readmissions, and having access to comprehensive data is crucial for achieving that goal.”

Real-World Applications of Data Exchange

Rachel Goldberg, a senior consultant at Intrepid Ascent, illustrated the benefits of data exchange with specific examples. She described a scenario where a skilled nursing facility, connected to a health information organization (HIO), can alert an emergency department if a patient is readmitted shortly after discharge. Frequent readmissions can signal underlying issues that require attention from community-based organizations.

Data sharing also streamlines pre-placement assessments. Participating continuing care retirement communities can readily access a prospective resident’s medical information,eliminating the need for time-consuming phone calls and data collection efforts.

Scenario	Without Data Sharing	With Data Sharing
Patient Readmission	SNF unaware of ED visit until contacted. delayed intervention.	ED alerts SNF instantly. Prompt inquiry & potential intervention.
New Resident Intake	Manual data collection. Potential delays & inaccuracies.	Immediate access to medical history. Streamlined assessment.

Challenges to Interoperability Remain

Despite the growing momentum, challenges related to interoperability and data standardization persist. A recent report by Argentum revealed that only 26% of senior care organizations have a clear and shared understanding of how to measure health and wellness outcomes. Furthermore, 77% identified interoperability issues as a major obstacle to adopting new technologies. According to a recent report from KLAS Research,interoperability remains a top challenge for 68% of healthcare organizations in 2024.

kasin emphasized the potential to unlock even greater value from existing electronic health records. “There’s immense potential in the data we already have,” he said, “if we can establish seamless connections between systems like PointClickCare, Matrix, and other widely used EHR platforms.”

The Future of Healthcare Data Exchange

The trend towards greater data sharing in healthcare is expected to accelerate in the coming years, driven by regulatory initiatives, advancements in technology, and a growing recognition of its impact on patient outcomes. The success of programs like DxF and TEFCA will be crucial in establishing a nationwide network for secure and efficient health information exchange. As interoperability improves, healthcare providers will be better equipped to deliver coordinated, personalized care that addresses the holistic needs of their patients.

Did You Know? The 21st Century Cures Act, passed in 2016, has been a key driver of interoperability efforts, mandating the use of standardized APIs for electronic health information exchange.

pro Tip: Healthcare organizations should prioritize investments in interoperable technologies and staff training to maximize the benefits of data sharing.

Frequently Asked Questions About Healthcare Data Sharing

• What is healthcare data sharing? Healthcare data sharing involves securely exchanging patient information between different healthcare providers and organizations to improve care coordination.
• Why is data sharing important in healthcare? It leads to more informed clinical decisions, reduced medical errors, and better patient outcomes.
• What is TEFCA? The Trusted Exchange Framework and Common Agreement is a federal initiative to establish a global floor of interoperability across the country.
• What are the challenges of data sharing? Interoperability,data privacy,security,and standardization are major challenges.
• How does data sharing benefit senior care? It enables better care transitions, reduces hospital readmissions, and supports personalized care plans for older adults.
• What role do Health Information Organizations (HIOs) play? HIOs facilitate the exchange of health information between different healthcare entities within a defined region.
• Is patient data secure when it is indeed shared electronically? Yes, data sharing adheres to strict privacy regulations, such as HIPAA, and employs security measures to protect patient information.

What are your thoughts on the role of technology in improving healthcare data exchange? Share your opinions in the comments below!

Do you believe increased data sharing will ultimately lead to better patient care experiences?

How can LeadingAge’s 2025 vision for optimized data flow specifically address the challenge of fragmented EHR systems in senior care?

The Imperative for Seamless Data Exchange in Senior Healthcare

The landscape of senior care is rapidly evolving. LeadingAge’s 2025 vision centers on person-centered care, and at the heart of delivering this lies optimized data flow. No longer can care be effectively delivered in silos. Efficient healthcare data exchange is crucial for proactive, preventative, and truly individualized care plans. This isn’t simply about adopting new technology; it’s a essential shift in how senior living communities, home health agencies, and other care providers operate. Key terms driving this change include interoperability, health data technology (HIT), and care coordination.

Key Challenges Hindering Data Flow Today

Several obstacles currently impede seamless data exchange in the senior care sector. Addressing these is paramount to realizing LeadingAge’s vision.

* Fragmented Systems: Many organizations rely on disparate, non-integrated Electronic Health Record (EHR) systems. This creates data silos, making it tough to obtain a holistic view of a resident’s health.

* Lack of Interoperability Standards: While standards like FHIR (Fast Healthcare Interoperability Resources) are gaining traction,widespread adoption remains a challenge. Without consistent standards, systems struggle to “talk” to each other.

* Data Security & Privacy Concerns: Protecting sensitive patient data is non-negotiable. Concerns around HIPAA compliance and potential breaches can slow down data sharing initiatives. Senior care data security is a top priority.

* Limited Technical Expertise: Smaller organizations may lack the in-house IT expertise needed to implement and maintain complex data integration solutions.

* Resistance to Change: Adopting new workflows and technologies requires buy-in from staff, and overcoming resistance to change can be a significant hurdle.

LeadingAge’s 2025 Roadmap: Core components

LeadingAge advocates for a multi-pronged approach to optimize data flow, focusing on these key areas:

1. Universal Adoption of Interoperable EHRs: Moving towards EHR systems that fully support FHIR and other interoperability standards is essential. This allows for seamless data exchange between providers, hospitals, and even family members (with appropriate consent).
2. Robust Data Analytics Platforms: Collecting data is only the first step. Organizations need robust senior care analytics platforms to analyze data, identify trends, and proactively address potential health issues. This includes predictive analytics for fall risk, medication adherence, and early detection of cognitive decline.
3. Secure data Sharing Networks: Establishing secure,cloud-based data sharing networks allows providers to share information quickly and efficiently,while maintaining data privacy and security. Healthcare information exchange (HIE) plays a vital role here.
4. Remote Patient Monitoring (RPM) integration: Integrating data from RPM devices (wearables, sensors, etc.) into EHRs provides a continuous stream of real-time health information, enabling more proactive and personalized care. Telehealth for seniors is increasingly reliant on this data flow.
5. Standardized Data definitions: Ensuring that everyone uses the same definitions for key data elements (e.g., diagnoses, medications, assessments) is crucial for accurate data analysis and reporting.

The Role of Emerging technologies

Several emerging technologies are poised to further revolutionize data flow in senior care:

* Artificial Intelligence (AI) & Machine Learning (ML): AI/ML algorithms can analyze vast amounts of data to identify patterns, predict risks, and personalize care plans. Applications include automated medication management, early detection of infections, and personalized cognitive stimulation programs.

* Blockchain Technology: Blockchain can enhance data security and transparency,making it easier to track data provenance and ensure data integrity. This is notably crucial for sensitive patient information.

* 5G Connectivity: Faster and more reliable 5G connectivity will enable seamless data transmission from RPM devices and other connected health technologies.

* Internet of Things (IoT): IoT devices, such as smart sensors and wearable devices, can collect real-time data on residents’ activity levels, sleep patterns, and vital signs.

Benefits of Optimized data Flow

The benefits of optimizing data flow in senior care are significant:

* Improved care Quality: A more complete and accurate picture of a resident’s health allows providers to deliver more personalized and effective care.

* Reduced Hospital Readmissions: Proactive identification of potential health issues can help prevent hospitalizations and readmissions.

* Enhanced Care Coordination: seamless data sharing improves dialog and collaboration between providers, leading to better care coordination.

* Increased Efficiency: Automated data collection and analysis can streamline workflows and reduce administrative burden.

* Lower Costs: Preventative care and reduced hospitalizations can lead to significant cost savings.

* Empowered Residents & Families: Access to their own health data