Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information

Executive Summary

Michelle Dougherty, MA, RHIA, CHP
AHIMA Foundation

Jennie Harvell
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services

December 2011

Individuals who receive long-term and post-acute care (LTPAC) services obtain care from a diverse group of physicians, clinicians, and specialists and experience frequent transitions between health care provider settings. The availability of health information to support and coordinate care is crucial for eliminating fragmentation and ensuring high quality, safe and efficient health care. Transitions in care are known to be particularly problematic because relevant information may not be communicated in a timely manner. Health information technology (HIT) and health information exchange (HIE) have the potential to address the information gap and improve the overall quality and continuity of care of LTPAC patients, reduce rehospitalizations, and control health care spending.

LTPAC providers generally do not have robust HIT capabilities to support the electronic exchange and use of clinical information. Without these capabilities, LTPAC providers cannot readily access patients’ clinical information from other providers. Conversely, hospitals, primary care professionals, caregivers and others cannot obtain timely and important LTPAC information. Today, electronic health record (EHR) incentive programs, which are not applicable to LTPAC settings, are advancing adoption of interoperable HIE for eligible hospitals and eligible providers. Given the lack of incentives or other requirements for LTPAC providers to use interoperable EHRs, other actions are needed to advance the use of this technology by this sector.

This report, prepared for and in collaboration with the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS) by the American Health Information Management Association (AHIMA) Foundation (with significant input and expertise from HIT, HIE, and LTPAC experts), identifies opportunities and tools to support cost-effective data re-use and interoperable HIE by LTPAC providers, particularly nursing homes and home health agencies. The opportunities described in this report use federally required assessment instruments, the Minimum Data Set Version 3 (MDS 3.0) and the Outcome and Assessment Information Set (OASIS), created and electronically exchanged by almost 100 percent of the nursing homes and home health agencies in the United States as the entrance point for HIE. The study applied HIT standards to the MDS 3.0 and OASIS to support the interoperable exchange of assessments and describes opportunities to re-use assessment content to exchange a summary of information that will be useful for shared care and transitions.

The tools developed in this study support the transformation of assessment content into interoperable and re-usable formats and are available to nursing home and home health agency providers, their HIT vendors, and HIE organizations. The report describes how the tools can be used to facilitate exchange of a subset of assessment content to provide a summary for other LTPAC providers, hospitals, physicians, and patients/caregivers to support continuity, coordination and transitions of care. The approach outlined for engaging LTPAC providers in HIE activities is expected to be low-cost and could serve as a stepping stone towards more sophisticated use of EHRs and comprehensive HIE opportunities. The report and appendices:

• Describe the drivers for LTPAC’s participation in HIE and data re-use activities.

• Describe the federal requirements for the nursing home MDS 3.0 and home health OASIS assessment instruments and their electronic transmission.

• Describe the HIT readiness of nursing homes and home health agencies.

• Identify and apply HIT content standards to the data elements on the MDS 3.0 and OASIS to support the interoperable re-use of assessment content.

• Identify a “Patient Assessment Summary Document” composed of a clinically relevant subset of MDS 3.0 and OASIS data elements that clinicians indicate would be useful to exchange at times of transitions and shared care.

• Support the development of an industry-accepted HIT exchange standard for the interoperable exchange of patient assessment instruments and applies that standard to the MDS 3.0.

• Identify the HIT content standards that would be used for the Patient Assessment Summary Documents for the MDS 3.0 and OASIS, describes how accepted HIT exchange standards could be applied to support the interoperable exchange of these patient assessment summary documents, and identifies issues/gaps that need to be filled with these exchange standards.

Finally, this report summarizes HIT activities underway in federal programs and selected state HIT and private sector initiatives, and identifies activities that support LTPAC providers in interoperable HIE. Some of these initiatives are re-using standardized assessment content and the work products created in this study. The re-use of patient assessment content in emerging initiatives validates the key premise of this study -- leveraging assessment data (available in almost all nursing homes and home health care providers) and standardizing the content supports its re-use for more robust clinical HIE activities. Using the tools developed through this study will support LTPAC providers’ involvement in a variety of HIE activities and the attainment of quality and continuity care goals envisioned in health care reform.