Health Information Exchange in Post-Acute and Long-Term Care Case Study Findings: Final Report. A. Criteria for Selecting the HDS and PAC/LTC Settings for Site Visits

09/18/2007

The criteria used to select the HDSs was based on the type and scope of electronic health information creation, storage, and exchange believed to be implemented in the system; the anticipated level of effort required to gather data about the information exchange mechanisms at each system; and to the extent possible, how the HDS is representative of those around the country and/or provides an instructive contrast to the other sites selected.

More specifically, the following criteria were used to prioritize candidate sites. The HDS should: (1) have an electronic health information system that allows for the exchange of health information across two or more settings or providers (e.g., hospital and physician offices, laboratory, pharmacy, radiology), and preferably has documentation to explain the clinical/organizational and technical components and capabilities of the health information system; (2) refer patients to unaffiliated PAC and LTC settings (defined as SNFs, NHs, and HHAs) in the same general geographic location (unaffiliated, for the purposes of this screening was defined as not being owned by the HDS);5 (3) preferably have at least six months experience with the software application(s) that support information exchange; and (4) be amenable to a site visit by a three-person team of data collectors who would require access to a variety of staff (including clinicians, information technology specialists, and managers).

Although the criteria were established a priori, it was later recognized that provider arrangements often do not fall into neat categories of affiliated and unaffiliated. As noted above, in some cases, organizations may have a preferred provider relationship, although they are not officially affiliated. Rather, provider arrangements continue to evolve. For example, physicians with multiple affiliations have proven to be an impetus for data exchange across health settings. In fact, within many situations, physicians "follow" patients across settings muddying the waters as to what constitutes affiliated and unaffiliated relationships.

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