Despite the identification and endorsement of several important HIT standards, including standards to support HIE, and the expected use of these standards in public and private sector demonstrations, e-HIE by health care providers, including PAC and LTC providers, is quite limited, and the use of interoperable HIT and e-HIE is even less common. The following describes several activities that could be considered to accelerate implementation of standardized e-HIE on behalf of patients treated by PAC and LTC providers.
The identification and specification of additional HIT standards is needed in certain areas including:
Specification by the AHIC of a transfer of care use case that involves the exchange of information on behalf of patients being treated in PAC and LTC settings would enable this type of exchange to be included in and focused on as part of the national HIT agenda, and would likely result in a nationally-recognized endorsement (i.e., by the HITSP and AHIC) of the HIT standards needed to support this type of exchange. Members of the PAC and LTC communities are working on developing a use case focusing on admission and/or discharge from PAC/LTC that could be considered by AHIC and if approved, the HITSP would identify the standards needed to support this type of HIE.
Specification of an implementation guide that would provide guidance to the PAC and LTC vendor communities as to how to integrate the CHI-endorsed patient assessment and HL7 CCD HIE standards into their software products.
Implementation of the NCPDP SCRIPT v10.1 standard in CMS e-prescribing regulations will enable NH providers and vendors to knowledgably invest in standardized e-prescribing products.
However, as observed during the site visits, implementation of HIT in general, much less the implementation of interoperable HIT and e-HIE remains a huge gap. Unaffiliated PAC and LTC providers were less likely to have implemented HIT than their counterparts that are part of chain organizations and/or are affiliated with integrated delivery systems. The anticipated public and private sector demonstrations of the use of the CHI-Patient Assessment standards and the HL7 CCD standard to exchange needed patient summary/discharge information as patients transition across settings of care are expected to demonstrate the use of and increase awareness of how standardized applications can support HIE. These demonstration efforts may wish to consider the feasibility of including unaffiliated PAC and LTC providers in the demonstration efforts.
Identification by the HITSP and endorsement by AHIC of HIE standards needed to support referrals and transfers in care, and the likely identification by CCHIT of the CHI-Patient Assessment and HL7 CCD standards as criteria for certified NH EHRs also will support implementation standardized e-HIE.
A dominant theme to emerge from the third annual LTC-HIT Summit in June 2007 was the need to accelerate and support the implementation of standardized HIT in PAC and LTC. Recommendations that were discussed during the 2007 LTC Summit included:
Request the Secretary of HHS to provide assistance to PAC and LTC providers in implementing HIT (including, for example, using standards for e-prescribing in LTC and federally-required patient assessments).
Engage state agencies (including Medicaid programs and the National Governors' Association) to support the implementation of interoperable HIT in LTC.
Educate providers regarding interoperable HIT (e.g., its uses, known and expected benefits, costs, etc.).
Further analyze and disseminate information on the costs and benefits of HIT implementation on behalf of PAC and LTC patients, including information on who incurs these costs and who reaps the benefits.
Reduce the risks PAC and LTC providers encounter in the acquisition of HIT products.
Identify and share information among PAC and LTC providers on how the use of HIT can change and enhance workflow.
Several actions are being undertaken to address many of these recommendations including:
The recent endorsement by the Secretary of HHS of the use of the CHI-Patient Assessment standards in federal health care programs.
Research being sponsored by ASPE to:
- examine the costs and benefits of HIT implementation, including e-HIE, on behalf of patients receiving PAC and LTC;
- support an infrastructure building effort that will:
- further apply CHI-endorsed standards to the MDS and OASIS;
- specify the HIE infrastructure for standardized patient assessments and patient summaries (respectively using the CDA and CCD standards); and
- examine intellectual property issues associated with federally-required assessments (i.e., the MDS, OASIS, and Inpatient Rehabilitation Facility PAI); and
- design a survey of NH EHR adoption and use.
The work being led by the private sector LTC community, and supported by ASPE, to specify the functions and standards needed in NH EHR products. The product of this work will be considered by CCHIT in specifying the certification criteria for EHRs used in NHs.
The anticipated private sector demonstrations of interoperable HIE involving PAC and LTC providers.
Additional consideration is needed to develop and implement a widespread education and outreach strategy to educate PAC and LTC providers and other stakeholders on a variety of HIT issues to increase awareness and use of interoperable HIT. Such an educational campaign could also share information about how workflow can be made more efficient through the implementation of various HIT applications. Educational and outreach efforts also should include discussions with other health care provider types (e.g., hospitals, physicians, HDSs), HIE organizations, and other stakeholders about the need to include PAC and LTC providers in HIE efforts.
"HIEcase.pdf" (pdf, 1.68Mb)
"HIEcase-A.pdf" (pdf, 236.81Kb)
"HIEcase-B.pdf" (pdf, 115.31Kb)
"HIEcase-C.pdf" (pdf, 169.18Kb)
"HIEcase-D.pdf" (pdf, 134.56Kb)