Few PAC/LTC settings expressed short or long-term plans to either: (1) implement an EHR system if they did not already have something in place; or (2) augment or replace their existing medical record system with something that was standards-based, interoperable, and/or more robust. Likewise, only a few settings (discussed below) had knowledge about the work being planned and conducted with SDOs such as HL7, NCPDP, CCD/CCR,18 and other standards-related activities (e.g., CHI and HITSP). None of the PAC/LTC settings, with the exception of the VNS of New York and to a lesser extent Erickson Retirement Communities, had representation in any of the SDO workgroups. However, the sites that we visited were more involved and active in participating in local, regional, and especially the national NH and home health organizations. Such professional associations (e.g., AHCA, NAHC, AAHSA) are becoming more connected with SDO activities and it is expected that their involvement will expand in years to come.
Several solutions for advancing e-HIE were observed during the site visits.
a. Patient/family caregiver portals. One possible answer to improving HIE between providers and settings, particularly PAC and LTC settings, is to enlist the participation of the patient and family caregivers. Erickson Retirement Community (Maryland CCRC) is developing a resident portal into its EHR (GE Centricity), which includes read-only access to medications, laboratory results, appointments, and problem lists. Once operational, patients can selectively share access to this information with unaffiliated providers. For example, the patient may be out of town and require care from a local ED. The patient could provide the ED staff with the access information to view key clinical information through the portal. Because the patient controls who is allowed to view the data, privacy protections are promoted.
b. Provider portals. Physicians are another potential target for innovative HIE solutions. As mentioned previously through a New York State HEAL NY award, the VNS of NY is developing a web portal for primary care physicians with a common data presentation. The MHHA (New York) also is piloting a web portal project with physicians in its service area with similar intent.
As previously discussed, the IHIE is developing a portal, called Docs4Docs, that will provide physicians and other clinicians with access to admission and discharge transcriptions, laboratory results, radiology, EKGs, and pathology reports across care settings. Using a web-based platform, physicians will be able to access this information from their outpatient offices, from the hospital or NH, or even from their private residence. The portal is supported by five of the large hospitals in the Indianapolis metropolitan area. At present, medication lists are not yet available via the portal. As implementation of this portal is fairly new, information is incomplete. At present, the hospitals do not yet collect all encounter information for all patients. The hospitals collect most of the inpatient encounter information from their own EHR and some information from outpatient or off-site encounters (i.e., one of the other hospitals that feed into the Docs4Docs). While the stated IHIE vision is to facilitate physician access to needed patient information regardless of location of the information, enabling physician access to patient information in NHs is not actively being pursued because at this time the IHIE does not include any representatives from PAC or LTC.
2. Disaster Preparedness
Hurricane Katrina increased awareness for the importance of having timely availability of health information during a natural or man-made disaster. One provider in the four cities included in this study addressed this concern. Hillside Rehabilitation, a NH in Utah, has developed a contingency plan to make available their patients' electronic health information in the event of an emergency. In partnership with its software vendor, BlueStep, Hillside patients' health information could be made available to health care providers in different parts of the country via a secure website.
"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)