Health Information Exchange in Post-Acute and Long-Term Care Case Study Findings: Final Report. A. Health Information Exchange by Any Means

09/18/2007

Several factors were identified as facilitating or creating barriers to the timely exchange of health information by any means, including non-e-HIE, needed to care for persons receiving care from PAC and LTC providers. As observed during the site visits, many stakeholders indicated that, at present, the key for securing timely information exchange were strong, cross-organizational interpersonal relationships. Such relationships were identified as essential for supporting timely and needed HIE regardless of the method(s) by which health information is exchanged (e.g., manually, by fax, or using HIT). At all sites it was observed that the relationships built between staff at institutions (e.g., hospital discharge planner and admission coordinator at a NH, liaisons from HHA/NH working in hospitals prior to discharge) were of paramount importance. Not only did these relationships tend to ensure that referrals were made more efficiently and the information shared was more complete (i.e., these relationships seemed to help reinforce accountability for information transfer), but also it seemed to increase job satisfaction. The site visitors observed that even to the extent e-HIE was used, personal relationships were not completely supplanted by technology, and it is likely that as HIT implementation becomes more widespread, this observation will persist.

Other factors that were identified through the site visits and a review of the literature as facilitating HIE included:

  • Medicare payment policies that some believe have created indirect incentives for HIE (e.g., capitated, episode-based prospective payment methods) and other policies that include direct incentives for the timely exchange of health information across organizations (e.g., pay-for-performance incentives).

  • Medicare requirements to use e-prescribing standards to support electronic medication ordering.

  • State requirements for the exchange of health information as patients transition across settings of care (e.g., requirements in the state of New York to use the PRI).

  • Cross-organizational use of software products that enable the standardized electronic exchange across settings of patient discharge information (e.g., use of ECIN to exchange the PRI in New York).

  • Anticipated revisions to the Joint Commission (previously known as JCAHO) hospital requirements that will focus, in part, on ensuring safe and effective hand-offs as patients transition out of hospitals to other settings of care.

Several factors that were identified as creating barriers to HIE included:

  • The perception (whether well-informed or not) that implementation of and concerns about being out of compliance with HIPAA creates barriers to HIE across health care settings.

  • The belief held by many PAC/LTC providers that they are effectively unable to request more complete/accurate health information from referring hospitals given the dependence of PAC/LTC providers on hospitals as a primary source of referrals.

  • Lack of awareness of the availability of HIT standards that, if implemented, could support e-HIE and health information re-use.

  • Failure to use HIT products that support standardized exchange of health information and information re-use.

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