Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4. Synthesis of Findings From Case Studies of Health Information Exchange to SUPPORT CARE Coordination for Persons Receiving LTPAC/LTSS

10/29/2013

During the literature review and key informant interviews, potential sites were identified for in-depth analysis of HIE activities. Site visits were conducted with three strategically identified providers engaged in HIE to support care coordination for persons receiving LTPAC/LTSS. The purpose of the site visits was to evaluate the information exchange practices for persons receiving LTPAC and/or LTSS related to transitions of care, shared care and other administrative purposes. HIE practices were evaluated regardless of format (telephone, fax, e-mail, exchange network), however, special interest was paid to the current status of electronic exchange including the policy drivers, barriers preventing its use and opportunities for expansion.

The sites provided a snapshot of exchange processes from different types of LTPAC and LTSS providers in different geographic regions: (1) Chicago's Rush University Medical Center's Bridge Model Care Transition Program, which improves care transitions through a patient-centered approach that engages a multidisciplinary health care team through intensive care coordination to help older adults safely transition back to the community that includes LTSS; (2) Beechwood Nursing Home, 272-bed SNF in Western New York, and one of the first LTPAC providers to participate in HIE through a regional HIEO; and (3) EMHC, part of EMHS, an integrated health care delivery system, which is exchanging information with affiliated and non-affiliated partners.

Observation protocols and interview guides guided the site visits. Interviews were conducted with LTPAC provider staff and stakeholders, including clinicians, QA/performance improvement staff, IT staff, administration, referral sources, and HIE network administrators. Key HIE exchange partners were contacted during the site visit including acute care providers who exchange important information during care transitions. The site visits provided rich case studies of best practices and lessons learned around HIE to support care coordination.

Each site visit was two days in length. A summary report was developed for each site that provides the following information: (1) background information on the site; (2) a description of the community HIEO; (3) a summary of grants, other policy initiatives and stakeholders that either supported the advancements in HIE or were key partners; (4) an overview of the site's EHR and HIT systems and development plans related to HIE; (5) findings from discussions on the workflow processes that required HIE; (6) a summary of HIE processes; and (7) identification of barriers and opportunities. Summaries of the site visits are included in Appendix H, Appendix I and Appendix J.

This section synthesizes findings and lessons from the site visits and implications for expanding HIE to support care coordination for persons receiving LTPAC services. The findings are organized as follows:

  • Site Visit Summaries and Key Characteristics:
    • Rush University Medical Center Transitional Care;
    • Beechwood Homes; and
    • EMHC.

       

  • Synthesis of HIE findings from the Site Visits:
    • HIE at transitions of care, shared care, and other administrative types of HIE;
    • Summary of electronic HIE;
    • Summary of LTPAC data that could be prioritized for electronic HIE;
    • Use of HIT standards by the sites to support HIE; and
    • Overall findings, challenges and opportunities to advance HIE.

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"HIEengageA.pdf" (pdf, 122.65Kb)

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"HIEengageI.pdf" (pdf, 264.75Kb)

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