Beechwood Continuing Care is a non-profit, long-term care community in the greater Buffalo, Western New York area. The community comprises independent living, assisted living, and rehabilitative/SNF services. The site visit conducted as part of this study focused on Beechwood Homes (Beechwood), a 272-bed nursing and rehabilitation facility with specialty units in early dementia, hospice, and rehabilitation. Its specialty rehabilitation unit, Wesley Rehabilitation Center, is designed specifically for residents with intensive, short-term rehabilitation or complex medical needs. Beechwood has embraced a patient-centered quality of life focus and is undergoing a transformation to a household environment rather than nursing units.
To deliver short and long-term care to its residents, Beechwood coordinates care and services with a number of health care professionals and community partners including physicians, local hospitals, ancillary services providers including pharmacies, labs and radiology, health plans, and other LTPAC providers. Beechwood has begun participating in the Western New York regional HIEO, HEALTHeLINK, which is advancing electronic information exchange capabilities in the area.
Grants, Policy Drivers and Other Funding Models Advancing HIE
Beechwood's payer mix is primarily Medicaid, Medicare, and Medicare managed care. They also have a limited percentage of private pay and insurance in their payer mix. Beechwood is not participating in any of the emerging payment models that could potentially advance HIE capabilities; however, the Western New York Beacon Community did provide grant funding for the interface costs to connect Beechwood to the regional HIEO. Both the Beacon grant and hospital readmission reduction initiatives helped to spearhead a focus on HIE practices including ways to improve practices and information sharing between the hospital and community partners.
Reducing Hospital Admissions/Readmissions. Although the CMS Hospital Readmission Reduction Program applies to hospitals, Beechwood continuously monitors their readmission rates and clinical processes to reduce unnecessary hospital transfers. Beechwood uses the INTERACTII program to assess and manage residents' change in condition. Standardized INTERACT protocols include checklists and documentation used by Beechwood to support communication between the attending physician and the receiving hospital should transfer to the hospital be warranted.
- ONC Beacon Grants. Beechwood was selected as one of five LTPAC partners in the Western New York Beacon Community. The Western New York Beacon Community's efforts are focused on improving clinical outcomes and patient safety through HIT and HIE. The Beacon grant supported the interface costs to connect the LTPAC vendors to the regional HIEO to send ADT alerts for a resident. In addition to Beechwood's hospital-SNF transfer initiative described above, the Western New York Beacon Community has identified four long-term care use case priorities for 2013:
- Lab and radiology results delivery from lab and radiology providers to Beechwood's EHR through HIE (currently in process).
- Care planning and regulatory requirements after admission acceptance including current data available, data/forms needed, responsible parties, and training needs (currently in process).
- Access to data needed for admission criteria including trigger mechanisms, data available/needed, responsible parties and training (completed).
- Patient preference notification (future consideration).
Community HIE Organization
As noted above, Beechwood participates in HEALTHeLINK the regional Western New York HIEO. There are more than 2,900 providersj participating in the HIEO with 35 of those providersk submitting clinical data. The data available includes: ADT alerts, radiology reports, radiology images, labs, transcribed reports (such as an H&P, discharge summary, operative report), ED reports, medication history data, and diabetic measures. HEALTHeLINK obtains its medication history from SureScriptsl and recently began receiving medication data from Buffalo Pharmacies (which is Beechwood's long-term care pharmacy). Buffalo Pharmacies is sending data on Beechwood residents including the resident name, drug name and strength, directions for use, quantity dispensed, date dispensed, and the prescriber.
Health care providers including Beechwood access patient information on HEALTHeLINK using the Virtual Health Record (VHR) portal. Any provider in the region who has signed a participation agreement and has Internet access can use the VHR. Providers may choose to get results delivered from HEALTHeLINK. Currently, Beechwood sends ADT alerts and is working on an interface to have lab and radiology reports delivered through HEALTHeLINK directly to their EHR system.
Summary of EHR and HIT systems and Development Plans Related to HIE
Beechwood has an EHR system, Answers on Demand (AOD), to support the clinical, billing, and administrative operations of their organization. AOD has been certified as an EHR module under the ONC Certification Program for MU Stage 1 program.m Consistent with Stage 1 certification, the AOD systems have the capability to create, export, and import a patient summary record (using the HL7 C32 CCD standard). However, at this time, Beechwood does not use this functionality due to workflow issues.
Beechwood has electronic, secure access to area hospital EHR systems (or a special shared drive) to support the information gathering and communication process at transition from the hospital. They also access patient health information electronically through HEALTHeLINK's VHR. The information accessed from the HIEO is used to support the admission assessment and care planning processes such as past medical history and recent hospital reports including the discharge summary. As noted above, Beechwood only sends ADT alerts to the HIEO and is working on receiving lab and radiology report results using a standard interface to their EHR. Beechwood does not send information electronically to hospitals and other community providers.
Beechwood developed a physician portal to their EHR to streamline sending their resident's health information to the physician for signature. Physicians log into the AOD system to access records that require their review and signature. Physicians can also review the resident's medical record and write progress notes and orders (e.g., medication, treatment, others). In 2013, Beechwood plans to automate physician order communication with the pharmacy by entering physician orders into the AOD system which are then transmitted to the pharmacy order entry system.
Health Information Routinely Exchanged
Beechwood regularly exchanges information with non-affiliated community health care partners including local hospitals, physician practices, labs, pharmacies, radiology/imaging, SNFs, HHAs, and hospice providers. They use many ways to communicate and share information such as face-to-face, telephone, fax/e-fax, e-mail, mail. In addition they use secure messaging, access to hospital EHR systems, and use of a community HIEO. Health information is communicated and shared at transitions of care and continuously during a resident's stay. Section 4.2in this report and Appendix K provide additional information on the information routinely exchanged.
Epic MU Stage 2 Certification Details: http://www.epic.com/software-certification.php.
Health care professionals include physicians, nurse practitioners, physician assistants, chiropractors, nurses, pharmacists, and dentists.
Health care providers include hospitals, regional reference labs, regional radiology, telemonitoring sources (home health), long-term care facilities, and medication history sources.
SureScripts is a company that operates the nation's largest electronic e-prescribing network, linking pharmacies and healthcare providers to make the prescribing process safer and more efficient.