Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2. Synthesis of Health Information Exchange Findings from Site Visits

10/29/2013

The exchange of health information is a critical function in the delivery of care to patients in LTPAC organizations. All three site visits identified multiple clinical and administrative processes requiring the exchange of information. LTPAC providers and their partners use many different methods to exchange information -- face-to-face communication, telephone, fax, e-mail, access to EHR systems, and HIEOs.

A number of findings are consistent across the three site visit locations:

  • LTPAC organizations are beginning to use electronic HIE, but in a very limited way.

  • Communication and sharing of information occurs in multiple ways to support transitions and shared care. Increasing the use of electronic HIE methods will improve the timeliness and efficiency of communication, although it cannot completely replace face-to-face and telephone communication between health care providers.

  • While HIEOs have some content that is useful for background information for admission, assessment, and care planning purposes, LTPAC providers require detailed medical record data prior to admission including narrative progress notes, assessments, and current medications that reflect changes. Access to the hospital EHR system often provides more timely and detailed information than what is currently available from HIEOs (as observed at two sites) to support the transfer of care process.

  • The two sites that are IDSs have community care coordination programs to achieve improved health outcomes for specific target populations, and focus on reductions in ED use and hospital readmissions, as well as the costs of care. Community care coordinators and teams work with HCBS providers, with communication primarily by telephone and fax. There may be opportunities for improved efficiency through the use of HIEOs by and other electronic communication with home and community-based providers; however, these types of providers are not currently participants of the HIEOs.

  • Some HIT messaging standards are embedded in LTPAC EHR systems and sometimes used to connect these providers with HIEOs. Further, the interoperability standards in Stage 2 of the EHR Incentive Programs (which will support more robust HIE for transitions in care or shared care with LTPAC/LTSS providers) are not yet used. Many of the standards required through the EHR Incentive Programs could be used to support HIE with and by LTPAC providers, but integration and use of these standards into LTPAC EHR products often requires additional investment of time, financial resources, and organizational awareness. Some standards are still early in their maturity level requiring a significant level of effort to implement.

A synthesis of the HIE findings from the three sites is summarized below using the framework developed for this project. The synthesis describes exchange activities to support transition of care, shared care, and other administrative functions from the perspective of the LTPAC organization. An expanded analysis of 35 identified information exchange workflows is detailed in Appendix K.

View full report

Preview
Download

"HIEengage.pdf" (pdf, 976.86Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageA.pdf" (pdf, 122.65Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageB.pdf" (pdf, 132.47Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageC.pdf" (pdf, 62.72Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageD.pdf" (pdf, 64.52Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageE.pdf" (pdf, 71.74Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageF.pdf" (pdf, 67.17Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageG.pdf" (pdf, 128.62Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageH.pdf" (pdf, 1.02Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageI.pdf" (pdf, 264.75Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageJ.pdf" (pdf, 663.47Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageK.pdf" (pdf, 126.77Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageL.pdf" (pdf, 141.17Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®

View full report

Preview
Download

"HIEengageM.pdf" (pdf, 83.93Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®