Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.3. Summary of Electronic Health Information Exchange

10/29/2013

Among the site visits (even in the most advanced) the information that is electronically available for exchange is limited and incomplete. LTPAC providers use multiple methods to share and exchange information frequently relying on mail, fax and secure e-mail when data and documents are required to move from one provider to another. While the current state reflects these traditional forms of communication, trends emerged across all three sites where technology supported electronic information exchange.

  • EHR Access and Other Tools. Some hospitals recognize the need of LTPAC providers and social worker/community care coordinators to have access to patient information in the hospital EHR both at preadmission and after admission. They have established agreements and secure protocols to either provide direct access to the hospital EHR or provide electronic data/documents on a dedicated network drive. One organization (Rush) uses a proprietary care management referral application that allows the secure, electronic exchange of unstructured notes and attachments to share information between providers who were subscribers of the service. Users of that application report it is helpful in sharing basic information; however, it does not provide two-way communication and is not as complete as access to the hospital EHR to support the preadmission and transfer or care process.

  • Physician Portals to LTPAC EHR. Two of the sites (Beechwood and EMHC) developed physician portals to their respective EHR applications to streamline the exchange process with the attending physician. In both cases, the physician can log into the SNF or HHA EHR system and access their patient's information to review and sign (e.g., telephone orders, POC, etc.).

  • HIE Organizations. Two of the sites (Beechwood and EMHC) have active HIEOs in their community. While the LTPAC providers can access their patient's information from the HIEO, there is very limited inclusion of LTPAC data on the exchange. LTPAC providers at both sites send and receive electronic ADT event notifications via an HL7 message standard. EMHC transmits to the HIEOs the home care POC via the HL7 results message standard, but the POC content is not standardized. Beechwood is developing an interface using the HL7 results message standard to receive electronic lab results from the lab through the HIEO to their EHR.

The type of information commonly available from the HIEOs includes: ADT events, problem list, prescription/medication history, allergy information, lab and other test results, vital signs, transcribed reports (e.g., hospital H&P and discharge summary), and visit summary records. While this information is useful in understanding the patient's history to support the assessment and care planning function, it does not include the type of information accessed from the hospital EHR on preadmission, which is needed to support the transfer of care/admission process for the LTPAC provider.

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