Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Beechwood Engagement with HEALTHeLINK

10/29/2013

Beechwood is one of five long-term care facilities currently participating in HEALTHeLINK. The other providers are Briody Healthcare Facility; Brothers of Mercy Nursing and Rehab, Heritage Centers, and Schofield Residence. Buffalo Pharmacies, Inc., an institutional pharmacy that serves LTPAC providers in Western New York, is also exchanging information.

Technology

To access information on HEALTHeLINK, providers only need an Internet connection. To exchange data with the HIE, Beechwood (and the other LTPAC providers) must have an EHR that has a custom interface to send and data using HIT standards whenever possible. For receiving data Beechwood and other LTPAC providers access the VHR portal. The VHR allows a clinician with patient consent, to query on a patient's name to see all clinical results available from sources connected to HEALTHeLINK. Some EHRs are capable of receiving patient information directly into the patient's electronic medical record while others have the added capacity to receive "pushed data" from the VHR.

Data Sent by Beechwood

In October 2012, Beechwood completed the first phase of engagement with the HIE which was sending ADT messages when a patient leaves the nursing facility. ADT event updates are sent from HEALTHeLINK to a provider through secure messaging using a Virtual Provider Network (VPN) connection. ADT messages are sent by the following standard categories of events:

  • ED visit to inpatient;
  • Inpatient admission;
  • Outpatient visit; and
  • Outpatient to inpatient admission.

At this time, Beechwood is not sending any other data to HEALTHeLINK beside the ADT event update. Area hospital staff has indicated that they would like nursing notes from long-term care providers, however, that use case has not been developed at this time.

Data Received by Beechwood

Beechwood primarily uses HEALTHeLINK to access information from the VHR portal and see the data that the patient has consented to be shared (limited to the data types listed in Table I-1). Beechwood users have an established security profile and login with two factor authentication. The exchange also has the capability to graph lab values for trending purposes.

Beechwood is currently working on having the Electronic Lab and Radiology Results Delivery functionality enabled. The first priority is to route lab and radiology results from the facility's lab and radiology providers though HEALTHeLINK and then into Beechwood's EHR system.

Additional Opportunities for Beechwood to Provide Information to the HIE

Beyond ADT events, Beechwood does not submit other health information to the HIE at this time; however they do have information generated during a patient stay that would be valuable to other providers/payers who use HEALTHeLINK. Potential information types include:

  • Immunizations and tuberculosis (TB) test results;
  • Advance directives;
  • Skin assessments;
  • Minimum data set (MDS) and assessment summary;
  • SNF admission History and Physical (H&P);
  • Nursing notes (e.g., three days prior to transfer to inform hospital nursing staff);
  • SNF transfer form;
  • SNF discharge summary; and
  • Scanned image of consent form(s).

Access and Security

Beechwood staff may access the VHR portal once a patient is identified for admission consideration (as long as patient consent has been obtained for data to be shared on the exchange). HEALTHeLINK has established strict policies for access and authentication. To access information, users log into the HIE portal. The login process prompts a phone call or text message from HEALTHeLINK with a unique pass code to enter the site. The system only calls the predetermined phone number for the user. Providers may also use a security fob. As an additional security feature, Beechwood receives a report weekly which identifies the facility users who have accessed HEALTHeLINK to verify that access is appropriate and to remove terminated users.

Users and Clinical Processes

The admissions and nursing staff are the primary users of HEALTHeLINK, but other facility staff use the HIE network including social work, therapy, and the attending physicians. The primary clinical workflow supported by the HIE is the admission/transition of care process. The nurse manager in the Wesley Rehabilitation Center is the most frequent user of the exchange due to the volume of admissions and discharges to the unit. The other disciplines using the exchange are frequently accessing information to support their assessment and care planning functions post-admission.

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