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

10/29/2013

Snapshot of Rush University Medical Center LTSS and HIE

  • Organization Type: Hospital (1 of 4 hospitals in Rush System for Health).

  • Size: 664 beds.

  • Transitional Care Programs: Health and Aging Department with Transitional Care Services including the Bridge Program. Approximately 1,800 patients in program annually.

  • Community Engagement: Founder and member of ITCC developer of the Bridge Model/Program.

  • CMS Funding: ITCC is participating in the CMS funded CCTP.

  • EHR: Epic Technical Support for Information Sharing:
    • Epic Care Anywhere -- HIE only for Epic clients (used primarily by hospitals and ambulatory care practices).
    • Allscripts -- Care management application to share information with other subscribers.
    • An HIEO is under development in Illinois and the Chicago area, but not operational at the time of the site visit.

A site visit was conducted to Rush University Medical Center (RUMC) to explore what, how, and with whom health information is exchanged including on behalf of persons receiving long-term services and supports (LTSS). RUMC is part of the Rush System for Health, an integrated delivery system with hospitals and ambulatory care practices. Rush is an urban hospital located in downtown Chicago, Illinois, with multiple programs focused on improving care transitions including improving transitions with skilled facilities, home health agencies (HHAs), reducing hospital readmissions and care coordination with community-based services.

A key component of Rush's Facility Transitions in Care and Bridge Programs is coordination with LTSS programs in the community. Through a patient-centered approach, Rush works to improve care transitions through intensive care coordination that starts in the hospital and continues into the community. The multidisciplinary health care team is extended beyond the hospital's physicians, nurses, pharmacists and case managers to also include the community resource team (therapists and community providers such as home health, skilled nursing facilities [SNFs], and other services). The team identifies and addresses the services and resources needed by the patient and works to eliminate barriers that will prevent them from safely transitioning back to the community and meeting their health care goals.

Rush University Medical System uses the Epic electronic health record (EHR) system for all patient care documentation in the hospital and ambulatory care sites. Epic is a Meaningful Use (MU) of Certified EHR Technology having achieved MU Stage 2 certification for its ambulatory and inpatient applications.1

Health information exchange (HIE) from hospital to long-term and post-acute care (LTPAC)/LTSS providers relied on multiple methods to communicate and exchange information including phone, fax/e-fax, secure e-mail, and the use a proprietary electronic referral application (AllscriptsCare Management application). Some Chicago-area hospitals allowed LTPAC providers to access their EHR to facilitate communication and information sharing, however, Rush's policy limits EHR access to only staff and physicians and does not allow access to non-affiliated providers such as LTPAC and LTSS providers.

The Allscripts Care Management application facilitates the electronic exchange of some health information (e.g., unstructured narrative messages as well as medical record document attachments) between Rush and their community partners including LTPAC organizations. The community partners who subscribe to the Allscriptsapplication can receive messages and attachments from Rush and pull some of the information into their EHR if they use an Allscriptsapplication.

LTSS Provider Definition

Long-Term Services and Supports (LTSS) are services and supports used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dressing, preparing meals, and administering medications. LTSS include institutional and community-based services such as nursing homes, care management, adult day care, home-delivered meals, transportation providers, and other services.

At Rush, HIE between the transitional care programs and LTSS typically occurs during four phases:

  • Pre-discharge (prior to and at transition).

  • At the point of transition.

  • Immediate post-discharge (within 24-48 hours after transition).

  • 30-Day followup after discharge (during shared care).

Clinical, demographic and service information is communicated by hospital case managers and care coordinators to community providers (HHA, nursing facilities, and/or home and community-based services [HCBS] providers). The lack of tools to facilitate exchange, such as a HIE organization (HIEO) is a challenge for Rush and their partners. Staff interviewed during the site visit identified a number of opportunities for improvement including:

  • Identifying the need for a HIEO available to all community partners.

  • Finding the right balance in the amount of information sent versus the information needed between the hospital and their community partners.

  • Developing standardized reports.

  • Integrating LTSS needs in a patient-centered plan of care (POC).

  • Redefining case management and care coordination to achieve a patient-centered, longitudinal care that includes partnerships with community partners.

Because of Rush's ongoing initiatives to improve transitions and coordination, they have pilot projects with HHAs and nursing facilities to improve processes and communication. These projects include ongoing multidisciplinary case management meetings on a regular basis to discuss care and process issues and work in partnership to improve outcomes.

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