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

• Access to hospital EHR
• Phone
• Fax
• Interview

• Medications
• Nurses notes
• H&P
• Diagnoses
• Operative report
• Other relevant clinical data such as functional status, therapy, skilled nursing services
• Hospital discharge summary

• Phone
• Fax
• Interview

• Recent hospital information
• Medications
• Nurses notes
• MDS
• Care plan
• Lab
• Other relevant assessments

• Phone
• Fax
• Interview

• Recent hospital information
• Medications
• Recent labs
• Other progress notes
• (Home health information if applicable)

Admissions. Patient representative to facility admissions.

• Fax or scan
• Paper copies
• Hospital EHR access by Beechwood

• Transfer form
• Medications
• Nurses notes
• H&P
• Diagnoses
• Operative report
• Other relevant clinical data such as functional status, therapy, skilled nursing services
• Hospital discharge summary

• Fax or scan paper copies HEALTHeLINK

• Order to admit & other admission orders
• H&P
• Past medical history information

• Fax or scan paper copies

• Transfer form
• MAR
• Recent nurses notes
• New labs

• Fax or scan paper copies

• Transfer form
• MAR
• Recent nurses notesNew labs

• Fax or scan paper copies

• See INTERACTII envelope content detailed above for transfer to hospital

• Fax or scan paper copies

• Transfer form
• Face sheet
• Most recent H&P & any recent hospital discharge summary
• SBAR/Nurse's progress notes
• Orders related to acute condition
• Current medication list or current MAR
• Advance directive
• Care limiting orders
• Relevant lab results
• Relevant x-ray reports
• Immunization records
• PT notes

• Fax or scan paper copies

• Discharge instructions & discharge POC (includes meds, diagnoses, therapy notes, functional status, followup care/ appointments & services)

• Phone
• Fax
• E-mail
• Mail

• Relevant information (demographics & type of services requested) related to community service

• Electronic message to HEALTHeLINK

• ADT events

• Phone
• Fax
• Mail
• HIE to assist with medication history
• AOD (for limited number of physicians testing signing orders in system)

• Telephone orders for all orders including medications that are to be implemented at the Beechwood

• Mail

• Therapy order
• Therapy evaluation
• Therapy Certification

• Fax

• Physician orders including medication

• Phone

• Lab order
• Diagnosis
• Patient demographic
• Face sheet
• Payer information

• Phone or web portal

• Radiology/ ultrasound order
• Diagnosis
• Patient demographic
• Face sheet
• Payer information

• Electronic access to HEALTHeLINK
• Written request for information from hospital

• Varies--Information not received such as Operative reportAssessment Tests & results

• In person interview or phone

• Varies

• Paper records mailed for review & signature or available in folder at Beechwood for physician to sign during on-site visit.

• Physician order recap
• Review care plan

• In-person participation in care conference
• Phone
• Mail

• Care plan

• Mail
• Phone
• In-person
• Notes with status updates & request (in folder for physician)

• Physician visit due date (& patient's to visit)
• Physician progress notes
• Physician orders
• Interdisciplinary progress notes
• Care plan

• Phone
• Fax

• Telephone orders
• Lab & other test results
• Summary of change

• Phone

• Summary of change, results, plan

• Mail
• Phone
• Paper copies

• Referral
• Medication list or administration record
• Face sheet

• Fax

• Physician orders including medication

• Phone and/or portal (for radiology)

• Test type
• Diagnosis
• Face sheet/ demographic information

• Mail (in special circumstances by fax)

• Medicare Certification/ Recertification Form

• Electronic submission via CMS required portal

• Mandatory data set

• Through NY State HCS

• Outbreaks
• Immunization result data starting November 2013, Other reportable infections
• Mandatory reporting such as emergency preparedness
• Receipt of emergency notifications from state

Emergency notifications & other requests for data & communication are sent from the state through HCS to Beechwood.

• Phone
• Fax
• Copies
• Mail

• Medical record information relative to coverage

• Fax

• Medicare coverage dates

• Phone
• Mail

• Medicare coverage letters

• Billing system
• Copies
• Mail

• Relevant medical record documentation