Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Health Information Exchange Partners -- Perspectives From Non-Affiliated Community Partners

10/29/2013

During the site visit, interviews were conducted with Beechwood's HIE community partners -- non-affiliated organizations that provide health care and/or services. Table I-4 summarizes the key organizations that Beechwood shares information with, identifies the type of information exchanged with each organization, and summarizes discussions on the exchange process and information sent/received.

TABLE I-4. Perspectives from Non-Affiliated Community Partners

Organization Information Exchanged Between Beechwood & Organization Additional Notes from Discussions
Hospital Systems:
  • Kaleida Hospitals
  • Catholic Health System
For a transfer from the hospital to Beechwood, the following information is provided. The information is typically in an electronic format such as PDF or JPG. 

Transfer form. Transcribed reports:

  • H&P
  • Op report
  • Discharge summaries.

Medication information (medication list & MARs). 

Lab & other test results. Other clinical information related to nursing, rehab service & functional status (e.g., progress notes & assessments).

During discussions challenges were identified with the availability of the discharge summary at the point of transfer to Beechwood. 

Hospital policy may result in delayed submission of the discharge summary to HEALTHeLINK until after discharge (once physician signature is obtained). When this happens the information on the discharge summary is not available to Beechwood staff at transition of care when it is needed. 

Significant challenges were identified & discussed related to the availability of accurate medication information at discharge including the ability to reconcile pre-hospital medications with the post-hospital medications. 

The lack of MAR data was another challenge identified when not provided at transition of care from the hospital to Beechwood. Beechwood staff uses the MARs to evaluate the medications the patient received in the hospital & the time. 

Update: Discharge meds are now available from the Catholic Health System & will be available from Kaleida by late 2013. 

Therapy information is not currently received by Beechwood & is an opportunity for HIE.

Pharmacy:
  • Buffalo Pharmacies
Physician orders including medications are written out by nursing & sent by fax to pharmacy. 

Buffalo Pharmacies sends the following paper-based records to Beechwood at the end of each month:

  • A list of physician orders including medication, treatment, & ancillary orders by patient
  • MARs for the month
  • Treatment Administration Records for the month.
Beechwood would like to move toward physician orders being generated in AOD & prefers that physicians enter the orders through their system. This would enable the use of electronic medication administration & treatment records (currently these are paper-based & manually completed). Beechwood believe that this would be the safest approach rather than trying to interface AOD to the physician's EHR. MU may be a challenge since physicians must prescribe a percentage of medications through their system. 

As noted above obtaining an accurate medication history is a challenge. SureScripts (which supplies information to HEALTHeLINK) does provide a medication history, however not all pharmacies use SureScripts, so the information may not be complete. AOD does not use SureScripts.

Laboratory:
  • Kaleida Lab
Lab orders. 

Lab results.

Lab results are being routed through HEALTHeLINK to the physician practice. Beechwood can access results through the HIE, but there is currently not a direct link to AOD. A custom interface is under development to allow lab results to be electronically delivered into the AOD system. Currently Beechwood maintains lab results in paper medical record. 

There is potential in the future to order labs through HEALTHeLINK, currently it is a manual process of calling the lab to set up the draw when a physician order is received.

Radiology/ Ultrasound:
  • Buffalo Ultrasound
Radiology orders. 

Radiology reports. 

Radiology images.

To obtain radiology/ultrasound services, Beechwood accesses Buffalo Ultrasound online system or calls in an order. The results are phoned to the facility to provide a verbal update & then the final reports are available online for access. Buffalo Ultrasound maintains a portal for Beechwood to order the test & access the results. 

Buffalo Ultrasound is currently working on automating the results delivery process through HEALTHeLINK. The order/requisition process will continue as is--Beechwood will either call Buffalo Ultrasound to request the test or submit the request through their portal. Buffalo Ultrasound does not plan on processing requests for tests through HEALTHeLINK due to patient identification issues.

Home Health & Hospice:
  • Amedysis Home Health & Hospice Care
  • Hospice Buffalo Palliative Care
When Beechwood discharges a patient to Home Health or Hospice they provide the following medical records in paper format:
  • 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
  • (Content sent in the INTERACTII envelope.)
The home health & hospice providers were interested in having the information available on HEALTHeLINK if it was feasible for the HIE & for AOD. 

The Home Health & Hospice providers discussed their HIE needs at transition of care from the hospital. They also need an up-to-date, timely discharge summary at the time of hospital transfer & reported that it was 1 of their biggest challenges in the transition of care process.

 

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