Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Western New York Beacon Community

10/29/2013

The Western New York Beacon Community is one of 17 Beacon Communities funded by the ONC to build and strengthen local HIT infrastructure and test innovative approaches to make measurable improvements in health, care, and cost. The Western New York Beacon Community's efforts focus on improving clinical outcomes and patient safety by using HIT and HIE in diabetes care management. The Western New York Beacon is using technology to achieve its goals, which include:2

  • Improving the care of patients with diabetes in primary care practices and demonstrating progress toward meaningful use (MU) requirements through the use of registries, electronic diabetes guidelines (EHR prompts and alerts), and medication histories.

  • Reducing emergency department (ED) visits, hospitalizations for ambulatory care sensitive conditions, and 30-day readmissions rates for individuals with diabetes, and for a subset of diabetics with co-morbid congestive heart failure.

  • Strengthening HEALTHeLINK by adding new data sources and expanding the number of data feeds contributing to the HIE (i.e., adding discharge medications from hospital data sources).

The Western New York Beacon Community has engaged multiple types of health care providers to achieve these goals. In addition to hospitals, physician practices, they have also engaged LTPAC providers, specifically five SNFs and five home health agencies. Nursing home partners were selected if they were willing and able to set up an EHR interface to HEALTHeLINK. To assist Beechwood in being an active participant in the Western New York Beacon initiatives, the Beacon grant covered the cost to develop an interface from the nursing home EHR (AOD) to HEALTHeLINK.

One of the initiatives that the Western New York Beacon Community is focused on is hospital discharge then admission to a SNF to determine how HEALTHeLINK can improve efficiency, improve the patient transfer process and reduce adverse outcomes (For more information seehttp://www.healthit.gov/system/files/beaconfactsheet_westernny.pdf). It should be noted that the Western New York Beacon Community is monitoring the efforts of the ONC Standards and Interoperability (S&I) Longitudinal Coordination of Care (LCC) workgroup specifically on emerging standards to support transfer of care information and in MU Stage 2 of the EHR Incentive Program.

In addition to the hospital-SNF transfer initiative, the Western New York Beacon Community has identified four long-term care use case priorities for 2013 (Attachment I-1):

  1. Lab and radiology results delivery from lab and radiology providers through HIE to Beechwood's EHR;
  2. Care planning and regulatory requirements after admission acceptance;
  3. Access to data needed for admission criteria; and
  4. Patient preference notification (future consideration).

Work has begun on the first use case priority to deliver lab and radiology results and on the second use case. Access to data for admission criteria is operational.


2. Western New York Beacon Community Fact Sheet. http://www.healthit.gov/system/files/beaconfactsheet_westernny.pdf (also available in Appendix A).

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