Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Opportunities to Re-Use Standardized Patient Assessment Content and Link with Other Data

12/01/2011

HIE activities are emerging in federal programs, state and private-sector initiatives that involve LTPAC providers. Some of these activities are using resources developed under this study by re-using standardized assessment content to support other types of interoperable HIE. These activities, briefly described below, can provide steps to increasingly sophisticated HIT use by LTPAC providers building from standardized assessment content:

  • Exchange of Transfer Documents. Massachusetts received a Challenge Grant from ONC to advance interoperable HIE on behalf of LTPAC providers. Through this Challenge Grant, Massachusetts is leveraging their state HIE and implementing the IMPACT program. The program is developing tools to support decision-making and information sharing at the point of transfer to reduce unnecessary hospitalizations. The Massachusetts IMPACT program is working with the Longitudinal Care Coordination Workgroup of the ONC S&I Initiative to identify standards needed for the exchange of an interoperable UTF. The Massachusetts IMPACT program anticipates re-using a subset of interoperable MDS and OASIS assessment content to partially populate the interoperable UTF. The re-use of assessment content is expected to support HIE when individuals transfer from LTPAC providers to acute care hospitals, and between LTPAC providers. In addition, the Massachusetts IMPACT program envisions re-using a subset of standardized MDS 3.0 and OASIS assessment data to support HIE with patients and family members.26

  • Exchange of Home Health Plan of Care. The New York e-Health Collaborative is advancing work in collaboration with Visiting Nurse Services of New York (VNSNY), physician practice groups, and other stakeholders to create an interoperable plan of care document for home care that would be continuously updated and shared between the home care agency and a physician. The plan of care document that will be standardized in the NY project is the "485 form" formerly required by CMS and remains in widespread use by home health agencies. Although originating in New York, this project is gaining state and vendor support around the United States. The project is advancing its work through the Longitudinal Care Coordination Workgroup of the ONC S&I Initiative to identify and harmonize vocabulary and exchange standards. The VNSNY anticipates re-using a subset of interoperable OASIS assessment content to partially populate the interoperable home health plan of care.

  • Detecting potential adverse drug reactions (ADRs). The University of Pittsburgh in Pennsylvania developed and evaluated a consensus list of laboratory, pharmacy, and MDS signals that can be used by EHR systems in nursing homes to detect potential ADRs. The results suggest that ADRs can be detected in nursing homes with a high degree of accuracy using an electronic clinical event monitor that employs a set of signals created from electronic laboratory, pharmacy, and MDS data.27 This type of clinical decision support tool uses lab, pharmacy and MDS data to generate alerts of potential ADRs. While this electronic clinical decision tool has not been standardized, content standards are available for medications, laboratory results and as described in this study, MDS data.28 The availability for content standards for lab results, medications and MDS data, could be used to develop standardized clinical decision support tools targeting ADR monitoring and prevention.

As LTPAC providers become more sophisticated in their HIT use (they use interoperable HIT/EHRs), it is anticipated that standardized assessments, assessment summaries and other information will be exchanged. Diagram 2 depicts how nursing homes and home health agencies could exchange interoperable assessment documents/summaries and supplement it with additional EHR data (e.g., medication information) as their use of standardized technology becomes more mature.

  DIAGRAM 2. Exchanging Interoperable Assessment Content by a More HIT Sophisticated LTPAC Provider  
Diagram 2 is described in text.

The top part of Diagram 2 shows the same current state of HIE for most nursing homes and home health providers as depicted in Diagram 1 (i.e., electronic transmission of non-interoperable federally required assessments from the provider to CMS). The middle of Diagram 2 depicts the "more HIT sophisticated" LTPAC provider using their software to:

  • Transform the non-standard CMS assessment document into an interoperable assessment document by linking the assessment items with HIT content standards and transforming it into the HL7 CDA format (an industry-accepted exchange format).

  • Generate a Patient Assessment Summary Document (using accepted HIT content and exchange standards) and possibly linking additional EHR data (such as medication data) to the Patient Assessment Summary Document.

  • Transmit these documents to the HIE Organization or directly to the receiving provider/patient/family member. If transmitted to the HIE Organization, the organization would make this information available to authorized entities.

Building on the standardized assessment content and exchange formats developed under this study, LTPAC providers will be positioned to more readily implement the advancements envisioned by the Massachusetts IMPACT program, New York e-Health Initiative and others to improve information sharing and re-use.

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