Health Information and Technology

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.7. Barriers for Challenges to Advancing Health Information Exchange

The findings and observations above begin to highlight a number of barriers or challenges related to HIE and advancing its use by LTPAC providers and the expanded use of electronic HIE. This section describes the barriers or challenges that were identified by the site visit providers. Medication Reconciliation Challenges at Transitions of Care/

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.6. Findings, Challenges, and Opportunities Identified from Site Visits

A number of overall findings and impressions emerged from the three site visits which provide a snapshot of the current state of HIE by LTPAC to support the transition of care, shared care and care coordination processes. In addition, barriers to and opportunities for advancing HIE in LTPAC settings were also identified across the sites visited.

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.5. Use of Health Information Technology Standards to Support Interoperability and Exchange

Basic HIT and interoperability standards are sometimes used to support electronic HIE at the sites (e.g., use of HL7 version 2 messaging). One of the three sites (Rush) has an EHR vendor that is certified for Stage 2 of the EHR Incentive Programs, but demonstration of HIE with LTPAC providers outside of their network was not observed.

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.4. Summary of Long-Term and Post-Acute Care Data That Could be Prioritized for Electronic Health Information Exchange

LTPAC organizations have a frequent and ongoing need to exchange information -- both as a receiver and a sender. As noted, electronic HIE is beginning to occur, but primarily by allowing access by LTPAC providers to hospital and HIEO information. Minimal information has been requested from LTPAC providers for inclusion by the HIEO, or sent electro

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.3. Summary of Electronic Health Information Exchange

Among the site visits (even in the most advanced) the information that is electronically available for exchange is limited and incomplete. LTPAC providers use multiple methods to share and exchange information frequently relying on mail, fax and secure e-mail when data and documents are required to move from one provider to another. While the curr

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2.3. Other Administrative Health Information Exchange

LTPAC providers exchange health information in support of administrative processes such as billing and required reporting.

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2.2. Health Information Exchange for Shared Care

LTPAC providers frequently coordinate and share care with other health care and service providers. When sharing care, there are related HIE processes to support assessment, care planning, and ongoing monitoring. A summary of HIE activities to support shared care is described below along with the type of data shared. During instances of shared care

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2.1. Health Information Exchange for Transition of Care

Health information is shared and exchanged to support a number of care processes as a patient transitions between care providers. The type of data shared to support transitions in care and the methods of exchange are summarized below. During transitions, information is typically exchanged face-to-face, by telephone, fax, and on some occasions, ele

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.2. Synthesis of Health Information Exchange Findings from Site Visits

The exchange of health information is a critical function in the delivery of care to patients in LTPAC organizations. All three site visits identified multiple clinical and administrative processes requiring the exchange of information. LTPAC providers and their partners use many different methods to exchange information -- face-to-face communicat

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.1.3. Maine HomeCare, Bangor, Maine

Background EMHC is the home care and hospice division of the EMHS. The health system is an IDS with hospitals, ambulatory care practices, LTPAC providers (home health, hospice, SNFs, and assisted living) and ancillary services. The home care division includes three agencies and seven offices serving both urban and rural areas covering two-thir

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.1.2. Beechwood Homes, Getzville, New York

Background

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.1.1. Rush University Medical Center, Transition of Care Programs

Background Rush University Medical Center (Rush) is part of the Rush System for Health, an IDS 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 SNFs and HHAs, and programs focused on red

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4.1. Summary of Site Visits

HIE has been a long-standing practice between LTPAC and other health care providers both at transitions of care and in support of shared care. The sites evaluated expressed the importance of timely, complete and accurate information for improved care coordination programs including integration of community services. Currently they use many ways to

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 4. Synthesis of Findings From Case Studies of Health Information Exchange to SUPPORT CARE Coordination for Persons Receiving LTPAC/LTSS

During the literature review and key informant interviews, potential sites were identified for in-depth analysis of HIE activities. Site visits were conducted with three strategically identified providers engaged in HIE to support care coordination for persons receiving LTPAC/LTSS. The purpose of the site visits was to evaluate the information exc

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.6.3. HIE to Support Eligibility and Authorizations

HIE is also being used to send information to the state Medicaid program for eligibility determinations. Currently, all 98 nursing facilities in Utah use the HIEO, Utah Health Information Network (UHIN), to send an electronic request to obtain preauthorization for Medicaid coverage. This exchange provides a low-cost mechanism to securely send ele

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.6.2. HIE to Support Care Transitions

This section describes some of the uses of HIE supporting care transitions with LTPAC/LTSS providers, specifically: (1) transfers from an LTPAC/LTSS to a hospital; and (2) transfers from a hospital to an LTPAC/LTSS provider. Interventions varied in how HIE was used to support care transitions. This section provides examples of the technology, work

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.6.1. HIE Interventions Identified for Study

HIE "interventions" or activities were identified that support transitions and information for persons receiving LTPAC/LTSS care and described in Appendix G. The interventions described in this section were not confirmed or updated by informants, other than for the three case study sites.

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.6. Health Information Exchange Interventions Identified for Study

This section describes and characterizes the use of HIE to support care coordination for persons receiving LTPAC/LTSS services based on the literature review, environmental scan, key informants, and site visits.

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.5.3. Care Transition and Coordination Measures Used by Identified HIE Interventions

Most the identified HIE interventions identified, including the sites visited measure the impact of the care transitions and coordination interventions. Not all of the measures may be directly attributable to the exchange of information nor were they reported to be so. It was also not possible from the environmental scan to separate measures used

Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.5.2. HIE Impact Measures

The literature review for this study specifically examined the evidence around the impact of electronic HIE. A summary of the literature review is provided in Appendix F. No studies of the impact of HIE in LTPAC/LTSS settings were identified. Further, the evidence of HIE impact remains sparse.

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