Preparing Nursing Homes for the Future of Health Information Exchange

Abstract

SummaryObjective: Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation. Background: NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes. Method: To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE. Results: All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information. Conclusion:We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical care. BackgroundHealth care providers in over 16,000 nursing homes (NHs) across the United States play an important role in providing care for over 1.3 million residents [1]. Caring for this many residents requires significant amounts of health information exchange (HIE) between a variety of stakeholders including nurses, physicians, pharmacists, and others working both within and outside NHs. HealthIT.gov defines HIE as an information system that, "allows health care professionals and patients to appropriately access and securely share a patient's vital medical information electronically. " [2]. Internal and external stakeholders involved in the care of residents use HIE most frequently to monitor resident care tasks, authorize care plans, communicate with each other about patient care, and for financial and administrative activities [3]. Without proper HIEs, health care providers in NHs are at greater risk of breaks in vital communication about resident care, using incomplete clinical data resources, and experiencing limited capacity to make informed care decisions [3]. Additionally, patients are at greater risk for reduced responsiveness to care needs, medical errors, and increased costs from inadequate and fragmented care [4].Providing access and securely sharing NH resident's personal health information (PHI) through a H...

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