Posted in Perspective

Long-term care: HIE with all members of the care team

Joy Duling, Central Illinois HIE
Joy Duling, Central Illinois HIE,

The number of Americans using long-term care services is expected to increase from 13 million to 27 million between 2000 and 2050. This growing importance of long-term care and post-acute (LTPAC) providers to deliver quality, cost-effective care outside the hospital makes it critical to integrate LTPAC clinicians into all coordination efforts.
Throughout the industry, HIEs are connecting providers to enable collaboration, but unfortunately, LTPAC providers are often the missing piece of the HIE puzzle because they have been left out of the Medicaid and Medicare EHR incentive programs.
As a result, progress toward EHR adoption and system integration has been constrained for LTPAC providers. When EHR systems are in place, they often focus only on the immediate need to create and transmit assessments that meet federal requirements for payment and quality reports. Because these systems address LTPAC-specific needs as opposed to the need to collaborate outside the organization, the EHR may not be able to connect to other systems. This lack of connectivity prevents the entire care team — hospital, physician and LTPAC provider — from seeing the whole picture of the patient’s healthcare needs.
Without the ability to participate in an HIE, LTPAC providers often admit patients with incomplete information about their medical status. Over a third of all Medicare patients discharged from acute hospitals receive LTPAC services, with almost 80 percent of those patients receiving skilled nursing or home care. Not only are resources strained as staff members spend time calling to request faxed copies of documentation, but the overall patient experience is diminished.
HIE participation reduces the time needed to prepare for a new admission and provides more accurate data that translates to better preparation and higher quality care. Consider a patient transferred to a skilled nursing facility from the hospital who requires specific durable medical equipment (DME). The single-page faxed referral might not describe the need, creating an unnecessary rush to obtain the DME once the patient arrives, as well as a delay in providing the exact care required. By contrast, an ability to view the patient’s electronic record prior to arrival would ensure a complete picture of the patient’s needs.
Connecting all the pieces
The Central Illinois Health Information Exchange (CIHIE), which serves a population of approximately 1.3 million patients across the mid-section of Illinois, is working to solve the long-term care integration challenge by including LTPAC organizations in an exchange that already includes hospitals, ambulatory clinics and physician groups. Using grant funding from the state of Illinois, CIHIE will have 30 long-term care facilities connected by fall 2013.  Many of the LTPAC organizations already were collecting data electronically, but few were able to communicate with information technology systems outside their own organizations. Achieving the interoperability needed to exchange protected health information required a two-step process to work around the challenges.
The first step was to enable connectivity with CIHIE by putting existing data into a format that can be accessed by all CIHIE participants. All LTPAC organizations must submit Minimum Data Set (MDS) data to the Centers for Medicare and Medicaid Services (CMS), so we simply convert existing MDS data to a continuity of care document (CCD) format. After conversion, the information is pulled into the HIE where it becomes part of the patient’s longitudinal record that can be accessed by any provider in our exchange.
While data fed straight from an EHR is more current than the periodic “snapshot” of a patient’s status that MDS data provides, we felt it was important to use data from an existing format. Otherwise, LTPAC participation might be limited by an inability to invest in EHRs capable of transmitting directly via HL7 or CCD.
The second step is to provide access to information from other providers. We offer an easy-to-use, intuitive clinician portal that enables all providers in our exchange to retrieve patient data. Organizations that have EHRs capable of consuming CCD data can pull it straight into their own systems. By having patient data available within their own systems, these organizations are able to seamlessly provide comprehensive, targeted care in an efficient manner.
The whole picture
HIEs play a critical role in care coordination and collaboration. While LTPAC organizations present unique challenges for HIE participation, our experience shows that solutions do exist. The best results in terms of increased care quality and cost savings occur when every piece of the patient care puzzle – including LTPAC providers – is in place.