Preparing Nursing Homes for the Future of Health Information Exchange

Abstract

Objective: 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.

Keywords: Health information exchange; health information technology; long-term care; nursing home; utilization.

Fig. 1

Use Case Non-Emergent Appointment

Fig. 2

Use Case Non-emergent Laboratory Specimen (Antibiotic Administration Monitoring)

Fig. 3

Use Case Non-Stat Pharmacy Order Communication (External Stakeholder)

Fig. 4

Use Case Non-emergent Social Services: Social Work Discharge Planning Communication

Fig. 5

Use Case Non-emergent: Admissions and Pre-Admissions

Fig. 5

Use Case Non-emergent: Admissions and Pre-Admissions

Fig. 6

Use Case Pharmacy and Medication Reconciliation