Preparing Nursing Homes for the Future of Health Information Exchange

• Published in: Applied clinical informatics Vol. 6; no. 2; pp. 248 - 266
• Main Authors: Alexander, G.L., Rantz, M., Galambos, C., Vogelsmeier, A., Flesner, M., Popejoy, L., Mueller, J., Shumate, S., Elvin, M.
• Format: Journal Article
• Language: English
• Published: Germany Schattauer GmbH 01.01.2015; Schattauer
• Subjects: Health Information Exchange - utilization; Health Services Accessibility - statistics & numerical data; Humans; Interviews as Topic; Nursing Homes - statistics & numerical data; Point-of-Care Systems - statistics & numerical data; Research Article; nursing home; utilization; health information technology; Health information exchange; long-term care
• ISSN: 1869-0327; 1869-0327
• DOI: 10.4338/ACI-2014-12-RA-0113

Summary 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. Citation: Alexander GL, Rantz M, Galambos C, Vogelsmeier A, Flesner M, Popejoy L, Mueller J, Shumate S, Elvin M. Preparing nursing homes for the future of health information exchange. Appl Clin Inf 2015; 6: 248–266 http://dx.doi.org/10.4338/ACI-2014-12-RA-0113