Long-Term Care Facilities Join Health Information Exchange

8 Health Information Exchanges Lead The Way

A Pennsylvania healthcare system has established an innovative method of connecting long-term post-acute-care (LTPAC) providers and hospitals online, and plans to take it nationwide.

The Keystone Beacon Community, led by the Geisinger Health System, has established electronic communication between long-term care facilities and hospitals with the help of a specially designed tool from software firm Caradigm, a joint venture between GE and Microsoft.

In late June, the Emmanuel Center for Skilled Nursing and Rehabilitation in Danville, Penn., where Geisinger is headquartered, became the first LTC provider to send continuity of care documents (CCDs) on a production basis to KeyHIE, the Beacon Community's health information exchange (HIE), so that hospital clinicians can view or download them to their electronic health records (EHRs). Four more LTC facilities are expected to go online with KeyHIE by the end of the year, said Jim Younkin, Geisinger's IT director, in an interview with InformationWeek Healthcare.

Using a special Web viewer, about half of the LTC facilities participating in the HIE can see hospital discharge summaries and other reports on patients they are receiving, Younkin noted. That capability has been available to them and to home health agencies since the beginning of the year.

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The greater challenge was to enable LTPAC providers to send their data to the acute-care hospitals. Most LTC facilities either lack EHRs or have systems that are incompatible with those used in acute-care hospitals. However, the nursing homes all have computer systems that they use to complete a federal minimum data set (MDS) form for each patient. This document must be submitted each month to the Centers for Medicare and Medicaid Services (CMS) for payment purposes.

When the Geisinger team looked at the MDS form, Younkin recalled, they discovered that it contained a large amount of clinical data and that each data element carried an XML tag. In discussions with the Department of Health and Human Services (HHS), which provides funding for the 17 Beacon Communities, Younkin and his colleagues found out that an HHS unit was already trying to convert the MDS data into a document compatible with HL7's clinical document architecture (CDA). Geisinger's staff suggested converting the MDS into a CCD, which is a type of CDA document.

The Geisinger team became the core of a workgroup in the government's S&I Framework wiki that built the specs for an MDS-to-CCD converter. Meanwhile, Geisinger told GE what it was trying to do, and GE offered to create a software tool. After Caradigm was formed, it took over the project from GE and completed development of its MDS-to-CCD transformer. "So GE/Caradigm was building out these specs that we had developed at a national level," explained Younkin.

Currently, he said, an implementation guide for the translator is going through HL7 balloting to create a new standard for HL7 users. The specs have already been published, so any vendor can use them to create a converter.

Home-care agencies have the same problem communicating with hospitals that nursing homes do. And, like skilled nursing facilities, home-care agencies must fill out a CMS form to get paid; in their case, it's the OASIS (Outcomes and Assessment Information Set) form. Younkin's team has already mapped OASIS to the CCD.

"We have included the OASIS-to-CCD transformer in the HL7 package for balloting and plan to build this tool for production use by the end of the calendar year," he said.

Geisinger also plans to make an MDS-to-CCD converter available to the 16,000 LTC facilities that submit MDS forms to CMS. The healthcare system will soon put out an RFP for a company to host the translator in the cloud, Younkin said. "Then any LTC or home-health agency could just use the service on a subscription basis. And once they had the CCD, they could send it to whomever they wanted to."

While Caradigm is interested in hosting this service--and will undoubtedly market its own product nationally--Geisinger "thought it would be a best practice to have an RFP and allow other firms to bid on it," Younkin said.

There is no doubt that the LTPAC community is interested in improving information exchange with hospitals. But so far, relatively few LTPAC providers have been able to do so. The concept of the MDS-to-CCD converter might help fill that gap.