Nursing Home Data Exchange Puzzle Solved

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Hospitals and physicians have long had difficulty getting detailed patient information from skilled nursing facilities, home health agencies, and other post-acute care (PAC) providers. But a federally funded project in Pennsylvania has taken a big step toward lowering that barrier to data sharing.

Keystone Beacon Community, one of 17 organizations that have received grants from the Department of Health and Human Services (HHS) to pursue health IT innovations, has developed a method for extracting key clinical information from electronic reports that skilled nursing facilities and home health agencies must submit to the Centers for Medicare and Medicaid Services (CMS). This data is then made available to providers who use the Keystone Health Information Exchange (KeyHIE).From there, the information can be downloaded to certain types of electronic health records, or it can go into other EHRs in the form of scanned documents.

"We did this because skilled nursing facilities and home health are critical to a patient's care," said James Walker, MD, project director for the Keystone Beacon Community and chief health information officer at the Geisinger Health System, in an interview with InformationWeek Healthcare. "It's really important that doctors and hospitals and EDs know what the skilled nursing facility and the home health agency know, and vice versa."

Through KeyHIE, which includes more than 50 hospitals and healthcare facilities, the nursing homes and home care agencies also have web access to hospital discharge summaries and reports, Walker said. Care managers at area hospitals send along additional information, including medication lists that incorporate patients' prescriptions before they were admitted to the hospital.

Up to now, this kind of two-way communication has been the exception rather than the rule across the country, Walker noted. If a patient in a skilled nursing facility has an infection and needs an antibiotic, for example, a nurse typically calls the patient's doctor and reads the patient's medication list to the physician on the phone.

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"That works fairly well, but it's not the same thing" as having the list in front of the doctor, Walker said. "So the value is making sure that the other people caring for a patient can understand more about what's going on in home health or a skilled nursing facility."

While many home health agencies have specialized EHRs, they are designed mainly to gather the information needed to complete the forms that CMS requires to approve a course of home care. Moreover, these EHRs are generally unable to communicate with hospital or ambulatory-care EHRs. Few nursing homes outside of big chains have any kind of EHR, Walker said.

However, because these providers have to submit the CMS forms online, much of the key clinical information is available in electronic form. Keystone can extract the data from those documents at little incremental cost, Walker said. The data is reformatted as a Continuity of Care Document (CCD), a standardized clinical summary that many EHRs can accept.

The data may not be current, because the CMS documents are prepared only when the agency requires them for new authorizations of care. "But doctors will tell you that even month-old information is a lot better than nothing," Walker said. "We don't regard this as the end game. It's just a low-cost way to get information to care team members that would otherwise be almost impossible to get."

Keystone Beacon Community and HHS are working together to disseminate the new method of data sharing to providers across the country. Keystone is preparing the specifications for publication and will also ask HL7, the healthcare data standards organization, to approve them as a new standard of information exchange, Walker said. The Beacon Community will publish the specs in any case, he added, but HL7's imprimatur would give healthcare providers additional confidence in the approach.

The ability to exchange information between hospitals and post-acute care providers will be important for healthcare organizations that want to take bundled payments from CMS and private payers. Additionally, it could help hospitals reduce readmissions--a key objective of facilities because of new CMS penalties that kick in later this year.

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