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CC BY-NC-ND 4.0 · Appl Clin Inform 2018; 09(04): 752-771
DOI: 10.1055/s-0038-1670651
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Use of Health Information Exchange to Augment Patient Handoff in Long-Term Care: A Systematic Review

Clemens Scott Kruse
1   School of Health Administration, Texas State University, San Marcos, Texas, United States
,
Gabriella Marquez
1   School of Health Administration, Texas State University, San Marcos, Texas, United States
,
Daniel Nelson
1   School of Health Administration, Texas State University, San Marcos, Texas, United States
,
Olivia Palomares
1   School of Health Administration, Texas State University, San Marcos, Texas, United States
› Author Affiliations Funding None.
Further Information

Publication History

22 April 2018

29 July 2018

Publication Date:
03 October 2018 (online)

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Abstract

Background Legislation aimed at increasing the use of a health information exchange (HIE) in healthcare has excluded long-term care facilities, resulting in a vulnerable patient population that can benefit from the improvement of communication and reduction of waste.

Objective The purpose of this review is to provide a framework for future research by identifying themes in the long-term care information technology sector that could function to enable the adoption and use of HIE mechanisms for patient handoff between long-term care facilities and other levels of care to increase communication between providers, shorten length of stay, reduce 60-day readmissions, and increase patient safety.

Methods The authors conducted a systematic search of literature through CINAHL, PubMed, and Discovery Services for Texas A&M University Libraries. Search terms used were (“health information exchange” OR “healthcare information exchange” OR “HIE”) AND (“long term care” OR “long-term care” OR “nursing home” OR “nursing facility” OR “skilled nursing facility” OR “SNF” OR “residential care” OR “assisted living”). Articles were eligible for selection if they were published between 2010 and 2017, published in English, and published in academic journals. All articles were reviewed by all reviewers and literature not relevant to the research objective was excluded.

Results Researchers selected and reviewed 22 articles for common themes. Results concluded that the largest facilitator and barrier to the adoption of HIE mechanisms is workflow integration/augmentation and the organizational structure/culture, respectively. Other identified facilitator themes were enhanced communication, increased effectiveness of care, and patient safety. The additional barriers were missing/incomplete data, inefficiency, and market conditions.

Conclusion The long-term care industry has been left out of incentives from which the industry could have benefited tremendously. Organizations that are not utilizing health information technology mechanisms, such as electronic health records and HIEs, are at a disadvantage as insurers switch to capitated forms of payment that rely on reduced waste to generate a profit.

Keywords

health information exchanges - clinical data - older patients - information technology - communications

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was not reviewed by Institutional Review Board because it is exempted, IAW 45CFR46.


 

  • References

  • 1 Vest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. J Am Med Inform Assoc 2010; 17 (03) 288-294
    CrossrefPubMedGoogle Scholar
  • 2 Meehan R. Transitions from acute care to long-term care: evaluation of the continued access model. J Appl Gerontol 2017; 00 (0): 1-20
    PubMedGoogle Scholar
  • 3 Cross DA, Adler-Milstein J. Investing in post-acute care transitions: electronic information exchange between hospitals and long-term care facilities. J Am Med Dir Assoc 2017; 18 (01) 30-34
    CrossrefPubMedGoogle Scholar
  • 4 Towne Jr SD, Lee S, Li Y, Smith ML. Assessment of eHealth capabilities and utilization in residential care settings. Health Informatics J 2016; 22 (04) 1063-1075
    CrossrefPubMedGoogle Scholar
  • 5 Abramson EL, McGinnis S, Moore J, Kaushal R. ; HITEC Investigators. A statewide assessment of electronic health record adoption and health information exchange among nursing homes. Health Serv Res 2014; 49 (1, Pt 2): 361-372
    CrossrefPubMedGoogle Scholar
  • 6 Filipova AA. Health information exchange capabilities in skilled nursing facilities. Comput Inform Nurs 2015; 33 (08) 346-358
    CrossrefPubMedGoogle Scholar
  • 7 MacTaggart P, Thorpe JH. Long-term care and health information technology: opportunities and responsibilities for long-term and post-acute care providers. Perspect Health Inf Manag 2013; 10 (Fall): 1e
    PubMedGoogle Scholar
  • 8 Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of care for the geriatric patient in the emergency department. Clin Geriatr Med 2013; 29 (01) 49-69
    CrossrefPubMedGoogle Scholar
  • 9 Richardson JE, Malhotra S, Kaushal R. ; HITEC Investigators. A case report in health information exchange for inter-organizational patient transfers. Appl Clin Inform 2014; 5 (03) 642-650
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Stone J, Hoffman GJ. Medicare hospital readmissions: issues, policy options and PPACA. Congressional Research Service; 2010: 1-37
    Google Scholar
  • 11 Kern LM, Wilcox AB, Shapiro J. , et al. Community-based health information technology alliances: potential predictors of early sustainability. Am J Manag Care 2011; 17 (04) 290-295
    PubMedGoogle Scholar
  • 12 Clarke J. What is a systematic review?. Evid Based Nurs 2011; 14 (03) 64
    CrossrefPubMedGoogle Scholar
  • 13 Greaves K. What is a systematic review?. Adv Skin Wound Care 2014
    PubMedGoogle Scholar
  • 14 Cook DJ, Mulrow CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 1997; 126 (05) 376-380
    PubMedGoogle Scholar
  • 15 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 (05) 336-341
    CrossrefPubMedGoogle Scholar
  • 16 Shea BJ, Grimshaw JM, Wells GA. , et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7 (01) 10
    CrossrefPubMedGoogle Scholar
  • 17 Reissman CK. Narrative Analysis. Newbury Park, CA: Sage; 1993
    Google Scholar
  • 18 Alexander GL, Rantz M, Galambos C. , et al. Preparing nursing homes for the future of health information exchange. Appl Clin Inform 2015; 6 (02) 248-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Meehan RA, Staley J. . 2017. Facilitating long-term care providers' participation in accountable care organizations through health information exchange. Perspectives in Health Information Management, 1–7. Available at: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=15594122&AN=124305208&h=TZesjBNWZQ2ZyhjpFNHpuIJ73B13Pf5XimwZIjiqvAcQi1ygWuyigSP9ubUqzJgqSDYGCXHkuy1aLes7fZB5hw%3D%3D&crl=c . Accessed September 5, 2018
    PubMedGoogle Scholar
  • 20 Jamoon E, Yang N, Hing E. Adoption of Certified Electronic Health Record Systems and Electronic Information Sharing in Physician Offices: United States, 2013 and 2014. U.S. Department of Health and Human Services. NCHS Data Brief, No. 236; 2016
    PubMedGoogle Scholar
  • 21 Alexander GL, Popejoy L, Lyons V. , et al. Exploring health information exchange implementation using qualitative assessments of nursing home leaders. Perspect Health Inf Manag 2016; 13 (Fall): 1f
    PubMedGoogle Scholar
  • 22 Yeaman B, Ko KJ, Alvarez del Castillo R. Care transitions in long-term care and acute care: health information exchange and readmission rates. Online J Issues Nurs 2015; 20 (03) 5
    PubMedGoogle Scholar
  • 23 Peters SG, Bunkers KS. Chronic care coordination. Chest 2015; 148 (04) 1115-1119
    CrossrefPubMedGoogle Scholar
  • 24 Hill D, Du Fresne LJ, Holder I, Samudio R, Sujana N. Interconnectivity of health information exchanges using patient access number (PAN). ASBBS eJournal 2015; 11 (01) 7-21
    PubMedGoogle Scholar
  • 25 Hassol A, Goodman L, Younkin J, Honicker M, Chaundy K, Walker JM. Survey of state health information exchanges regarding inclusion of Continuity of Care Documents for long-term post-acute care (LTPAC) patient assessment. Perspect Health Inf Manag 2014; 11 (Fall): 1g
    PubMedGoogle Scholar
  • 26 Campion Jr TR, Vest JR, Kern LM, Kaushal R. ; HITEC investigators. Adoption of clinical data exchange in community settings: a comparison of two approaches. AMIA Annu Symp Proc 2014; 2014: 359-365
    PubMedGoogle Scholar
  • 27 Lyngstad M, Hellesø R. Electronic communication experiences of home health care nurses and general practitioners: a cross-sectional study. Studies in Health Technology and Informatics, 201 (Nursing Informatics 2014: East Meets West eSMART+ - Proceedings of the 12th International Congress on Nursing Informatics, NI); 2014:388–394. Doi: 10.3233/978-1-61499-415-2-388
    PubMedGoogle Scholar
  • 28 Wang T, Wang Y, Moczygemba J. Organizational factors influencing health information technology adoption in long-term-care facilities. Health Care Manag (Frederick) 2014; 33 (01) 30-37
    PubMedGoogle Scholar
  • 29 Hamann DJ, Bezboruah KC. Utilization of technology by long-term care providers: comparisons between for-profit and nonprofit institutions. J Aging Health 2013; 25 (04) 535-554
    CrossrefPubMedGoogle Scholar
  • 30 Wolf L, Harvell J, Jha AK. Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records. Health Aff (Millwood) 2012; 31 (03) 505-513
    CrossrefPubMedGoogle Scholar
  • 31 Light RJ. Measures of response agreement for qualitative data: some generalizations and alternatives. Psychol Bull 1971; 76 (05) 365-377
    CrossrefPubMedGoogle Scholar
  • 32 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22 (03) 276-282
    CrossrefPubMedGoogle Scholar
  • 33 Mishuris RG, Yoder J, Wilson D, Mann D. Integrating data from an online diabetes prevention program into an electronic health record and clinical workflow, a design phase usability study. BMC Med Inform Decis Mak 2016; 16 (01) 88
    CrossrefPubMedGoogle Scholar
  • 34 Holden RJ, Carayon P, Gurses AP. , et al. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013; 56 (11) 1669-1686
    CrossrefPubMedGoogle Scholar
  • 35 Gaskin S, Georgiou A, Barton D, Westbrook J. Examining the role of information exchange in residential aged care work practices--a survey of residential aged care facilities. BMC Geriatr 2012; 12 (01) 40
    CrossrefPubMedGoogle Scholar
  • 36 U.S. Department of Health and Human Services. Available at: https://www.healthit.gov/playbook/care-settings/ . Accessed April 19, 2018
    PubMed
  • 37 Wei Q, Courtney KL. Nursing information flow in long-term care facilities. Appl Clin Inform 2018; 9 (02) 275-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Sockolow PS, Weiner JP, Bowles KH, Abbott P, Lehmann HP. Advice for decision makers based on an electronic health record evaluation at a program for all-inclusive care for elders site. Appl Clin Inform 2011; 2 (01) 18-38
    Article in Thieme ConnectPubMedGoogle Scholar