141st APHA Annual Meeting and Exposition

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284733
Health information exchange: Coordination with home health care


Monday, November 4, 2013

Andrea Hassol, MSPH, Abt Associates, Cambridge, MA
James Younkin, Geisinger Health System, Danville, PA
Kimberly Chaundy, MS, Geisinger Health System, Danville, PA
Mary Honicker, Geisinger Health System, Danville, PA
Deborah Deitz, BSN, Abt Associates, Cambridge, MA
Henry Goldberg, Abt Associates Inc., Cambridge, MA
James Walker, MD, Geisinger Health System, Danville, PA
Background: The Keystone Health Information Exchange (KeyHIE) serves more than 40 largely rural counties in central Pennsylvania; members include hospitals, physician practices, nursing homes and home health agencies. HHAs often lack complete and timely information, especially for new patients and for patients in their care who are admitted to the hospital or emergency department (ED). HHAs can locate or ‘pull' their patients' information from KeyHIE; in addition, KeyHIE ‘pushes' alerts to HHAs whenever their patients visit an ED or are admitted to the hospital. Standard patient assessments from nursing homes (MDS) and other HHAs (OASIS) are also available in KeyHIE; the first such effort in the nation.

Purpose: To understand how three different HHAs use KeyHIE, and potential benefits for care continuity and efficiency.

Methods: Focus groups, interviews and direct observations of HHA nursing, case management, and medical records staff as they used KeyHIE for new and returning patients, before and after the implementation of alerts. Results: HHA medical record staff used the record locator service in KeyHIE to find information about care provided elsewhere, especially for new patients whose health records are incomplete. HHA visiting nurses and schedulers benefitted from the alerts, to avoid sending nurses and therapists to the homes of patients who were in the hospital or emergency room. Both uses improved care continuity and HHA efficiency.

Discussion/Conclusions: The optimal implementation and workflows for health information exchange will vary depending on the size and organizational structure of each HHA. Both information ‘push' and ‘pull' offer substantial benefits to HHAs in terms of efficiency, and for their patients in terms of the real-time information required to support true continuity across the care continuum.

Learning Areas:

Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Explain two different and complementary uses of Health Information Exchange in home health care. Describe how HHA organizational structure may influence the use of an HIE. Identify potential costs and savings of HHA participation in an HIE that offers record locator and ‘alert’ services.

Keyword(s): Health Information Systems, Home Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I lead the internal evaluation of the Keystone Health Information Exchange, and also the Keystone Beacon Community, on behalf of Geisinger Health System. I have been the director of multiple federally funded contracts focused on the use of health IT in care delivery.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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