Electronic Health Information Exchange Use in Skilled Nursing Facilities

Electronic health information exchange portals were used by skilled nursing facilities for 46 percent of the patients it was available for, according to a study published in The American Journal of Managed Care.

Overall, the researchers found that electronic health information exchange use was more likely for new patients and when a patient was discharged from the emergency department.

While most health systems have adopted the use of electronic health records (EHRs), there has not been much focus on what value-generating electronic health information exchange looks like to support transitions between hospitals and skilled nursing facilities.

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More than 4 million Medicare patients are discharged to a skilled nursing facility annually, and weak transitional care practices from hospitals to the facilities compromise quality and safety outcomes for the older population admitted there.

“A key contributor to poor hospital-(skilled nursing facility) transitions is the lack of robust information-sharing infrastructure between these settings, often resulting in missing, delayed or difficult-to-use information received by (skilled nursing facility) providers,” the authors wrote.

Dori A. Cross, Ph.D., assistant professor and University of Minnesota’s School of Public Health, along with her team, retrieved data from 5,487 patients discharged to three skilled nursing facilities between June 2014 and March 2017. The three facilities chosen made up nearly 45 percent of total referrals.

Administrators, nursing directors and a few nurse unit managers had access to a view only portal feature.

Researchers used the hospital EHR data to pull the patient’s medical record number, hospital admission and discharge time stamps, demographics, reason for hospitalization, diagnoses, mediations and the name of the facility they were discharged to. The data were merged with the audit file of portal logins.

Two indicators were established — a broad window and a narrower transition window — to measure the use of the portal to access the hospital information.

The broad window represented a portal login that took place within a 16-day window starting 48 hours before hospital discharge to 14 days after or until the time of hospital readmission.

The narrower window captured activity more directly related to transitional care and measured the use of the system between 48 hours prior to discharge and up to 72 hours following it.

The team hoped to answer the following questions: to what extent is electronic health information exchange used to support post-acute transitions, what factors are associated with variation in whether electronic health information exchange was used during a patient’s transition and what skilled nursing facility organizational factors facilitate or prevent the integration of the data with existing transitional care practices?

Of the 5,487 hospitalized patients discharged to any of the three facilities, there was corresponding use of electronic health information exchange for 2,525 patients (46 percent) in the 16-day broad window. During the narrower transition window, the access rate was 28.9 percent.

Two of the facilities saw an increase of system use over time, while the third saw usage drop.

Researchers also interviewed 16 respondents from the hospital and skilled nursing facility to see the drivers of informational need and electronic health information exchange use to support transitional care — patient complexity, patient familiarity, inadequacy of other information transfer mechanisms and weekend discharges.

Despite the research team finding that medical complexity was linked with lower electronic health information exchange use, facility respondents felt opposite. They used the portal to get more detailed history and needs for complex patients. Respondents also used the data to gain insights on newer patients.

According to the authors, the current electronic health information exchange infrastructure may not be delivering the value necessary to make providers incorporate the system into their workflows.

“Our findings also reveal that (electronic health information exchange) use is constrained by implementation issues such as limited system access rights and vague usage guidelines for when and how the portal could be used,” the authors noted.

The researchers suggested that in order to benefit from electronic health information exchange, the system design and information accessibility needs to be modified. Community-based hospital-skilled nursing facility collaboration and policy efforts that more explicitly incorporate data elements to the needs of facility providers could be ways to see the benefits of the information.

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