Improvement in transitions of care between hospitals and skilled nursing facilities (SNFs) has been identified as one key to better care, reduced readmissions and lower cost. A recent study in the American Journal of Managed Care, however, found that health information exchange between hospitals and skilled nursing facilities is underused.
The study, co-authored by Dori A. Cross, Ph.D.; Jeffrey S. McCullough, Ph.D.; and Julia Adler-Milstein, Ph.D., examined data exchange between a large academic medical center and three local SNFs over several years. The hospital extended a “view-only” portal feature (EpicCare Link) to enable the SNFs to access hospital records for patients discharged to their facility. Administrators, nursing directors and, occasionally, nurse unit managers were granted access. The SNFs’ physicians had full access to the hospital electronic health record and therefore did not require portal access, the paper noted. This portal access was in addition to standard discharge protocol, which included a paper discharge summary and nurse-to-nurse phone call.
The researchers found that the portal was never accessed for more than half of all patients for whom it was available, and it was used just 29 percent of the time in the time frame surrounding handoff. Researchers found that HIE use was more likely for new vs. returning SNF patients (and when a patient was discharged from the emergency department rather than an inpatient unit.)
The authors say the results “demonstrate that SNF portal use was driven in part by contextual factors that heightened informational needs, such as lack of familiarity with a patient or referrals from hospital units with less robust paper discharge documentation. But, surprisingly, use was less likely in contexts where real-time electronic information retrieval could offer unique value, such as caring for particularly complex patient populations or managing transitional care when handoff occurs outside of traditional business hours.”
They wrote that this finding suggests that current HIE infrastructure may not be delivering the value necessary to motivate SNF providers to incorporate into existing workflows. “Indeed, qualitative inquiry reveals that nursing and social work documentation from the hospital is critical to supporting post-acute care delivery but is often unavailable or difficult to access via the portal.”
The study concluded that increased implementation and value requires hospitals and SNFs to co-develop system design, usage guidelines and workflows that meaningfully integrate HIE into care delivery.
