Statewide HIEs pilot links to long-term/post-acute-care providers

Statewide health information exchanges in four states--Colorado, Massachusetts, Maryland and Oklahoma--are using "challenge grants" from the Office of the National Coordinator for Health IT (ONC) to develop ways of connecting long-term and post-acute-care (LTPAC) providers online with hospitals, physicians and other providers. A representative of the Colorado HIE, known as CORHIO, told attendees at the recent Healthcare Information and Management Systems Society's (HIMSS) annual conference in Las Vegas how that organization is trying to meet this challenge.

Janice Whittleton, director of business development and outreach for CORHIO, first sketched out the dimensions of the problem: Nearly 20 percent of Medicare patients discharged from the hospital are readmitted; 80 percent of those readmissions are preventable; and 40 percent of Medicare discharges are to LTPAC care settings.

Clearly, this problem calls for better care coordination. But the majority of skilled-nursing and long-term-care facilities still rely on paper, fax, and phone for communications. Only 20 to 30 percent of nursing homes, for example, have adopted some kind of health IT, compared to 90 percent of hospitals and 40 to 57 percent of physician offices, she said.

Alongside its main effort to create health information exchanges all over the state, CORHIO has launched a pilot to increase the use of health IT in 160 LTPAC organizations in Colorado, Whittleton said. The goal this year is to get all of them using CORHIO's HIE platform, provided by Medicity. Next year, CORHIO aims to help most of these facilities implement electronic health records, as well.

Access to the HIE will allow the LTPAC providers to begin ordering lab and imaging tests online. It also will give them access to test results, transcribed notes and clinical summaries known as Continuity of Care Documents (CCDs). Whittleton accented the importance of having two-way electronic communications between hospitals and LTPAC facilities, as well as the ability to link to physicians and home health providers through CORHIO, using Direct clinical messaging.

While the LTPAC providers prepare to implement EHRs, she noted, they can use CCDs generated by CORHIO from community data to obtain clinical snapshots of patients when they enter nursing homes or other PAC facilities. These will be a big improvement over the discharge summaries they currently receive.

LTPAC providers are not eligible for Meaningful Use incentives. But Whittleson said that because of new Medicare regulations that penalize hospitals for preventable readmissions--as well as other payment reforms--healthcare systems and large physician groups may be motivated to help LTPAC providers acquire health IT.