What Minnesota Nursing Homes Learned During an HIE Pilot

| April 14, 2014

Nursing homes haven’t received any rewards from the federal government for making Meaningful Use of Electronic Health Records (EHR). But a number of nursing homes in Minnesota are demonstrating that EHRs and health information exchange (HIE) are still worth the investment.

Nursing homes haven’t received any rewards from the federal government for making Meaningful Use of Electronic Health Records (EHR). But a number of nursing homes in Minnesota are demonstrating that EHRs and health information exchange (HIE) are still worth the investment.

The Minnesota nursing homes recently completed a demonstration project that allowed them to collaborate with referral hospitals to exchange residents’ personal health information during care transfers.

The Centers for Medicare and Medicaid Services (CMS) funded the demonstration, which was led by Stratis Health, Minnesota’s Medicare Quality Improvement Organization. CAST participated in the project.

The official report on the demonstration hasn’t yet been completed. But a recent analysis in McKnight's Long-Term Care News offered a sneak peak into the initiative’s challenges and successes.

Initial Challenges Followed by Success

The Minnesota HIE project faced 2 challenges at the very beginning, according to McKnights.

First, project leaders realized early that they had to make sure every participant in the demonstration understood the same definition of health information exchange. Nursing homes and hospitals in the demonstration had to exchange data using interoperable EHRs. Exchanged data needed to flow seamlessly from one system to another so staff in both settings could easily use it.

Once project leaders established a common definition of HIE, they faced a second challenge: recruiting skilled nursing providers that were using interoperable EHRs. This task turned out to be more difficult than project leaders anticipated. As a result, the project experienced a longer-than-expected ramp-up period, and a later-than-expected completion date.

Once participants were in place, however, the demonstration moved quickly and exceeded expectations, according to McKnight’s.  

Medications Management

In addition to exchanging basic patient information, demonstration participants also tested a prospective medication review (PMR) system. The PMR allowed a skilled nursing facility’s dispensing pharmacy to look at an incoming resident's medications before that resident was admitted. Pharmacy staff could then flag medication-related issues and follow up with the hospital before discharge.

This early exchange of medication information eased care transitions. It also freed nursing home staff from the burden of phoning or faxing the hospital with medication-related questions after the resident was admitted to the nursing home.

CCD Documentation

The demonstration confirmed the value of using an electronic continuity of care document (CCD) to exchange patient data. Participants found that the CCD’s 15 standard fields gave health care providers all the information they needed to care for a nursing home resident across settings.

Only 2 software products used in the demonstration could produce a CCD. Stratis Health is conferring with technology vendors about the need for this EHR functionality, according to McKnight’s.

Taking HIE to the Next Level

Some demonstration participants plan to continue using the information exchange they've been testing through the demonstration. Moving forward, the participants say they will focus more on improving workflow. They will also identify meaningful metrics to facilitate clinical decision-making.

Nursing Homes Can’t Wait

“This initiative really reinforces that long-term care deserves some government largess to defray the significant expense of implementing a robust EHR,” concludes the McKnight’s article. “The government is expecting its Meaningful Use dollars to support health information exchange, and nursing facilities are one of the most important players in HIE.”

The article acknowledges the financial burden that an EHR investment might represent for a nursing home. But it also maintains that this investment is no longer an option.

“What nursing homes really can't afford to do is wait to get on this bandwagon,” says McKnight’s. “That's because, as the Minnesota project itself illustrates, there's already momentum behind HIE, and long-term care facilities that are laggards likely will be at a competitive disadvantage.”

Stratis Health recently updated the toolkit it developed with initial funding support from Aging Services of Minnesota, the LeadingAge state partner, to help aging services providers implement and maximize the value of an EHR system. The update references the CAST’s EHR Selection Matrix and our online EHR Selection Tool

CAST based its EHR whitepaper, EHR for LTPAC: A Primer on Planning and Vendor Selection, on the guidance and templates offered by the original Stratis toolkit. Currently, CAST is in the process of updating its whitepaper for a 2014 release. The updated whitepaper will reflect the Stratis Health update.