- Lack of robust health data-sharing infrastructure between hospitals and skilled nursing facilities (SNFs) is a key reason for poor hospital-to-SNF transitions for patients, resulting in missing, delayed or difficult-to-use information received by the SNF facilities, according to a recent study published in the American Journal of Managed Care.
Greater than four million Medicare patients are discharged to skilled nursing facilities every year, according to the study. These patients are generally older, have more complex conditions, and are a major driver of healthcare spending.
“Weak transitional care practices between hospitals and SNFs compromise quality and safety outcomes for this population,” the researchers noted. The study was conducted by Dori A. Cross, assistant professor at the University of Minnesota School of Public Health, Jeffrey S. McCullough, associate professor of health management and policy at the University of Michigan School of Public Health, and Julia Adler-Milstein, associate professor in the Department of Medicine at University of California, San Diego.
The analysis found that health information exchange (HIE) was employed SNFs for close to half of the patients for whom it was available. Nearly 30 percent of patients had records accessed within three days of hospital release.
Problems with health data sharing result in worse patient outcomes in SNF settings and increased likelihood of rehospitalization, the study observed.
In its analysis of a large academic hospital deploying HIE portal to share transitional care information with local SNFs, the study found that HIE tools are underused to support postacute care transitions. Usage patterns vary significantly across SNFs within a single community.
The study’s results indicate that portal use is motived by contextual factors that increase informational needs, such as not being familiar with a patient or referrals from hospital units with inadequate paper discharge information.
However, portal use was less frequent in situations where timely electronic information retrieval could offer unique value, such as caring for complex patient populations or managing transitional care when handoff occurs outside of normal business hours.
This result indicates that the current HIE portal infrastructure may not be providing the value needed to motivate SNFs to add portal use into existing workflows. Qualitative inquiry uncovered that nursing and social work documentation from the hospital was important to supporting postacute care delivery but is often not available or challenging to access using the portal.
The research found that HIE use is constrained by execution obstacles such as limited system access rights and unclear usage guidelines for when and how the portal could be used.
“In the absence of strategic direction from the hospital, we observed significant variation in portal usage patterns across enabled SNFs. SNFs and hospitals need to work together to develop policies that clearly articulate what types of information retrieval and use cases are possible and clarity around when the system can be used,” the study said.
The study emphasized that strengthening community collaboratives provides a great opportunity to engage across organizations in this quality enhancement initiative. Further, more guidance at the federal level may be needed to understand HIPAA concerns and ensure consistent data sharing procedures across organizations.
Community-based hospital–SNF collaborations are crucial for developing clear guidelines that promote effective usage practices.
The study recommended that hospitals work more actively with SNFs in order to understand their patient data needs and organizational constraints, such as suboptimal staffing structures and workflows. Hospitals should keep in these factors in mind when deploying HIE portals and other technology to ensure relevant data is more accessible.
In addition, policy initiatives can advance system design and processes that allow transfer of data specific to the needs of SNF providers, the study noted.
“HIE between hospitals and SNFs is underused. A mixed-methods approach is critical to understanding and explaining variation in implementation and use. Creating value requires hospitals and SNFs to codevelop system design, usage guidelines, and workflows that meaningfully integrate HIE into care delivery,” the study concluded.