Objective To assess primary care teams’ perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers. Materials and Methods We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients’ diagnosis and discharge instructions, timing alerts to patients’ discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on. Discussion Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use. Conclusions Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.

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Electronic health information exchange (HIE) may improve care for geriatric patients receiving care across multiple sites by reducing test duplication, medication prescribing errors, and adverse events. This project evaluated the implementation of an HIE intervention at two VA medical centers offering VA providers real-time notification of non-VA inpatient or ED use, followed by post-hospital geriatric care coordination. We interviewed 23 providers (physicians, nurses, social workers and other care team staff) about their experiences with the program. Interviews were analyzed using the Consolidated Framework for Implementation Research (CFIR) to examine 1) goals and expectations for notifications and transitional care; 2) barriers to effective use of notifications and coordination; and 3) suggestions for improvement. Overall, care team members were positive about the intervention, noting it cut down on time searching for outside medical records and that care coordination visits were helpful in answering patients’ questions and clarifying discharge instructions. However, some providers were not aware of the alerts, found the HIE interface challenging to use, or were concerned that expanding the program would create workflow issues. Suggestions for improvements included sharing information about newly prescribed medications, lab and radiological tests, and progress alerts during the episode of care; and including non-VA providers to facilitate care coordination. Social workers also asked to be included on alerts to improve follow-up. Our findings suggest HIE can be a useful tool for coordinating care across sites, provided information can be easily shared between all care team members and HIE interfaces are streamlined to reduce additional work.