A Case Report in Health Information Exchange for Inter-organizational Patient Transfers

Abstract

SummaryObjective: To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities. Methods: A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant. Results: Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers. Conclusions: Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities. [4,5]. Although patient transfer problems exist internationally [6,7], the problem has added urgency in the United States because Medicare no longer reimburses healthcare costs for patients with congestive heart failure, acute myocardial infarction, or pneumonia who have unplanned readmissions to a hospital within 30 days of initial discharge [8]. Moreover, beginning in 2015 Medicare will no longer reimburse unplanned readmissions for at least four additional patient conditions [9,10].Health information exchange (HIE) is one informatics-based approach that can address this problem. HIE can facilitate information sharing that in turn improves care coordination and reduces unplanned or unnecessary patient rehospitalizations [3,11,12]. However, there are known HIE barriers for inter-organizationa...

Barriers to Communication and Information Exchange in Patient Transfer and Its Consequences

“…With efficient and effective legal support and also support from deputy treatment affair, it is possible to make the hospitals adopt transfer standards, such as scientific and regular feedback, and thus overcome the barriers of a lack of both coordination and feedback. One of the strategies for establishing the feedback system in CTGI can be setting up the audit system and designing standard patient transfer forms to evaluate the quantity and quality of the transfers and sending feedback to groups involved in patient transfer (Farley-Hills & O'keeffe, 2010;Richardson, Malhotra, & Kaushal, 2014). Meanwhile, it is possible to receive complaints of legal entities by adopting the appropriate methods in CTGI.…”

Linking the health data system in the U.S.: Challenges to the benefits

“…Clinical staff acceptance is always a challenge to any new technology adoption. Several barriers from end users of HIE usages are: lack of access to incentives/capital by healthcare providers [12], start-up costs [6], time burdens/constraints [48], [49], resources to select and implement a system (38%) [7], multiple logins [12], [39], prolonged data retrieval time, frequent system timeouts [16], redundant data, inconsistencies and physiological incompatibilities [39], [50], misalignment with current clinical workflows [19], [32], [39], [51], vulnerable information accessibility and misuse [48], and trust in external HIE partners [52].…”

“…Automatic notification of HIE data availability [60] would be an excellent feature as well as improving system and data retrieval response time [16]. For the long-term HIEs success, researchers believed that understanding end users' HIE perspectives and requirement is crucial as well as to engage end users from the beginning [51], [55]. Early user engagement pays off as physicians who prefer viewing patient health information electronically are at least three times more likely to adopt and use HIE [6].…”

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

“…Fifty-nine of the included articles described studies that used qualitative methods to investigate interventions in all categories. 30,31,33,55,57,65,66,69,78,103,107,108,110,115,118,119,121,124,129,130,[136][137][138]140,146,158,159,164,168,171,176,179,192,194,199,[212][213][214][215][216]224,225,233,237,241,245,247,248,257,268,…”