Journal Of Healthcare Information Management

care as a “continuous caring relationship” (Institute of Medicine, 2005) and “ seamless service”. Continuity is achieved when clinicians and care providers at both the discharging (e.g., acute care hospital) and admitting (e.g., LTPAC facility, home health or rehabilitation) sites have visibility and understanding of the medical history and care provided at the other site.

When describing the healthcare trajectory of older adult patients transitioning from acute care to long term care (and often being readmitted back to acute care), it is evident that achieving continuity of care will necessitate seamless transfer and visibility of health data for older adult patients regardless of setting. Older adults are more likely to have complex care needs, prolonged illness, and may be treated by different care providers in different care settings. Continuity of care for these patients is dependent upon adequate communication, record keeping, sharing of records, and on the sending and receiving of summaries of care (Gulliford, Nathani, & Morgan, 2006). The Office of the National Coordinator for Health IT (ONC,

2013) described the value of continuity of
care as offering better coordination of care,
thus providing a path to improved com-
munication and quality of care, and reduc-
ing unnecessary emergency room use and
hospital readmissions. Continuity of care
is critical for older adults as they transition
from acute care to long term care.

DEMOGRAPHIC IMPACT

Life expectancy nearly doubled during the
20th century with a ten-fold increase in the
number of Americans age 65 or older, with
projections of 70 million Americans age 65
or older, by the year 2040 (National Insti-
tute on Aging, 2015). Use of long term care
services in the United States is changing
accordingly with estimates of the number
of people using skilled nursing facilities,
alternative residential care, or home care
services growing to 27 million people in
2050 (Harris-Kojetin, Sengupta, Park-Lee,
& Valverde, 2013). However, older adults
are entering nursing home facilities at an
older age than in the past, with a median age
of 85 and with higher acuity levels (Toles,
Young & Ouslander, 2013). Nursing home
residents have shorter lengths of stay than
in years past (Toles, et al, 2012). Alternative
long-term care options, such as assisted liv-
ing and home health, provide choices for
older adults seeking post-acute care, par-
ticularly those who are healthier (Castle,
2008; Zhang, Unruh, & Wan, 2013). This
usage pattern is associated with higher acu-
ity levels, or people who are sicker, and have
more complex medical cases being cared for
in skilled nursing facilities. Communica-
tion of nursing home patients’ health status
and history is critical. Still, nursing facil-
ity residents tend to experience multiple
transitions of care to emergency rooms and
acute care hospitals to address and man-
age illness, and back again, leaving patients
vulnerable to poor health and quality of
life outcomes from the transition includ-
ing medication error, repeated tests and
treatments, and re-hospitalizations (Toles,
Young & Ouslander, 2013). For older adults,
who may be managing multiple co-morbidi-
ties, the medical information can be lengthy
and complex. Moreover, many older adults
do not have a consistent caregiver who can
help to communicate or clarify any medical
information to a LTPAC setting. When older
adults are making care transitions from
acute care to long term care, it is important
for the patients to have a seamless transfer
of information about their health. Visibility
into health data for patients enables pro-
viders to understand their health needs to
inform a care plan, thus creating continuity
of care from the acute care hospitals to the
long term care setting.

SUMMARY OF CARE

When a patient is discharged from the hospital to long term care, a summary of care from the patient’s stay is shared between the acute care hospital and LTPAC setting. With the influence of Meaningful Use requirements, this summary of care is shared within a continuity of care (CCD) document. The CCD is a standard format for sharing summary of care data when a patient is ready to transition from one setting to another, and allows the data to be used by an HIE (Coleman, et al, 2007) and can contain information such as a resident’s diagnoses, medications and allergies. While the majority of summaries of care are elec-

ABSTRACT

Older patients discharged from acute care hospitals to long term post-acute care (LTPAC) settings are often doing so with high acuity levels, managing multiple co-morbidities and varying degrees of social support. The extent to which their medical information can be shared and integrated into a coordinated care plan has potential impact on the quality of care they receive and their health outcomes. As providers aim to ensure continuity of care for their patients, they must now consider best practices of how to share medical information to coordinate care with electronic data. Health information exchange (HIE) may be seen as a technological and organizational catalyst to increase continuity of care for patients transitioning between acute care hospitals and LTPAC settings. Whether a patient is discharged to a short term rehabilitation center, a long term care setting, or home healthcare, HIE can enable an improved continuity of care by enabling health data to be transferred electronically to care providers. However, best practices and everyday use of HIE are still evolving. This is especially true for LTPAC settings that, because of financial resources and lack of eligibility to federal reimbursement programs, have been lagging behind in technology adoption. This paper describes the parameters of HIE and its potential for improving continuity of care for older adults.