between LTPAC and acute care settings.
Moreover, they are working to provide
value to LTPAC organizations through
reduced staff time, improved clinical decision making, improved patient satisfaction
and decreased costs.
VIVIAN’S CONTINUITY OF CARE
In our earlier example of Vivian, HIE use
could make it easier for hospital staff to see
her allergies immediately. Likewise, HIE
use could make Vivian’s transition of care
back to the SNF one that preserves her safety by having good visibility into the medications Vivian is taking, and the medical tests
she had done during her hospital stay. This
exchange of data using the CCD is certainly
not complete, but this information will help
to protect Vivian from exposure to potentially life-threatening allergens, allow her
medication reconciliation to include any
new regimen from the hospital, and allow
members of the care team to be reminded
that Vivian had a recent hip fracture, is
recovering from pneumonia, all while
managing diabetes. HIE is the catalyst for
allowing Vivian to maintain continuity of
care, in a more efficient and effective way
through her care transitions.
Best practices and everyday use of HIE
are still evolving. It is imperative to continue to evaluate how best to promote continuity of care in LTPAC settings. Going forward, continuity of care will rely on health
information exchange to enable quality for
older adults in long term care settings.
ACKNOWLEDGEMENTS
I want to thank Ms. Jennifer Staley for her
assistance in the literature searches for this
paper. JHIM
Rebecca A. Meehan is an Assistant Professor of
Health Informatics in the School of Library and
Information Science at Kent State University in
Kent, Ohio. She earned a doctorate in gerontology
and medical sociology from Case Western Reserve
University. Having worked as an applied social
scientist in healthcare settings, and as a senior user
experience researcher for the software industry, she
now teaches usability and human factors in health
informatics and health information systems at Kent
State University.
REFERENCES
1. American Academy of Family Physicians.
(2005). Continuity of care: Definition of American
Academy of Family Physicians. (2005).
2. American Recovery and Reinvestment Act of
2009 (ARRA), Pub. L. No. 111– 5, Division A, Title
XIII and Division B, Title IV, Health Information
Technology for Economic and Clinical Health
Act (HITECH Act, 2010) (codified at 42 U.S.C. §
17930, et seq)
3. Bjorkelund, C., Maun, A., Murante, A., Hoffman,
K., DeMaeseneer, J., Farkas-Pall, Z. (2013).
Impact of continuity on quality of primary care:
from the perspective of citizens’ preferences and
multimorbidity – position paper of the European
Forum for Primary Care. Quality in Primary Care,
21:193–204.
4. Byrne, C. & Doughtery, M. (2013). Long-term
and post-acute care providers involved in health
information exchange. Final Report. Office of the
Secretary for Planning and Evaluation. http://
aspe.hhs.gov/report/long-term-and-post-acute-care-providers-engaged-health-information-exchange-final-report.
5. Cabana, M. and Jee, S. (2004). Does continuity
of care improve patient outcomes? J Fam
Practice, 53( 12), p. 974-980.
6. Castle, N. (2008). Special care units and
their influence on nursing home occupancy
characteristics. Health Care Management Review,
33(1), 79–91.
7. Centers for Medicare and Medicaid (CMS)
(2015). Federal register, proposed rule 80 FR
42176. http://www.gpo.gov/fdsys/pkg/FR-2015-
07-16/html/ 2015-17207.htm.
8. Coleman, E., May, K., Bennet, R., Dorr, D., &
Harvell, J. (2007). Report on health information
exchange in post-acute and long-term care.
Office of the Assistant Secretary for Planning and
Evaluation. February 1, 2007. HTTPS://ASPE.
HHS.GOV/BASIC-REPORT/REPORT-HEALTH-INFORMATION-EXCHANGE-POST-ACUTE-
AND-LONG-TERM-CARE#TABLE2. Accessed
November 30, 2015.
9. Doughtery, M. (2011). Opportunities for
engaging long-term and post-acute care providers
in health information exchange activities:
exchanging interoperable patient assessment
information. Office of the Assistant Secretary for
Planning and Evaluation (ASPE). December 1,
2011. http://aspe.hhs.gov/daltcp/reports/2011/
StratEng.pdf . Accessed November 30, 2015.
10. Gulliford, M., Naithani, S. & Morgan, M.
(2006). What is ‘continuity of care’? J Health Serv
Res Policy, 11( 4):248-50.
11. Harris-Kojetin, L., Sengupta, M., Park-Lee, E.,
& Valverde, R. (2013). Long-term care services in
the United States: 2013 overview. Hyattsville, MD:
National Center for Health Statistics.
12. Hassol, A., Goodman, L., Younkin, J.,
Honicker, M., Chaundy, K., and J. Walker (2014).
Survey of state health information exchanges
regarding inclusion of continuity of care
documents for long-term post-acute care (LTPAC)
patient assessment. Online Perspectives in Health
Information Management; Fall, p. 1-9.
13. HealthIT.gov (2012). What is Health Information
Exchange? November 29, 2012. https://www.
healthit.gov/sites/default/files/beacon-factsheet-keystone.pdf. Accessed December 2, 2015.
14. HealthIT.gov (January, 2013). Health
information exchange challenge grant program.
Website: http://www.healthit.gov/providers-professionals/health-information-exchange-challenge-grant-program. Accessed November
20, 2015.
15. HealthIT.gov (March, 2013). What is health
information exchange? Website: https://www.
healthit.gov/providers-professionals/faqs/
what-health-information-exchange. Accessed
December 1, 2015.
16. HealthIT.gov (February 2015). EHR Incentives
and certification. Website: https://www.healthit.
gov/providers-professionals/meaningful-use-definition-objectives. Accessed December 1,
2015.
17. Meehan, R. (2015). Electronic health
records in long term care: Staff perspectives.
Journal of Applied Gerontology, October, 2015;
doi: 10.1177/0733464815608493.
18. Mukamel, D. Spector, W., Limcangco,
R, Wang, Y., Feng, Z. and Mor, V. (2009). The
costs of turnover in nursing homes. Med Care,
47( 10): 1039-1045.
19. Institute of Medicine. (2005). Crossing the
quality chasm. A New health system for the 21st
century. Washington, DC: National Academy
Press.
20. National Center for Health Statistics. Health,
United States, 2014: With Special Feature on
Adults Aged 55–64. Hyattsville, MD. 2015.
21. National Institute on Aging (NIA), 2015.
https://www.nia.nih.gov/about/living-long-well-
21st-century-strategic-directions-research-aging/
introduction. Website accessed December 6,
2015.
22. Naylor, M., Brooten, D., Campbell, R., Maislin,
G., McCauley, K., and Schwartz, J. (2004).
23. Transitional care of older adults hospitalized
with heart failure: a randomized, controlled trial. J
Am Geriatr Soc., 52( 5):675-84.
24. Office of the National Coordinator (ONC)
(March 15, 2013). Health IT in Long Term and
Post-Acute Care: Issue Brief. Available at:
https://www.healthit.gov/sites/default/files/pdf/
HIT_LTPAC_IssueBrief031513.pdf.
25. Shortell, S. (1976). Continuity of medical
care: Conceptualization and measurement. Med
Care;14:377–91.
26. Toles, M., Barroso, J., Colón-Emeric, C.,
Corazzini, K., McConnell, E., & Anderson,
R. A. (2012). Staff Interaction Strategies that
Optimize Delivery of Transitional Care in a Skilled
Nursing Facility: a Multiple Case Study. Family
& Community Health, 35( 4), 334–344. http://doi.
org/10.1097/FCH.0b013e31826666eb.
27. Toles, M., Young, H. & M. Ouslander. (2013).
Improving care transitions in nursing homes.
Generations. January 31, 2013; accessed
November 28, 2015: http://www.asaging.org/
blog/improving-care-transitions-nursing-homes.
28. Zhang, N., Unruh, L., & Wan, T. (2013). Gaps
in nurse staffing and nursing home resident needs.
Nurs Econ. 31( 6):289-297