‘Sky is the limit’ for health information networks’ SNF insights

An expanding health information exchange connecting 71 hospitals and nearly 600 post-acute providers in New Jersey is exceeding expectations and providing staffing insights not necessarily envisioned when state officials launched a patient discharge initiative.

State lawmakers required that all nursing homes join the The New Jersey Health Information Network by 2021, which would enable hospitals and post-acute providers to receive discharge alerts. To date, 545 of 662 facilities have complied, creating a robust network that state officials describe as helpful for revealing insights into developing public health concerns.

“If we see an uptick in transfers out from certain facilities to the hospital, then we know that something is going on within that region or within that health system or care setting,” said Jennifer D’Angelo, vice president and general manager of NJHIN. “We can take a deeper dive and look to see, is it an influenza outbreak? Is it a COVID outbreak or some other kind of [threat]?”

The HIN staff examines incoming information and is in regular communication with the state’s department of health and the Long-Term Care Office of Resiliency. Those agencies can reach out to specific providers to see what conditions might be driving hospital transfers and if a facility needs additional resources.

Predicts staffing needs

Even with limited data being collected to inform admission discharge and transfer alerts, some forward-thinking providers have begun using the network and its mapping feature to shape their own care delivery responses.

Complete Care has shifted staff in response to anticipated discharges of its own patients and increases in hospitalizations near specific facilities. It’s akin to an early-warning system.

“During COVID, there were state maps that showed you hot spots for COVID, but we don’t have that for other things like influenza or RSV,” said Jennifer Leatherbarrow, senior vice president of clinical informatics for the Toms River-based firm. “So this is really the only tool that’s available readily to us right now, and it’s actually turned out to be a really nice tool.”

Complete Care’s regional operational style allows the company to shift resources as needed, putting nursing, infection control or management staff in place in facilities expected to require more help — similar to how it has approached hurricane coverage or shifted resources during the days of COVID units.

“A lot of it is anticipating, and our infection preventionists are very good at just keeping an eye on where those hot spots are occurring so that we can gear up if we need to for anything that might happen over that next couple of days especially over weekends,” Leatherbarrow told McKnight’s Long-Term Care News.

D’Angelo said she has heard multiple stories from skilled nursing providers — especially larger, multisite organizations — beginning to use the information for their own planning purposes.

“Having that visibility and having that real-time notification happen, they’re able to scale up or down and adjust appropriately for that,” she told McKnight’s. “Now that they have this care coordination/population health component — where we have the information inbound and outbound, notifying providers, care teams and [informing] transitions of care — having that information centralized really helps with those event notifications and being able to staff appropriately. Some have gotten more sophisticated depending on their size.”

While skilled nursing providers, and more recently assisted living providers, are required to participate in the network, officials also made it worth their while to comply. The state has awarded more than $4 million in incentives to providers who upgraded systems or spent staff time on network efforts.

The federal HITECH Act of 2009 offered financial incentives that led to huge interoperability gains in hospitals and other settings, but nursing homes were left out of those efforts.

But under New Jersey’s program, notifications and the ability to track who needs following outside the SNF are finally helping “close the loop,” D’Angelo said. That can also be true when patients go from a SNF to home care because the system provides reminders for follow-ups too.

Expanding the reach

Plans for information sharing won’t end there. The HIN is preparing to launch an expansion of next-stage capabilities, in which Complete Care expects to have about 16 facilities piloting additional information sharing.

“I think the sky is the limit here,” Leatherbarrow said. “Anything that comes across my desk, I am jumping on that opportunity because I really think this is where we need to go in order to grow as a company and to provide the best care possible. We need information. Knowledge is power.”

First up: allowing skilled nursing EHRs to ingest clinical care documents so they can be used by clinicians and be part of your existing workflows.

Another project, said D’Angelo, involves improving sharing of POLST, or end-of-life care, forms through the network, regardless of where or when those were completed.

“In a perfect world, I think that every patient should be able to carry their electronic record with them and every setting they go to, whoever’s taking care of that patient should be able to log in and see all of their records,” said Leatherbarrow. “I think we’re headed that direction, but we’re not there yet. But as somebody on the outside — because I’m from Ohio — New Jersey is actually further along in this process than a lot of other states. I’m hoping that they’re going to pave the way and show the rest of the country how to do this.”

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