While nursing homes have traditionally been one of the weakest links when it comes to health information exchange and care coordination, a new project aims to help improve those facilities' electronic communication with hospitals.

A recent study published in Applied Clinical Informatics, "Preparing Nursing Homes for the Future of Health Information Exchange," spotlights the efforts of University of Missouri researchers as they worked to get 16 nursing homes up and running with HIE capabilities.

The MU researchers took stock of these facilities' readiness for electronic data exchange – evaluating their Wi-Fi capabilities, for example, and assessing the state of their computer hardware. With help from Centers for Medicare & Medicaid Services money – a $14.8 million CMS grant aiming to reduce avoidable re-hospitalizations among nursing home residents – they then helped the nursing homes acquire the infrastructure they lacked.

Researchers then conducted 32 hours of clinical observation, 68 site visits and 230 interviews to study how staff integrated the technology and HIE processes into their workflow.

MU researchers also spotlighted the areas most integral to patient care, and explored how technology can facilitate those tasks. With diagrams, they developed visual representations of the communication flow and how technology could streamline and integrate existing processes.

[See also: Post-acute HIEs make strides]

"Our goal was to develop a more integrated system by providing an information exchange that could be used by all stakeholders involved in patient care," said Greg Alexander, associate professor in the MU Sinclair School of Nursing and lead researcher of this study, in a statement. "We want to build a network through identifying key players and their needs."

Researchers found that all the nursing homes used IT to support patient care, whether through tracking dietary needs and medications or to complete other administrative activities. Most of the technology was used to communicate patients' information within the nursing home rather than to communicate with external units, such as hospitals or off-site pharmacies.

Many nursing homes used technology to complete tasks, such as keeping track of patients' medications or scheduling appointments, but these systems often were separate. The researchers concluded that many nursing homes needed additional technological and human resources to build and implement an effective HIE network.

"The exchange of accurate, complete and timely information between hospitals and nursing homes can be complicated when older adults transfer from one place to another," said Alexander. "Ultimately, we want to facilitate a way for staff members to communicate safely and securely about patients' health. We want to prepare nursing homes to communicate externally as well as internally so that care transitions smoothly and patients have better health outcomes."

In the next phase of the project, researchers will evaluate whether HIE implementation improves communication about resident care, and will assess how clinicians and other staff feel about integrating the HIE into their workflow, according to MU. The goal, ultimately, is to provide a mechanism for nursing homes and hospitals to share patient information and medical documents securely through the health information exchange.