Why the sudden interest?

Kansky said the HITECH provisions of the stimulus act, although not directly related to long-term care, may have raised awareness of HIEs. Another push comes from the ONC's 2011 HIE challenge grant program. The ONC in January awarded grants, covering various aspects of information exchange, worth $16 million to eight organizations. HIEs in Colorado, Maryland, Massachusetts and Oklahoma will specifically use the funding to focus on improving long-term and post-acute care transitions.

The Colorado Regional Health Information Exchange (CORHIO), for example, will allocate its $1.7 million grant toward long-term and post-acute care providers in Boulder, Colorado Springs, Pueblo and the San Luis Valley. The integration project will take place over the course of this year, according to Phyllis Albritton, CORHIO's chief executive officer.

The four communities involved with CORHIO's grant have a head start of sorts. Those areas previously opened an information-sharing dialog among providers of all kinds – including long-term care, information sharing and health-outcome goals.

 "The leaders of the long-term care piece have already been at the table," Albritton said. "We can say, 'You are not left out of the equation.'"

Challenges Remain

Even with growing awareness and federal dollars, long-term care faces a number of HIE challenges. The biggest task ahead will be determining what information needs to be shared among long-term care facilities and hospitals to coordinate care.

 "What are the minimal elements necessary to make a clean handoff from one healthcare provider to another?" Albritton asked, framing one inquiry the CORHIO project hopes to answer.

The Chesapeake Regional Information System for our Patients (CRISP), a statewide HIE in Maryland and an ONC grantee, focuses on care summaries and discharge data. David Finney, project manager for CRISP, said the idea is to have nursing homes provide care summaries to hospitals when patients are hospitalized. Those summaries would include a patient's medication list and allergy information. The long-term care center would then receive discharge data from the hospital upon the patient's return. A discharge summary may include test results, a list of medications on discharge, instructions for follow-up care and clinical notes from treating providers in the hospital.

CRISP plans to bring six long-term care facilities into the exchange over the next 18 months. "We will be looking really closely at what the care transition looks like and the impact of that moving electronically as opposed to paper, fax, or not at all," Finney said.

Coordinated care between long-term care centers and hospitals can reduce the potential for errors, such as medication mix-ups, health IT executives said. A faulty handoff, in which an updated medication list is omitted or belatedly transmitted, could result in improperly restarting a patient's medication.

 "The point of transfer requires a reconciliation of medicines coming from the hospital to the new care setting," Dougherty said.
That's true in the opposite direction as well, as a long-term care patient's medication status needs to be reported to the hospital and reconciled, she said.

Information needs don't end with care and discharge summaries. Ted Kremer, executive director of the Rochester (N.Y.) Regional Health Information Organization, said the 17 long-term care facilities linked to the exchange receive discharge information, lab results and radiology reports, among other data.

 "Long-term care does drive the data requirements in a new direction," Kremer said. "They need more data and a different kind of data."
That list includes items such as dietary information, social work assessments and nursing flow sheets. Part of the exchange's job, Kremer said, involves working with hospitals to find out what information is available.