The long-term and post-acute care environment has an image of lagging far behind its acute care counterparts on information technology adoption. For the most part, that perception is true. Yet there are developments within the LTPAC space with regard to health information exchanges that are flouting that trend.

One of the most ambitious HIE projects for the LTPAC sector is the recently announced engagement of Jacksonville, Fla.-based BridgeGate Health as a facilitator for the Central Illinois Health Information Exchange, based in Peoria, Ill. Deploying the KeyHIE Transform software, developed by Geisinger Health System and powered by BridgeGate, the goal is to ensure care coordination between LTPAC providers within the scope of the Central Illinois HIE, said BridgeGate CIO and co-founder Scott Sirdevan.

“We couldn’t be happier to team up with Central Illinois HIE to help them improve the quality of care for their seniors in that region,” Sirdevan said.  “Central Illinois is very forward-thinking and we are proud to work beside them to provide an avenue for their long-term care providers to exchange information. The short-term and long-term value is truly significant.”

KeyHIE Transform extracts clinically relevant patient information from the Minimum Data Set or Outcome and Assessment Information Set that nursing homes and home health agencies are required to submit to CMS and converts the information into a standardized Continuity-of-Care Document. This technology allows the Central Illinois HIE to transform “non-interoperable” data into an interoperable form and then share it within the exchange.

Central Illinois is the third LTPAC HIE client for BridgeGate, as the firm has also recently worked with Geisinger KeyHIE in Pennsylvania and MICHIana for southern Michigan and northern Indiana.

The new Illinois relationship is not without major challenges, however.

A rigid deadline for 2014 will have everyone involved scrambling to get all the moving parts working in synch by October. Dictating the accelerated schedule is the Illinois Office of Health Information Technology, which bestowed the HIE with a $349,000 “White Space Grant” for the project. Federal health officials refer to “White Space” healthcare providers as those who are practicing in areas that are currently underserved by health IT infrastructure. The Central Illinois HIE serves approximately 1.3 million people across multiple counties in the mostly rural region.

“When you boil it down, that dollar amount is really small,” said Zane Schott, vice president of business development for BridgeGate. “But more important for us is to have skilled nursing facilities and home health agencies together and interoperable and this is just the first step.”

Joy Duling, executive director for Central Illinois HIE, is optimistic about how the technology configuration will translate into better care for LTPAC patients in the region.

“Better coordination between long-term care facilities, hospitals and other care providers represents an opportunity for us to improve the quality of care that is being delivered to our seniors,” Duling said. “Missing or delayed information can mean costly duplication of services or errors that significantly impact the patient experience.”

Leaving seniors behind?

LTPAC providers are behind the rest of the industry in IT adoption for a number of reasons: It is largely composed of small, independent faith-based care organizations; its revenues mostly come from low Medicaid fees; staff turnover is among the highest of any industry; and its resident population is mostly impoverished. Together it adds up to a distinct lack of funds and resources. Compounding the situation is that LTPAC has been virtually omitted from the ARRA picture as acute care organizations vie for billions in technology funding.

Sirdevan and Schott are sympathetic to the LTPAC industry’s plight and BridgeGate was founded specifically to serve traditionally underserved constituents. Using the KeyHIE system, they contend that seniors will have access to the information available that other patients have.

“Seniors are a forgotten class of patients,” Sirdevan said. “They don’t have access to the same level of technology that younger, healthier patients do.”

Therefore, BridgeGate team members are committed to a principle they call “no senior left behind.” By working within the LTPAC HIE domain, they can advance technological capabilities for facilities that are stuck using manual processes and archaic legacy systems.

“Hospitals have the big focus, but dollars are scarce in LTPAC,” he said. “The large acute care HIEs with big staffs won’t work in this environment. Our platform is specifically crafted for them.”

Bridging gaps

As they stand now, LTPAC HIEs are being set up as parochial entities serving skilled nursing facilities and Home Health Agencies within specific geographic boundaries. Sirdevan maintains that this arrangement is necessary for the time being in order to bring these “mom and pop heritage- and faith-based operators” up to speed with the technology and in line with other providers of similar size and scope.

“The solution is designed so that SNFs in particular with no electronic medical records or point-of-care system have the ability to use this technology,” he said. “It concentrates on the areas where they are required to submit information electronically and they can do so outside of the HIE. That was unthinkable even two years ago.”