The digital disconnect in post-acute care
EHR vendors expand
As hospital interest in PAC grows, the leading suppliers of acute-care EHRs are also expanding their products into that market, says Kuhnen. Epic, for example, is giving PAC providers some ability to view data and to document in the EHRs of hospitals and ambulatory care clinics.
Similarly, Healthy Planet, Epic’s population health management software, can be used by home health aides or someone else who would not otherwise have access to a clinical record, he notes. Healthy Planet allows such users to assign tasks to people electronically and to do clinical documentation. A hospital could use that data to trigger an intervention if a patient’s condition deteriorates.
Baker also sees growing integration between hospital and nursing home systems. “Epic, Cerner and Meditech have the ability to aggregate [acute care] data in the ancillary areas like radiology, lab and pharmacy. When they have an enclosed system with a skilled nursing facility inside it, they can provide those physicians access so they can look up the latest data on the patient.”
When hospitals and nursing homes are online with each other, and physicians can see what’s happening with their patients, the improved visibility should lead to higher quality and lower cost, Kuhnen says.
“Reducing length of stay is a clinical win if a patient is ready to move on to a less-acute setting. And we know that post-acute-care facilities have at times held patients longer than necessary. So closer scrutiny of what’s happening in these settings should benefit patients clinically, and there’s a financial incentive to reduce wasteful care.”
Home health agencies’ ability to exchange data with hospitals is rudimentary, Seiser says, but most can send and receive a limited amount of information fairly well.
Some home care agencies have also improved their ability to communicate with physicians, he says. For example, he has seen advanced systems in agencies that allow physicians to view home care data online. But those capabilities are not being widely used.
Reducing oversight burden
Besides improving quality, the increasing digitization of PAC providers could help reduce the burden of repetitive daily tasks involved in the oversight of post-acute care, such as signing orders and care plans and reviewing patient information. But that relief has not yet arrived for most physicians.
For example, internist Jeffrey Kagan, MD, of Newington, Connecticut, derives 15% of practice revenue from his work in seven nursing homes. Six of them send him orders to sign. The one that doesn’t requires him to pick up them up in person.
Some of the others fax orders to him, some use email, and a couple skilled nursing facilities allow him to go to a website and digitally sign orders there. Home health agencies send orders by fax, snail mail or courier.