The digital disconnect in post-acute care
Kagan, a member of the Medical Economics editorial advisory board, would like them all to go online. “It would make my life much easier,” he says.
Kagan also complains about the information overload that he constantly encounters in nursing homes. In the past, he recalls, patients would arrive at a nursing facility with a one-page clinical summary that would include basic data. It would be followed by a two- or three-page discharge summary that included history highlights and physical.
But nowadays, with hospitals easily able to print out sections of the patient’s EHR or the whole chart, they send the entire H&P, he says.
“For a quick little admission where the patient had a knee replacement, you’ll get 20-25 pages of documentation,” he says.
Kubitschek has some of the same frustrations as Kagan. But Asheville, North Carolina, has much better IT integration between PAC providers and physicians than most of the country.
One reason is that most of the specialized physicians who staff the 29 local nursing homes belong to a single group owned by Team Health. All the internists and other specialists in the group use the same EHR (Geri-Med), and local primary care doctors can view that record online.
Team Health recently interfaced Geri-Med with PointClickCare, the most commonly used EHR in nursing homes. Now nurses in skilled nursing facilities can enter certain kinds of notes into Geri-Med, says Kubitschek.
This model improves both communications and the quality of care, says Kubitschek, a Medical Economics editorial advisory board member, partly because the geriatric specialists who follow patients in the nursing facility can see them more often than primary care doctors did.
Also, his access to the specialists’ Geri-Med EHR gives him a birds-eye view of the relevant portions of the patient’s hospital record as well as their nursing home encounter notes. Moreover, his EHR can exchange secure messages with Geri-Med, including attachments of clinical summaries.
Physicians should not expect PAC providers to improve their digital capabilities significantly in the near future.
There’s still a lot of paper in PAC facilities, and document scanning is state-of-the-art in many facilities, Seiser points out. Even skilled nursing facilities and home care agencies with EHRs are not yet exchanging much data electronically with hospitals or ambulatory-care providers.
“The ability to do discrete two-way integration of data is not there yet,” he says. “But the vendors are getting a little better at it, and so are the hospitals. It will continue to ramp up in sophistication.”