A Long-Term Care Facility Accesses the Health Information Exchange (HIE) and Discovers a Resident’s Forgotten Cancer Diagnosis
Either because of age or illness, residents who are admitted to skilled nursing facilities often have difficulty remembering their medical histories or even their diagnoses. Family members cannot always fill in the holes, especially if the resident has been independent and took care of his or her own health.
That was the case with “Tom,” a resident at Absolut Care, a 160-bed skilled nursing and rehabilitation facility in Endicott, New York. He and his family forgot to mention something very important when he was admitted, something that the staff needed to know. Especially when Tom’s health began to decline.
The facility’s physician found a lump on Tom’s throat and referred him to a specialist. Although a diagnostic ultrasound showed a mass on Tom’s thyroid, the specialist was not alarmed by what he saw. He decided to recheck the mass in six months rather than order a biopsy.
But the facility’s clinical staff wasn’t satisfied. So, they looked up Tom’s past health history in the HealthlinkNY Health Information Exchange (HIE). The HIE contains health records from all of a patient’s different health providers, so that providers can access the patient’s complete medical record.
The staff were amazed by what they found: a biopsy had been performed on Tom’s thyroid mass four years previously, and it had been positive. It turned out an endocrinologist had been caring for Tom before he arrived at Absolut Care, but the skilled nursing facility hadn’t been informed about the diagnosis.
Once the discovery was made, “Tom” resumed seeing his endocrinologist. “He is now on the right track,” says Donna Grover, Medical Records Director at Absolut Care. “He is doing much better.”
HealthlinkNY Helps Reduce Hospital Readmissions
There are other ways the HIE is important, especially when it comes to reducing the number of preventable hospital readmissions within 30 days, which often is a big challenge for skilled nursing facilities which care for people with complex medical conditions. So, it was quite an achievement when Absolut Care had zero readmissions in the first quarter of 2018, compared to a 23% readmissions rate for the first half of 2017. The national readmissions average is 18.2% for long-term-care facilities, according to the Centers for Medicare & Medicaid Services.
Grover says HealthlinkNY has played a key role in driving the rate down. “HealthlinkNY allows me to compare the patient’s lab results at the facility against the results of hospital tests,” she explains. “A white blood count may be trending slowly up, from 7,000 to 8,000 to 9,000. Nine thousand is not critical, but it tells you that something is going on and it needs attention.” She notes that laboratories do not flag such nuanced changes even though they could indicate further care is necessary.
“I have a list that’s a mile long of what I use HealthlinkNY for,” Grover says. “I log in while I’m in our morning meeting, so I can answer questions about the residents. What were the results of the urine culture? Did the resident complete all the necessary testing in the hospital? Which patients received a flu shot at the doctor’s office? Who received a pneumonia shot while in the hospital?”
Staci Romeo, Executive Director of HealthlinkNY, notes that HealthlinkNY is an indispensable tool for every healthcare provider, from primary care and specialty practices, to hospitals, home health agencies, EMS agencies, and skilled nursing/rehabilitation facilities. “Patients receive care in many different settings,” she explains. “Unless a clinician has access to a patient’s complete medical record, the clinician does not see the full picture of the patient’s health.”
What the Public Needs to Know
Although the HealthlinkNY HIE connects providers primarily in New York State, there are similar networks operating in all 50 states, according to the Office of the National Coordinator of Health Information Technology. The Strategic Health Information Exchange Collaborative (SHIEC), the HIE national trade association that began in 2015 with 19 members (including HealthlinkNY), now has more than 70 HIE members across the United States. SHIEC estimates that today the records of more than 200 million American patients can be accessed by their providers in an HIE.
As HIEs become more widely available, Romeo encourages patients to be proactive and make sure their providers can look up their records in the HIE.
“Studies show that when medical professionals access patient data in the HIE, the patient spends less time in the hospital and undergoes fewer laboratory tests and radiology exams. “With the HIE, providers have the information they need to make the right diagnosis, and it reduces the risk of medical errors,” Romeo says. “It also makes it easier for patients to fill out paperwork. There’s always something to be gained when providers use the HIE.”
HealthlinkNY is a Qualified Entity, certified by New York State, to operate the regional Health Information Exchange (HIE) in the Hudson Valley, Catskills, and Southern Tier of New York. The HIE network allows hospitals and other healthcare providers to contribute and access records for patients they have in common, thus improving healthcare quality, coordination, and value, by making healthcare more efficient and reducing waste. Together with its strategic partner, HealtheConnections, the HealthlinkNY HIE now extends from the Lower Hudson Valley to Central New York and up to the Canadian border. The HIE connects providers in 24 counties, more than 40% of the counties in New York State, and supports all 66 hospitals in its service area, or 27% of the state’s hospitals.
As the region’s hub of health information and improvement, HealthlinkNY supports healthcare delivery reform (DSRIP), bridges the information gap between behavioral health and physical health providers, provides data analytic capabilities to public health departments and fosters collaboration among public and private health plans.
Through the HealthlinkNY Community Network, HealthlinkNY collaborates closely with regional partners to develop and administer innovative ways to improve community health and reduce health disparities. The Community Network’s current regional campaigns include: promoting mental health in the workplace to reduce the region’s high suicide rate; promoting health equity; and working to identify and respond to the social determinants of health, such as transportation as a barrier to good health. The Community Network is also working to reduce the impact of addiction in the region, serving as the lead agency for the Southern Tier Addiction Resource Center and a partner on the Data Informed Opioid Response Collaborative in the Hudson Valley.