Something wasn’t right with Tom, a 64-year-old resident at the Absolut Care skilled nursing facility in Endicott, New York. His health had been declining for a year and no one could figure out why. A diagnostic ultrasound was ordered in May and there it was: a lump was found in his thyroid. But the doctor did not see a need to do a biopsy, saying it should be checked again in six months.
When Tom’s health continued to deteriorate, Donna Grover, director of medical records at Absolut Care, decided to dig into Tom’s health history. Absolut Care is accessing the HealthlinkNY Health Information Exchange (HIE), which pulls together a patient’s complete medical record from all of his or her different providers. Grover looked up Tom’s records and found a biopsy had been performed on a thyroid mass four years ago. With a phone call, Grover managed to track down the pathology report. It had been positive. Somehow, the diagnosis had fallen through the cracks.
Tom is being treated now by an oncologist. Grover hopes that the prognosis will be good. Grover’s easy access to Tom’s medical records may have saved his life.
TRACKING DOWN RECORDS TAKES TIME
Residents of skilled nursing facilities typically receive care in many different locations: primary and specialty practices, hospitals, diagnostic centers and laboratories and in the skilled nursing facility itself. A skilled nursing facility needs to have access to records from all of these encounters so they can properly care for their residents.
Either because of age or illness, residents may have difficulty remembering their medical histories, medications, care instructions or even their diagnoses. Family members may not be able to fill in the information gap. So, tracking down medical records from different sources consumes a large part of a facility’s care manager’s time.
That’s why many long-term care organizations are connecting to the HIE. “HealthlinkNY is fabulous technology,” said Rita Mabli, president and CEO of United Hebrew of New Rochelle, a comprehensive campus of senior care. “It keeps everyone in the loop. For example, when we are in a time-sensitive situation and need documents from other facilities, we can look in HealthlinkNY and obtain the records immediately. Otherwise, we would have to sign an authorization form, send it to the facility and have to wait two weeks to get the records.”
Mabli adds that her team also uses HealthlinkNY to avoid inconveniencing a resident by having to repeat a test or procedure when the results are available online. That also reduces the cost of care. “Instead of ordering another x-ray or contacting a doctor for information, we see the information right away,” she explained.
MORE INFO CAN REDUCE READMISSIONS
Reducing the number of preventable hospital readmissions within 30 days is a big challenge for skilled nursing facilities, which care for people with complex medical conditions. But now they have a financial incentive to do so. Medicare has introduced a Skilled Nursing Facility Value-Base Purchasing Program that includes a hospital readmission measure. Facilities are eligible for an additional performance payment based on their score.
Last year, Absolut Care’s hospital readmissions rate was running about 23 percent, which is higher than the national LTC average of 18.2 percent. So, Absolut Care introduced new systems to knock its rate down. The facility contracted with a medical practice to have a physician and nurse practitioner on site two or three days a week and it assigned a resident care manager for each of its four units. It also began to mine more data in HealthlinkNY for follow-up care after hospitalization. The result: Absolut Care had a zero readmissions rate in the first quarter of 2018, followed by a respectable 8.2 percent in the second quarter 2018.
Grover, the medical records director, says HealthlinkNY played a key role in driving the rate down. The HIE makes a resident’s record, test results and discharge instructions immediately accessible, so there is no gap in care, she explained.
Grover says if the follow-up exam involves lab work or diagnostic imaging, HealthlinkNY allows her to compare those results to the results of hospital tests. “A white blood count may be trending slowly up, from 7,000 to 8,000 to 9,000,” she said. “Nine thousand is not critical, but it tells you that something is going on and it needs attention.” She noted that laboratories do not flag such nuanced changes even though they could indicate further care is necessary.
Lastly, HealthlinkNY allows skilled nursing facilities to receive alerts about a resident’s change in status within the hospital, such as when a visit to the ER has resulted in an admission. Maintaining an accurate census is necessary for accurate billing. “Even if you call the hospital, they are not always as knowledgeable as HealthlinkNY is,” Grover said.
It’s no wonder that many skilled nursing facilities are using the HIE to improve care for residents. Now facilities, including United Hebrew and Absolut Care, are taking the next step. In addition to looking up records in the HIE. United Hebrew is currently building a connection to the HIE so they can upload their records, and Absolut Care is anticipating that they will soon be building a connection as well. Those records are valuable to any provider who cares for a resident. When health care providers can see the complete picture of their patient, health care quality is vastly improved.
Staci Romeo is executive director of HealthlinkNY, which operates the Health Information Exchange (HIE) in the Hudson Valley, Catskill and southern tier of New York state, and connects to the statewide Health Information Network of New York (SHIN-NY). She can be reached at firstname.lastname@example.org.