Post-acute Care Integration, Part 2: Overcoming Obstacles

In the first of this two-part series, we discussed what’s driving hospitals to integrate their information systems with post-acute care facilities and outlined some of the benefits patients might expect. But while the destination is worth it, the road to interoperability can be a bumpy one that requires careful planning and navigation. In this installment, we detail some of the obstacles to integration and how to prepare your organization to get around them.

Integration Challenges to Overcome

First off, post-acute care facilities have been slow to adopt EHR systems. The primary reason has traditionally been a lack of resources due to higher dependence on public payers and exclusion from the federal EHR incentive program. It wasn’t long ago that the fax machine was a sufficient link to the hospital or doctor’s office. But today, in response to bundled payments and accountable care requirements, post-acute care must work with hospitals and other providers to enable bi-directional data exchange.

While many post-acute care facilities now have EHR systems, most have not invested in interface engines, limiting the amount of information available and making it harder to exchange. This slows the integration process because it forces the post-acute care facility and the hospital to get more creative in determining integration methods and what data can feasibly be shared.

Any change is hard, and the move to data exchange can be a seismic cultural shift for many post-acute care facilities. Their legal staff may have never executed data sharing agreements before, and clinicians new to data sharing may be concerned about patient privacy and the accuracy of data contained in these new integrated health records.

Then there are security concerns with integrating a hospital’s EHR with potentially outdated post-acute systems that may harbor application vulnerabilities and offer limited to no support. Also smaller IT staffs at post-acute care facilities may lack the experience needed to identify, fix and respond to security issues if and when a breach occurs. This is concerning for hospital IT leadership, whose own organization’s infrastructure and reputation can be put at risk when an integrated post-acute care system is breached.

Preparing for Integration

So how can a hospital get started? Begin by understanding the motivations behind the desire to integrate including the community’s changing demographics and care needs, population health goals and incentives, and the mix of payment structures in place. Then uncover and plan to address all integration challenges whether they be cultural, technological, legal, financial, or something else.

Below are a number of the critical questions hospitals should answer before beginning the integration process.

1. What is driving our need to integrate?
2. What kinds of reports, measures or benchmarks need to be supported through this integration?
3. What data sets and data types need to be exchanged?
4. Does the post-acute care facility have an interface engine?
5. Is the facility able to receive, parse and store HL7 and CCD transactions?
6. Do we have any security concerns with the facility’s systems?
7. Have they conducted security audits? What were the findings?
8. Are they aware of and equipped to deal with repercussions of a compromised system?
9. Does the facility have a business continuity plan in case of outages or breach?

To reap the benefits of interoperability, hospitals and post-acute care facilities must plan carefully and assess all options before taking on interoperability projects. To help, they should consider seeking an implementation partner with hands on experience in tackling the unique challenges they’ll face.

Finally, the hospital or health system needs to be prepared to shoulder a significant portion – perhaps even the lion’s share – of the cost of integrating with its affiliated post-acute care facilities. Most post-acute care organizations aren’t going to have enough staff or budget to fully meet the challenge alone, and the benefits will undoubtedly justify the investment.

This piece was written by Glen Mamary, CIO Advisor for J2 Interactive, a software development and IT consulting firm. Mamary previously served as CIO at Hunterdon Healthcare and Chief of Information Resource Management with the Department of Veterans Affairs. To view the original piece, click here.