Improving Rural Healthcare Transitions Through Health Information Exchange

The transition of patients between care locations has repeatedly been characterized by serious quality gaps that can compromise medical safety. To address these gaps, this project enhanced an existing health-information exchange (HIE), the Keystone Health Information Exchange (KeyHIE), to enable clinicians to work more effectively and efficiently and to utilize the HIE more fully when managing care transitions. At the time of this project, KeyHIE connected 20 hospitals, 173 physician practices, 28 home health agencies, 70 long-term care facilities, and one pharmacy in central and northeastern Pennsylvania.

Enhancements to KeyHIE included adding critical transitions-of-care clinicians as exchange users including case managers, home-health nurses, emergency responders, and long-term care facility clinicians. The ability of these users to improve patients' transitions of care was expected to be improved by providing them instant notifications of patient admissions to and discharges from regional hospitals and emergency rooms. The exchange's clinical content was expanded by adding additional laboratory and radiology reports' medication lists from pharmacy benefit management companies and retail pharmacies, problem lists, allergy lists, electrocardiogram traces, and consult reports. Finally, the investigators worked to automate the distribution of patient information from participants' electronic health records (EHRs) to KeyHIE and from KeyHIE to the EHRs of other care providers.

The project team examined the impact of the enhanced KeyHIE on exchange utilization, care-process and patient outcomes, and care-process efficiencies over the five-year study period using surveys with clinicians to understand their motivations for using the exchange, and with clinicians and patients to understand their perceptions of the exchange's usefulness; collected detailed data from a subset of high-use clinicians about whether and how their diagnostic and care plans were affected by information available in the exchange and how their patients' outcomes change with exchange use; and conducted pre- and post-sub-studies of care efficiency at selected provider facilities.