While the long-awaited goal of interoperability seems to be advancing for EHR-equipped care providers, the idea of enabling health equity across the care spectrum seems untenable for post-acute care facilities without similar technological capabilities.
Early this year, the Office of National Coordinator approved the first six qualified health information network (QHIN) candidates to implement the Trusted Exchange Framework and Common Agreement (TEFCA) to support the interoperability of health records.
Over nearly two decades, the federal government and the healthcare industry have spent billions to implement electronic health records in physician practices and hospitals. But government incentives under Meaningful Use did not extend to post-acute care providers. These providers often rely on paper documents for transfer and discharge, papers that can get lost or misplaced and compromise patient care.
Every patient — regardless of age, race, sex, location, and non-medical social determinants of health (SDOH) — deserves the same access to quality care. Likewise, every care setting, including post-acute care and skilled nursing facilities, needs the same access to secure patient health information in order to provide equal care.
But as interoperability marches on, many post-acute care providers are being left behind.
Rather than more regulation, post-acute providers need technology that allows them to easily exchange digital documentation and information with other healthcare providers as well as food banks, social workers, charitable housing associations, and other community providers.
Digital fax provides a viable option for effective data exchange
While the physical fax machine has limited utility beyond mere data transmission, digital cloud fax solutions, on the other hand, can close the technology gap and pave the way for equitable care.
Simply put, paper faxing processes do not meet the security or privacy requirements to enable interoperability across all care settings. However, digital faxing solutions are available today that can solve that problem. Digital cloud faxing, when combined with new technologies like NLP and AI, can intelligently extract vital information from unstructured digital faxes. The data extracted can be used to easily exchange information in an accepted format that both enables interoperability and promotes better health outcomes.
Population health extends well beyond providers
The idea of health equity extends beyond the healthcare setting and providers to encompass the social determinants of health (SDOH). In broad terms, a person’s health is determined by:
- Socioeconomic status: education, income, employment status, family/social support and community safety (40%)
- Health behaviors such as smoking, drug/alcohol use, sexual habits, diet/exercise (30%)
- Access to healthcare and the quality of that care (20%)
- Physical environment (10%)
Eighty percent of physicians believe that the United States cannot improve health outcomes and reduce expenses without addressing SDOH issues, according to a national physician survey. Nearly all physicians (94%) believe that at least one SDOH issue affects outcomes among their patients, which causes stress on a weekly basis. Those frustrations include:
- Limited time during a patient visit to discuss SDOH (71%)
- Insufficient workforce to help patients navigate community resources (64%)
- Unavailable, inadequate, or difficult-to-access community resources (57%)
As interoperability becomes more commonplace, communication will improve among providers and hospitals with EHR systems or similar technology as patients move between care settings.
But until post-acute care facilities and social services organizations have a similar level of interoperability sophistication, communications will lag or be disrupted as patients move to post-acute care or community-based services. Current interoperability efforts create an uneven playing field between the haves and have nots that exclude many post-acute care facilities from accessing the same data available to those with EHR technology or similar systems.
Post-acute care providers lack sophisticated interoperability technology
Consider Grace Cordovano’s heart-wrenching LinkedIn video post from March, where she described the unnecessary suffering a patient with metastatic cancer endured because an order for hospice was not included with a patient’s discharge instructions provided to skilled nursing. It was after 5 p.m. on a Friday, and no one from the hospice agency was answering the phone. It’s unclear whether information was missing or hadn’t been ordered in the first place. Regardless, the patient was in agony, and Cordovano could do nothing but weep over the plight of the patient.
If discharge papers had been sent via digital cloud fax, before the patient showed up at the SNF, the nursing staff would have had ample time to contact hospice for enrollment confirmation or to ensure that the proper arrangements had been made. Because of the lack of earlier federal incentives, many post-acute providers, which can’t afford to implement the full cost of an EHR, don’t have management systems capable of exchanging data that meets emerging interoperability standards, such as HL7 FHIR (Fast Health Interoperability Resources). And community-based organizations do not have the means or systems in place to exchange data that support patients with food and housing insecurities and other SDOH needs.
Common standards for equitable care
Imagine patient information being sent securely to post-acute providers or social services organizations with the actionable patient data needed to populate intake forms, order prescriptions, or check on the status of social services.
Significant efforts are underway to create common data standards and terminology on SDOH factors to facilitate effective data exchange among providers and other sectors. However, locking providers into one data exchange method doesn’t truly advance interoperable care at all access points or every care setting. When the industry is encouraged to innovate and solve problems such as equal access to digital exchange of patient information, solutions emerge that provide the easy on ramp for post-acute care.
Acute care hospitals with advanced interoperability systems can start with a FHIR message and easily convert the data to send it as a digital fax. With the right technology, post-acute settings can also ensure that interoperability standards are met (at an attainable price) by upgrading obsolete paper-fax processes to a digital fax platform and adding new technologies in an integrated environment to easily turn digital data into a FHIR message.
Health equity is about ensuring that patients receive the highest level of care, regardless of status or social factors. But, until all care providers are equipped with the right kinds of tools and solutions to effectively exchange data, true health equity will not be available for many who need it most.
Bevey Miner is Executive Vice President, Healthcare Strategy and Policy for Consensus Cloud Solutions.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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