Image of Joshua R. Vest, Ph.D., MPH
Joshua R. Vest, Ph.D., MPH

The creators of a new automated hospital transfer form say they have identified the five must-have pieces of information needed to reduce clinical complications when nursing home residents are brought for emergency care. 

Poor information-sharing and incomplete access to data can complicate the care of nursing home residents in the transfer situation, according to the prototype developers, who conducted an information-gathering study among key stakeholders. Their automated transfer form, called the Fast Health Interoperability Resources automated transfer form — or SMART on FHIR — is based on the information desired by end users and their preferences for care delivery, the authors said.

In a series of interviews, surveys and a design workshop, the consensus was that both clinical and nonclinical data are key to a smooth care transition, reported Joshua R. Vest, Ph.D., MPH, of the Regenstrief Institute and Indiana University. Among all of the desired elements, it was agreed that the transfer form must include: 

  • The emergency contact/healthcare proxy’s information; 
  • the resident’s current medication list;
  • the specific reason for emergency department transfer;
  • an explanation of the resident’s baseline neurological state; and 
  • relevant diagnoses/medical history. 

The nonclinical data elements were included mainly to encourage communication and improve information-sharing between nursing home and hospital, the authors noted.

A challenge facing the prototype is that not all of the desired data elements are available electronically, Vest acknowledged. 

“The use of an emerging standard is an advantage over prior efforts and the number of FHIR resources is expansive, but many potentially useful resources still remain at low maturity-levels or have not been specified,” he said. “Opportunities exist to improve the content within the transfer form as more resources become available, or as more data types are shared by nursing homes through health information exchange,” he added.

More data will be included in future iterations of the transfer form application when this happens, the authors said.

Full findings were published in the AMIA annual Symposium Proceedings Archive.