In organizations representing the continuum of care, there can be significant challenges coordinating care as patients are transitioning between various care settings. By having access to hospital and provider data, post-acute care facilities (long-term care and skilled nursing facilities) are able to have a clearer picture about a patient’s clinical history.
HealthShare Exchange (HSX) currently has 7 participating post-acute care facilities that are utilizing services to bridge gaps and provide quality care.
- Encounter Notification Service (ENS) – For Post-Acute Care Facilities
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Once an organization supplies Admit, Discharge, Transfer (ADT) feeds to HSX, HSX can automatically subscribe discharged patients from the facility for a period of time.
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ENS auto-subscription then can provide notifications back to the participating HSX-Member organization about these discharged patients who are subsequently admitted within a defined timeframe (e.g. 90 days) to other HSX-Member emergency departments and hospitals, which can be valuable for care coordination and bundled payment programs.
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- Clinical Data Repository
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Collects and retains medical-records data about patients, permitting a patient’s provider and/or care-team members to query for clinical information about the patient.
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Post-acute care facilities have the opportunity to access the CDR through the HSX query portal or through EHR integration.
Clinical Data Repository (CDR) Overview
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- Direct Secure Messaging (DIRECT)/ Provider Directory (PD)
- Point-to-point exchange of clinical information between providers’ direct addresses using the national Direct Project standards — included, but not limited to, sending of continuity of care (C-CDA) documents with discharge information and referrals for transitions of care. HSX can offer direct addresses to providers and facilities, as needed.
- The HSX PD contains more than 9,000 direct addresses for healthcare providers who actively participate with HSX for direct messaging; interoperability testing is completed before providers’ direct addresses are added to the PD to ensure employed providers within hospitals and health systems can engage with Direct in a meaningful way.
- Automated Care Team Finder (ACTF)
- Uses the patient’s member identification with his or her healthcare insurer to identify the patient’s primary care provider and route continuity of care (C-CDA) documents, containing discharge information, leveraging the HSX PD.
- Post-acute care facilities that are able to generate ADT feeds and want to automatically route information to patient’s external care providers are eligible to participate with this service.
- Clinical Activity History (CAH)
- Collects recent clinical history about a patient from the patient’s healthcare insurer, based on the patient’s member identification within the health plan and translates this claims/utilization data to a clinical care document — returning this information to the requesting provider organization.
- Admission, discharge, transfer (ADT) feeds trigger the clinical activity history documents to be delivered to the requestor.
- Download our Clinical Activity History Overview
By participating with HSX, post-acute care facilities can:
- Electronically share continuity of care documents post-discharge to help patients connect with downstream providers
- Receive documents electronically from hospitals to assist with the admissions process into skilled nursing, short stay rehab or long-term care.
- Better coordinate care by receiving notifications for residents who have been discharged from the post-acute care facility and subsequently present to a HSX-Member emergency department or hospital within a specified period of time
- Securely access a centralized repository of health information from multiple hospitals and providers
To learn more, download our Post-Acute Care Facility fact sheet