Challenges stemming from gaps in medical data along the health care continuum and a lack of seamless sharing of crucial information between nursing homes and other entities have grave consequences, especially given the more serious patient acuity levels being discharged to post-acute care facilities. And yet, this is an issue that has failed to garner adequate attention from the federal government.  

The problem has been felt on the front lines for years, according to Lisa Chubb, chief clinical officer with Brickyard Healthcare in Indiana. There’s a lot of technology being introduced in the sector to bridge the gaps, but the industry isn’t at a point of seamless interoperability yet, she said. 

This view is backed by scientific research.

About 50% of hospital information is missing for patients transitioning to post-acute care, while 76% of critical data points are also often missing, according to a study in the JAMA Network.

That could all change, if federal agencies are tasked with creating a streamlined data sharing process.

Chubb discussed care continuity and gaps in data at a recent Skilled Nursing News webinar, along with Bevey Miner, executive vice president of health care strategy and policy at Consensus Cloud Solutions, and John McFarlane, chief clinical officer at Ignite Medical Resorts. Consensus sponsored the webinar.

Currently, there needs to be better control over what information is being sent between hospitals and nursing homes, and how it’s being sent. Nursing homes often don’t have access to resident data in hospital systems, and even if they do, they’re only able to obtain partial info. Inadequate communication around followup appointments is a point of contention too, Chubb said, along with issues related to medication.

“Not only are there gaps with regulatory requirements from acute care to the post-acute setting, the medications often are vastly different from what the patient was on at home versus what they’re on in acute care, and what they’re on when we get that acceptance,” said Chubb. “So that’s a huge gap as well, as far as all of the data that we’re seeing every day when it comes to these transitions, and how complicated it is.”

And, patients are being discharged at a much higher level of acuity than ever before, Miner added, making it even more important that the patient’s data travels with them. Companies like Consensus do offer solutions that can help address problems such as unstructured data and help bridge the gap and improve care continuity. However, more large-scale changes at the level of mandated data sharing standards are needed to drive true health care interoperability, and there is reason to believe that meaningful progress will occur. Operators can expect to hear more from the federal government on data interoperability in the near future, Miner said, with agencies seeking to put rules in place in accordance with the 21st Century Cures Act signed into law in 2016.

Unstructured, missing and inaccurate patient data

Data is often missing, inaccurate, or unstructured, said Miner, meaning there may be hundreds of pages on a patient, but not in a form that can be analyzed digitally and organized in a way to inform swift care-related decisions. Even if the nursing home and hospital share EHR software, and are owned by the same entity, data integration is still not happening, Miner said. 

“Healthcare is the last industry to really go to complete interoperability,” noted Miner. “Look at the financial industry. You get ubiquitous access to your money anywhere in the world.”

Nursing home operators are instead having to obtain discharge summaries and get a diagnosis after the patient is admitted to the facility, she said. It has taken so long for health care interoperability to catch up because there are no data sharing standards.

“The continuity is so disruptive it actually leads to worse health outcomes,” said Miner. “Other unstructured data like PDFs, scans, TIFF images, forms that are handwritten, it actually makes the problem even worse.”

Hospital teams could say they’ve given all information needed, but it’s difficult to parse and time consuming for an already overburdened nursing home workforce. Unstructured data could create a bottleneck in discharge management too, Chubb said, with the nursing home thinking the patient is much more ill than they currently are, or vice versa, with the most vital information buried in a 100-page document.

“That’s one of the big areas when it comes to the referral versus getting to the bedside,” Chubb said of unstructured data. “What information do we need, how often do we need it, and when does that clinical liaison or that admissions director go back to the hospital and request further information?”

McFarlane added that there needs to be a standard method of transferring data for a referral, and ensuring new staff on the acute care end are educated on what that information the top page needs to have to ensure a timely acceptance on the post-acute end.

Turnover at hospitals has been hurting hospital-nursing home relationships overall, he said, including data transfers and discharge management.

“It’s mostly stagnant or maybe slightly worsened in terms of just the communication, the information that we receive, the accuracy of it,” McFarlane said of hospital staff turnover. “Sometimes we don’t always receive updates before the patient has been admitted, so we don’t always fully understand what we need to safely take care of that patient.”

However, the method of data transfer is inconsequential if data entered is incorrect or incomplete, and getting whole or correct info from the previous care setting is one of Ignite’s biggest challenges, said McFarlane.

Data gaps and nurse burnout

Gaps in data is a huge component of staff burnout in the nursing home, Chubb said, with medical records nurses and assessment coordinators constantly chasing down information. And when they do receive it, it’s not structured in an efficient way.

“It creates unnecessary inefficiencies with staff … what we find is that the role of the nurse has become more investigative,” added McFarlane.

Searching through unstructured data for information that should be easily accessible and provided brings unnecessary stress for staff already behind on 8 to 10 admissions per day, he said. 

“We’re already kind of behind the eight ball. Our accessibility to medications is more limited than an acute care, hospital-based system,” said McFarlane. “It certainly is a huge piece of why I think nurses ultimately end up leaving our setting and may ultimately leave the nursing practice altogether. It’s a huge driving factor.”