








key: cord-289018-6rnvwptr
authors: Wong, Serena P.; Jacobson, Heather N.; Massengill, Jennifer; White, Heidi K.; Yanamadala, Mamata
title: Safe Inter-Organizational Health Information Exchange During the COVID-19 Pandemic
date: 2020-10-22
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.10.022
sha: 
doc_id: 289018
cord_uid: 6rnvwptr

Accurate and timely transmission of medical records between skilled nursing facilities and acute care settings has been logistically problematic. Often people are sent to the hospital with a packet of paper records, which is easily misplaced. The COVID-19 pandemic has further magnified this problem by the possibility of viral transmission via fomites. To protect themselves, staff and providers were donning personal protective equipment to review paper records, which was time-consuming and wasteful. We describe an innovative process developed by a team of hospital leadership, members of a local collaborative of skilled nursing facilities, and leadership of this collaborative group, to address this problem. Many possible solutions were suggested and reviewed. We describe the reasons for selecting our final document transfer process and how it was implemented. The critical success factors are also delineated. Other health systems and collaborative groups of skilled nursing facilities may benefit from implementing similar processes.

In July 2017, our health system's accountable care organization established the Health 15 Optimization for Elders (HOPE) Skilled Nursing Facility (SNF) Collaborative, which now includes 16 25 skilled nursing facilities from seven surrounding counties. One focus of the collaborative is to personal protective equipment (PPE) to review paper documents to avoid fomite transmission 22 of . 1 In addition to delaying care, this was burdensome and wasteful, considering the 23 nationwide shortage of PPE. 24 HOPE leadership took this opportunity to both address the infection control need, and 25 to improve transitions of care between SNFs and hospitals. One factor long impacting 26 continuity of care between settings is a lack of interoperable clinical information systems. 2 Too 27 often paper documentation is misplaced in emergency departments, which were not designed 28 to maintain paper records. Hospital care suffers when source documents including medication 29 administration records, medical and nursing notes, and advance directives are not available to 30 care providers who need to review it in detail. The ideal solution would attain two goals: 1) 31 transfer medical documents safely and efficiently to the hospital team, and 2) integrate data 32 into the medical record for all staff to review. In the nine weeks since implementation, the process has been used 287 times 71 throughout our three-hospital health system, with overall increasing usage as shown in Figure   72 1. Week 1 usage was high in part due to receipt of requested records for patients already 73 admitted; all other data points were spontaneous file transfers from SNFs to the hospital. There 

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