An Open-Standards-Based Interoperability Solution Enabling Seamless Information Exchange Between Acute and Long-term Post-acute Care Facilities: A Design Science Research (Preprint)

Abstract

Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, significant care delays, and even readmissions. Unfortunately, long-term and post-acute care (LTPAC) facilities often lag behind other healthcare facilities in adopting health information technologies (HITs), increasing the difficulty of electronic information exchange to facilitate care transitions. Research suggests that there needs to be innovative HIT tools to facilitate seamless information exchange between acute and LTPAC facilities. The research gap is most evident when considering the implications of the inability to transfer patients' health records between these facilities electronically.

This study aims to design and evaluate an open-standards-based interoperability solution facilitating seamless bidirectional information exchange between acute and LTPAC facilities using two vendor electronic health record (EHR) systems.

Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute and long-term care facilities using different EHR systems. The design is refined by verifying and validating different data formats employing open standards and web protocols. Different approaches were applied in the study focusing on the relevance cycle, including eliciting the detailed requirements from stakeholders in the health system that understand the complex data formats, constraints, and workflows associated with transferring patient records between two different EHR systems. The design and architecture are continuously revised, working with other healthcare personnel, IT professionals, and expert vendor associates. We used literature reviews, and experts in the healthcare industry from different organizations were sought with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact is evaluated at a healthcare organization with a combined footprint of acute and post-acute care operations using two different EHR systems.

The resulting interoperability solution offered integrations with source systems and was tested to facilitate bidirectional information exchange for patients transferring between an acute care facility using Epic EHR system and a long-term care facility using PointClickCare (PCC) EHR system. The prototype is hosted in the acute care facility network facilitating the electronic information exchange between the two EHR systems. The solution consumed HL7 V2 ADT information, HL7 FHIR information, and PCC APIs. This solution served as a proof of concept for bidirectional data exchange between Epic and PCC for medications, yet the solution is designed to expand to additional data elements such as allergies, problem list, and diagnoses.

Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and long-term care settings, there are differences in patients and the delivery of care that are distinctly unique. In addition, the healthcare system's components that offer long-term and acute care in the United States evolved independently and separately. The study demonstrates the interoperability solution improves the information exchange between acute and long-term care facilities by simplifying data transfer eliminating manual processes and reducing data discrepancies using a design science research methodology.