Skilled Nursing Facilities Lack Enhanced Patient Data Sharing

Skilled nursing facilities (SNFs) reported significant deficiencies in the completeness, timeliness, and usability of patient data sharing from hospitals to SNFs, according to a study published in JAMA Network Open. This negatively impacts transitions of care.

SNFs serve patients that often have high-risk or complex chronic conditions and care needs, resulting in frequent transitions between home, acute, post-acute, and long-term care settings. Thus, these transitions require care coordination between providers— a collaboration that becomes easier with efficient EHR use, health data exchange, and interoperability.

However, the current state of patient data sharing is relatively unknown even though there’s been over a decade of investment in health IT infrastructure and new incentives to promote coordination between hospitals and SNFs.

In order to measure the accuracy, timeliness, and usability of patient health information between hospitals and SNFs, researchers surveyed 471 SNF directors of nursing.  

Of these 471 respondents, only 64 noted excellent performance on all three dimensions of patient data sharing. On the contrary, 141 reported below-average performance on all three measures. The respondents said social determinants of health and behavioral health status were the two most common pieces of missing information.

Receipt of hospital information was delayed and often arrived after the patient, respondents added.

Overall, 358 respondents said there was at least one usability deficiency. However, researchers noted if there was a hospital clinician on-site at the SNF, information sharing was more complete, timely, and usable. Furthermore, hospital accountable care organization participation was linked with enhanced and more timely patient data sharing.

“Given the shortcomings across all 3 dimensions, our results strongly suggest that hospitals have not sufficiently invested in understanding SNF information needs to support transitional care,” wrote the study authors. “Hospitals have many fronts on which they are being asked to improve care transitions and care coordination, and must make difficult prioritization decisions across them.”

But to address these issues, the researchers said some solutions are simpler than others.

“For example, most hospitals use the default discharge summaries included in their EHR and may assume that it is technically complex and expensive to redesign them,” the study authors explained.

“However, given that nearly half of our sample reported that the hospital offered an SNF-tailored discharge summary, there are templates that could be shared and deployed more broadly, which would be facilitated by hospital EHR certification criteria that define and include this as a standard template.”

The research team also said complex workflow for discharging clinicians adds to the difficulty of improving the timeliness of patient data exchange. The research team said these demands could limit a clinicians’ basic patient care knowledge.

To enhance timeliness, clinicians could be motivated by positive performance feedback or even rewarded for timeliness.

“However, for timeliness, as well as for determining essential information content for inclusion, a national standard may be necessary to achieve consistency and promote investment in larger process fixes for communication and coordination (such as how to share laboratory results that are returned after discharge or how to identify the clinician responsible for after-hours questions),” the study authors said. “These investments could have spillover benefits outside of hospital-SNF transitions.”

To boost individual dimensions of patient data sharing on all three dimensions, the researchers recommended SNFs employ clinicians who work at both the SNF and another care site.

“These shortcomings are likely associated with a suboptimal transition experience,” the study authors concluded. “Shared clinicians represent a potential strategy to improve information sharing but are costly. New payment models such as accountable care organizations may offer a more scalable approach but were only associated with more timely sharing.”