title: Preparing Nursing Homes for the Future of Health Information Exchange.
abstract: OBJECTIVE
  Our purpose was to describe how we prepared 16 nursing homes (NHs) for health information exchange (HIE) implementation.
  
  
  BACKGROUND
  NH HIE connecting internal and external stakeholders are in their infancy. U.S. initiatives are demonstrating HIE use to increase access and securely exchange personal health information to improve patient outcomes.
  
  
  METHODS
  To achieve our objectives we conducted readiness assessments, performed 32 hours of clinical observation and developed 6 use cases, and conducted semi-structured interviews with 230 participants during 68 site visits to validate use cases and explore HIE.
  
  
  RESULTS
  All 16 NHs had technology available to support resident care. Resident care technologies were integrated much more with internal than external stakeholders. A wide range of technologies were accessible only during administrative office hours. Six non-emergent use cases most commonly communicated by NH staff were: 1) scheduling appointments, 2) Laboratory specimen drawing, 3) pharmacy orders and reconciliation, 4) social work discharge planning, 5) admissions and pre-admissions, and 6) pharmacy-medication reconciliation. Emerging themes from semi-structured interviews about use cases included: availability of information technology in clinical settings, accessibility of HIE at the point of care, and policies/procedures for sending/receiving secure personal health information.
  
  
  CONCLUSIONS
  We learned that every facility needed additional technological and human resources to build an HIE network. Also, use cases help clinical staff apply theoretical problems of HIE implementation and helps them think through the implications of using HIE to communicate about clinical care.
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: G L
authors.initials: GL
authors.lastname: Alexander
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: M
authors.initials: M
authors.lastname: Rantz
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: C
authors.initials: C
authors.lastname: Galambos
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: A
authors.initials: A
authors.lastname: Vogelsmeier
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: M
authors.initials: M
authors.lastname: Flesner
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: L
authors.initials: L
authors.lastname: Popejoy
authors.affiliation: University of Missouri , Columbia, Missouri.
authors.forename: J
authors.initials: J
authors.lastname: Mueller
authors.affiliation: Primaris , Columbia, Missouri.
authors.forename: S
authors.initials: S
authors.lastname: Shumate
authors.affiliation: Professional Services, Iatric Systems, Inc.
authors.forename: M
authors.initials: M
authors.lastname: Elvin
mesh_terms: D066275:Health Information Exchange / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data
keywords: Health information exchange; health information technology; long-term care; nursing home; utilization