Transferring Patients to the Next Level of Care


Vol. 9 •Issue 11 • Page 55
Transferring Patients to the Next Level of Care

Partners Continuing Care’s CIO explains how her organization developed an application to seamlessly transfer patients.

Boston-based Partners Healthcare System made a strategic decision four years ago to develop its own software application to assist case managers with the transitioning of patients in their acute care hospitals to the next level of required care. Partners took this approach instead of purchasing the technology.

Why is this important? Partners’ Continuing Care Division is composed of home care, rehabilitation hospitals and skilled nursing facilities. According to Cara A. Babachicos, CIO of Partners Continuing Care, when case managers need to transition a patient to care through a non-acute provider, it is often an unwieldy, time-consuming project. They must collect all the data required for the non-acute provider to adequately care for a patient.

Products on the market in 2001 did not offer a total solution to this problem.

“The product we developed internally, called 4NEXT [for the next level of care], provides a gold standard for what the non-acute facility needs in terms of care planning. It includes patient demographic information, insurance information and care planning. It is HIPAA-compliant, transmitting minimal patient information until the patient has been accepted by the non-acute provider,” Babachicos told ADVANCE.

An automated process

Maureen Banks, RN, MS, MBA, CHE, president of Partners’ Division of Skilled Nursing Facilities, and director of 4NEXT at Partners, referenced a research study indicating that the facility could improve processes to get the patient into the right bed at the right time. Bottlenecks were impacting the entire Partners continuum. “Out of the study came this concept of having a more automated process that care coordinators [case managers] could use in addressing some of the bottleneck problems,” Banks noted.

The case manager at the acute care facility first logs into the search-and-sort function of the application, Babachicos said, which allows the case manager to eliminate the manual search process. “4NEXT keeps an online database of information about facilities in New England, as well as across the country,” she explained.

Banks said the search-and-sort function accesses a nationwide database of non-acute providers including hospice, IV infusion companies, and skilled nursing and nursing facilities. The database also includes rehabilitation and home care agencies as well as durable medical equipment (DME) for the purchase of medical supplies, wheel chairs, hospital beds and other medical equipment. “We incorporate quality standards into our database, showing facilities that are likely to ascribe to the standards of care we want for our patients – and be solid enough businesses to move through the rigors of an intensive accreditation process. Because we get our provider lists directly from the source, such as the Centers for Medicare & Medicaid Services (CMS) and JCAHO, we know the information is reliable,” Banks said.

Partners validates the provider list for the New England states; about 80 percent of the patients discharged from Partners go to other health care provider facilities in New England. Because much of the information is now online, Partners is able to further query specialty programs. For example, does the facility offer care for adolescent brain trauma? Is the facility a pediatric hospice? Does the facility offer a kosher kitchen? What languages are spoken there?

All of this information is helpful to the care coordinators as they are discharging patients. They can search for key characteristics for the patient and his/her family, Banks said.

“The 4NEXT product is built so that a number of different searches can be performed, including looking for skilled facilities for rehabilitation services as well as a follow-up home care referral. Today, patients may go to a skilled nursing facility for rehabilitation for just two weeks and then return home, where home health agencies continue to provide care,” she noted.

In addition, case managers may now send referrals electronically via 4NEXT. At its basic level, 4NEXT is a communication tool. It allows tertiary care and community hospitals to communicate with the next care provider, or providers, to see who can accept a patient needing post-acute care. Generally a case manager refers patients to various post- acute facilities or a home care agency asking if they can take on the new patient.

“Being efficient in transitioning patients at the right time provides a significant advantage to both the patient and his/her family,” Babachicos said. “Timely placement of patients in need of non-acute services also helps free up acute patient beds sooner. Let’s say you want to send a patient from an acute care setting to a rehabilitation facility. With 4NEXT you could send multiple, simultaneous referrals to facilities, and they could each respond as to whether they have the capacity to accept the patient. The referring hospital — in consultation with the patient and family members — still makes the final decision on where the patient will go. But, with this technology in place, the review process and final acceptance can happen much faster.”

The 4NEXT product allows a facility to send a comprehensive, standardized referral to the non-acute care provider through a portal that can be accessed on the desktop of the receiving facility. Babachicos said that 4NEXT presents patient information for the next provider in a formatted package containing primarily electronically stored data, but can also include written documents if necessary.

Locating a facility

The provider database is updated annually for facilities within New England, as well as those across the United States, Banks said. The lists include detailed information about facilities in New England, while there are major points of information for facilities in states outside of the region. For example, Banks said, a care coordinator in Massachusetts can type in a remote city and state, and search for home care companies, rehabilitation facilities, DME suppliers, home IV infusion companies, hospices, etc., within a specific mile radius. The system displays the addresses and phone numbers of facilities matching the search criteria.

Once the patient’s clinical needs have been matched with the post-acute facility, the transition process begins. The 4NEXT system sends a comprehensive package of clinical information in a real-time standardized format. For up to 72 hours after a patient is discharged, any pending information, such as lab results or a note dictated by a physician, will be sent along to the next care provider.

A significant benefit of the 4NEXT system, Babachicos said, is that the process of transferring a patient — previously paper- and faxed-based — can now be electronic. “As you can imagine, within the old paper-intensive process, there were many inefficiencies,” she said.

Babachicos noted that the old way of transferring patients was static. “We are now leveraging the information that we have in our information systems, using interfaces. We’re getting that information to the care providers through a secure encrypted connection so they can get what they need in a secure format. The process doesn’t allow them to actually get into our information systems, but rather allows the site to see what they have been given access to by the referring acute facility. This allows the receiver to perform a comprehensive review that’s in the required format and is much more accessible, accurate and understandable,” she said.

During the process of accepting a patient from the acute care setting, a number of steps must take place, Banks said. In the traditional method, people did things sequentially, which often lengthened the acceptance or denial process. “First, somebody would have to drive to the hospital, find the record, read the record and fax it. Then the facility would have to make sure the patient’s insurance would be accepted, and that the facility could accept the patient clinically with its current open beds,” Banks said. “What we had done previously worked in silos; we can now do things simultaneously, so a facility knows quickly that a patient has been accepted or rejected.”

When the referral is initiated at the acute care setting, the system integrates the functionality of the search, sort and transition of care. “The care coordinator can meet with a family in the Boston suburb of Brighton, for example, where there are three nursing homes,” Banks said. “The care coordinator can click on the three nursing homes in Brighton, and build the initial data screen, click the ‘send’ command, and all three facilities will receive the inquiry. The screening process occurs simultaneously. One may say it can’t accept this patient for whatever reason,” Banks said. When the other two accept the patient, the family can then make their decision on where to go.

Babachicos noted, “With the paper process, you often had to wait to hear the first provider decline before you could inquire with a second or third provider.”

Banks added, “The family may have a preference for one of the facilities. It always comes back to the family/patient choice.”

The technology also allows Partners to provide ongoing communications with the next care provider. “We can ask the facility in Brighton to let us know within the next hour whether they can accept a new patient. Partners Continuing Care can also instantaneously see that Brighton wants two additional pieces of information before they’ll make a determination on the inquiry,” Banks added.

4NEXT pages the appropriate care coordinator when an acceptance or rejection has arrived. “The care coordinators are in meetings with families throughout the day, so the functionality allows them to receive a page when an acceptance or rejection has come in from a facility,” Banks said.

The future of 4NEXT

Babachicos said that at the health system level, Partners is looking to create an executive tool that summarizes and enforces compliancy in sending critical data elements to the next care provider. “Even though Partners is a large integrated delivery system with a lot of information systems at various organizations, we consider the 4NEXT product to be moving toward a gold standard of patient discharge and transfer.

“Our goal is that all patients discharged from Partners facilities will have the same presentation, the same components in place, in a high-level, high-quality display,” she said.

Mr. Mitchell is managing editor of ADVANCE for Health Information Executives.

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