CIS 450 Module 2 Information Systems Across Care Settings Example

One Patient, Five Systems: Following Health Information Across Care Settings

Student Name

Health Care Administration Program, Aspen University

CIS 450: Informatics in Healthcare

Instructor Name

Month Day, Year

One Patient, Five Systems: Following Health Information Across Care Settings

Patients move between hospitals, clinics, nursing facilities, home health agencies and public health services, but their information often does not move with them. Each setting uses its own information systems, designed for its own work. This paper follows a composite patient with heart failure through five settings to show what each setting's systems do and where information breaks down.

The Patient

Mrs. R., 79, has heart failure and diabetes. In one month she is hospitalized for fluid overload, transferred to a skilled nursing facility for rehabilitation, discharged home with home health nursing, seen by her primary care physician and reported to the health department after testing positive for influenza. Her information passes through at least five separate systems.

The Hospital

Hospitals use comprehensive electronic health records with order entry, medication administration, results, documentation and billing. Adoption is now nearly universal, but capability varies. A national analysis found that 80.5% of hospitals had adopted at least a basic record system, yet only 37.5% had adopted most functions for using data in performance measurement and 41.7% most patient engagement functions, with critical access and small hospitals lagging (Adler-Milstein et al., 2017). The authors called this a digital advanced-use divide.

The Skilled Nursing Facility

Skilled nursing facilities use records designed around long-term assessments, therapy minutes and regulatory reporting. Mrs. R.'s hospital discharge summary arrived as a faxed document and was scanned, not imported, so her medication list had to be retyped. A transcription error changed her diuretic dose, which a nurse caught two days later.

Home Health

The home health agency uses a mobile system for visit documentation and a federally required assessment. Its nurse received the nursing facility's discharge summary by fax and a separate list from the pharmacy. The agency's system could not see the hospital's record, so the nurse reconciled three medication lists by hand in Mrs. R.'s kitchen.

Primary Care

The primary care practice's record received an electronic discharge notice from the hospital through the regional health information exchange but nothing from the nursing facility or home health agency. The physician learned of the dose error only when the home health nurse called. Primary care is supposed to coordinate, yet it often has the least complete picture.

Public Health

The influenza test result was reported electronically by the laboratory to the state health department's surveillance system. Public health information systems have historically struggled to receive the volume and types of electronic data clinical systems can send; analysts warned of a crisis as meaningful use rules required providers to send immunization, surveillance and notifiable disease data that many public health systems could not yet accept (Lenert & Sundwall, 2012).

Settings Compared

The table summarizes the five settings.

Interoperability

Interoperability is the ability of systems to exchange and use information. A national hospital survey found that fewer than three in ten hospitals could locate, send, receive and fold outside records into their own systems in 2015, a modest rise from the year before, and the integration step had not moved at all (Holmgren et al., 2017). Mrs. R.'s experience reflects that gap: information was sent and received, but rarely integrated.

Consequences

Fragmented information caused a medication error, duplicated work, delayed physician awareness and wasted nurse time. For patients with complex chronic illness who move often between settings, these gaps are common and can lead to readmissions.

What Would Help

Improvements include sending structured discharge summaries and medication lists electronically to every next setting, participation of nursing facilities and home health agencies in health information exchange, notifications to primary care whenever a patient is admitted or discharged anywhere, and public health systems able to receive standardized data. Administrators in each setting can push for these connections.

The Administrator's Role

Administrators choose systems, negotiate interfaces and set transition procedures. They can require that referral partners exchange data electronically, join regional exchanges and measure how often transitions include complete medication lists. Viewing information flow from the patient's perspective, across settings, reveals gaps that any single organization misses.

Ambulatory Specialty and Pharmacy Systems

Mrs. R. also saw a cardiologist whose practice used a different ambulatory record, and her pharmacy used its own dispensing system. Pharmacies often hold the most accurate list of what patients actually fill, yet that information rarely flows back to clinicians' records automatically. Each additional system is another place where information can diverge.

Patient-Held Information

Mrs. R.'s daughter kept a paper list of medications and a folder of discharge papers, which proved more complete than any single system. Patients and families often become the unofficial integrators of fragmented records. Portals that combine data from several organizations could ease that burden, but only if the organizations share data in the first place.

Long-Term and Post-Acute Care Gaps

Post-acute and long-term care providers were not eligible for the federal incentive payments that accelerated hospital and physician adoption, so their systems developed later and often with fewer interoperability features. That history explains why transitions into and out of nursing facilities remain especially vulnerable to information loss.

Measuring Transitions

Organizations can measure information flow directly: the share of discharges with a structured summary sent electronically to the next provider within a day, the share of admissions triggering a notice to the primary care physician and the share of transitions with a reconciled medication list. What gets measured across settings tends to improve.

Home Monitoring Data

After discharge, Mrs. R. received a scale that transmitted weights to the home health agency. The agency could see rising weights, but the primary care practice could not. Remote monitoring adds yet another data stream that must be routed to whoever can act on it.

Conclusion

Mrs. R.'s month showed five settings using five kinds of systems, each suited to its own work but poorly connected to the others. National data show near-universal hospital adoption but an advanced-use divide and limited interoperability, while public health systems have struggled to receive data. Closing these gaps requires attention to information flow across settings, not only within them.

References

Adler-Milstein, J., Holmgren, A. J., Kralovec, P., Worzala, C., Searcy, T., & Patel, V. (2017). Electronic health record adoption in US hospitals: The emergence of a digital "advanced use" divide. Journal of the American Medical Informatics Association, 24(6), 1142-1148. https://doi.org/10.1093/jamia/ocx080

Holmgren, A. J., Patel, V., & Adler-Milstein, J. (2017). Progress in interoperability: Measuring US hospitals' engagement in sharing patient data. Health Affairs, 36(10), 1820-1827. https://doi.org/10.1377/hlthaff.2017.0546

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: A crisis of opportunity. American Journal of Public Health, 102(3), e1-e7. https://doi.org/10.2105/AJPH.2011.300542