HCIS 318 Week 5 Technology and Communication Methods Example

Getting the Discharge Summary to the Nursing Home Before the Patient Arrives: Comparing Fax, Direct Messaging, Exchange Queries and FHIR Interfaces for One Transition of Care

[Student Name]

University of Phoenix

HCIS/318: Health Care Industry Terms for IT Professionals

Week 5 Assignment

[Instructor Name]

[Date]

The hospital, nursing home and figures are composites written for a model paper; standards and findings come from the sources listed.

An 81-year-old woman is discharged on a Friday afternoon from a community hospital, where she was treated for pneumonia, to a skilled nursing facility for two weeks of rehabilitation. The nursing home needs her medication list, diagnoses, allergies, recent vital signs, functional status, code status and follow-up appointments before she arrives, ideally in a form its nurses can use immediately. How that information travels determines whether her first evening goes smoothly. This paper compares four methods the hospital could use.

What the Nursing Home Needs

The receiving nurse must reconcile medications within hours, set up oxygen if needed, know whether the patient can walk alone and understand what to watch for. Missing or late information leads to omitted doses, unnecessary calls to the hospital and sometimes readmission. The need is for complete, accurate data, delivered before arrival, in a form that can enter the nursing home's own record.

Method 1: Fax

The traditional method is to fax a printed discharge summary and medication list. Fax is familiar and works with any facility. But pages can go to the wrong number, arrive incomplete or late, and must be read and retyped by a nurse. The data arrive as images, not structured information, so nothing flows into the nursing home's system. At this hospital, a review found that a third of faxed packets to nursing homes lacked at least one item, most often code status.

Method 2: Direct Secure Messaging

Direct is a standard for encrypted, email-like messages between verified addresses. The hospital's EHR can send a continuity of care document, a standard electronic summary, by Direct to the nursing home's address. It is faster and more secure than fax and can carry structured data. Whether the nursing home can import it depends on its own system; many small facilities can only view the document, not merge it.

Method 3: Health Information Exchange Query

If both organizations belong to the regional health information exchange, the nursing home can query it for the patient's recent records, including the hospital's discharge summary and results. This gives access to more history, but it depends on the nursing home knowing to look, having staff trained to search and the hospital having sent complete data to the exchange.

Method 4: FHIR Interface

FHIR, a standard published by HL7 International, represents health data as small, defined pieces, such as a medication, an allergy or an observation, that systems can request and exchange through web-based application programming interfaces (HL7 International, n.d.). With a FHIR connection, the nursing home's system could pull the patient's medication list and allergies directly into its own record, ready for reconciliation. It is the most structured option, but it requires both systems to support FHIR and someone to build and maintain the connection.

Why Exchange Remains Hard

Technology is only part of the story. Pine (2019), in an ethnographic study of medical records coders and birth certificate clerks, found that administrative data are produced through workers' situated judgments about which sources to trust and how much effort to spend clarifying unclear information; data quality depends on that human work. Sittig and Singh (2020) argued that the COVID-19 pandemic exposed the lack of a national health information technology infrastructure able to share data quickly across organizations. Both points apply to a Friday discharge: a perfect interface still delivers whatever the discharge nurse entered, and a region without shared infrastructure falls back on fax when it matters most.

Comparing the Methods

Speed: fax and Direct are immediate once sent; exchange queries depend on the receiver; FHIR is immediate and automatic. Structure: fax sends images; Direct and exchange send documents that may be structured; FHIR sends discrete data. Reliability: fax is most prone to loss; the others log delivery. Cost: fax is cheapest to run; FHIR costs the most to build. Fit for a small nursing home: fax and viewing Direct messages require no new technology; importing documents and FHIR require capable systems and support.

Recommendation: A Staged Approach

The hospital should immediately replace fax with Direct messaging to every nursing home that has a Direct address, sending the summary at the moment the discharge order is signed, and add a checklist that blocks sending until code status, allergies and medications are complete. Within a year, it should help its five highest-volume nursing homes join the regional exchange and train their admission nurses to query it. Over two years, it should build FHIR connections with the two nursing homes whose systems support them, so medication lists flow directly into their records.

What Each Method Costs the Nursing Home

The receiving side's costs are often overlooked. Fax costs the nursing home nurse time: reading, retyping and calling the hospital about missing pages, which the facility's director of nursing estimated at 40 minutes per admission. Viewing Direct messages costs little once an address is set up. Joining the exchange carries a modest annual fee and training time. A FHIR connection requires the nursing home's EHR vendor to support it, which may mean an upgrade the facility cannot afford without help. The hospital, which benefits from fewer readmissions, could share those costs through its post-acute partnership program.

Measuring Success

Measures include, reported monthly, the share of discharges with a complete summary delivered before arrival, the time from discharge order to receipt, medication discrepancies found on admission and readmissions within 30 days from partner nursing homes, compared with the year before the change.

Conclusion

Fax, Direct messaging, exchange queries and FHIR interfaces each move a discharge summary differently. The best choice depends on speed, structure, reliability, cost and the receiving facility's capacity. A staged plan that starts with what nursing homes can use today and builds toward structured exchange improves the hand-off now while preparing for better tools, and it keeps in view that the people who enter and read the data matter as much as the pipes.

References

HL7 International. (n.d.). FHIR overview. https://www.hl7.org/fhir/overview.html

Pine, K. H. (2019). The qualculative dimension of healthcare data interoperability. Health Informatics Journal, 25(3), 536-548. https://doi.org/10.1177/1460458219833095

Sittig, D. F., & Singh, H. (2020). COVID-19 and the need for a national health information technology infrastructure. JAMA, 323(23), 2373-2374. https://doi.org/10.1001/jama.2020.7239