Interoperability and Your EMR: Why Automating Referrals is the Next Step for Your Agency

In the world of health information technology, interoperability and interface both refer to the electronic transfer of patient data. Perhaps the easiest way to distinguish the two is this: interface relates to the transfer of data from one software vendor or system to another; interoperability relates to the transfer of information or data from one healthcare provider or organization to another.

Interoperability is what gives providers access to the crucial patient data they need, when they need it. It is of paramount importance in the home healthcare arena, since long-term and post-acute care (LTPAC) patients are more likely to have chronic conditions and co-morbidities that necessitate frequent transition between multiple care providers.

Why is interoperability important for YOUR agency?

Smooth transitions of care among healthcare providers require access to the right patient information at the right time. An electronic medical records system (EMR) that incorporates a strategic, standards-based approach to interoperability and information exchange is essential to enabling the secure and timely capture, sharing, interpretation, and utilization of patient data among authorized healthcare providers across the care continuum.

Interoperability has become increasingly critical for home health agencies (HHAs) since the implementation of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, a bipartisan bill passed in 2014. The IMPACT Act requires that assessment data be standardized in order to facilitate coordinated care and enable assessment data comparison across all four LTPAC settings: HHAs, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.

The 21st Century Cures Act was signed into law in December of 2016, bringing interoperability and patient data access into even sharper focus. In March 2020, the U.S. Department of Health and Human Services (HHS) issued two final rules implementing these Cures Act provisions. The rules require public and private entities to securely and confidentially share health information between patients and other parties.

Indeed, it seems like new regulations crop up every few months, all aimed at improving access to patient data through interoperability. The message is clear: interoperability is no longer a choice for healthcare providers.

According to Home Healthcare News, the COVID-19 pandemic has further highlighted this message. Now more than ever, the need for timely and accurate patient data is crucial, “as patients are flowing in and out of hospitals, with hospitals looking to quickly discharge individuals back home whenever possible to alleviate capacity.”

Despite the demonstrated need, when it comes to interoperability, hospice and home health agencies (HHAs) lag far behind other healthcare providers—especially smaller and/or private agencies that aren’t affiliated with a hospital or health system. But communication, cooperation, and connection are the future of healthcare. Accepting—and embracing—interoperability can position your agency for ongoing and future success.

EMRs today must conform to nationally recognized interoperability standards, and part of the certification process for any EMR vendor is proving their interoperability by demonstrating they can produce and consume (export and import) clinical data and summaries. This is where Thornberry Ltd and NDoc® stand out. Most EMR systems tout their interoperability capabilities, but in reality, seamless interoperability among EMR vendor systems is rare. NDoc is built natively on the HealthShare™ interoperability platform, the market-leading engine for health information exchange, and is fully CCHIT Certified® 2011. The NDoc EMR system has proven itself in the secure, seamless, and reliable transfer of clinical health data.

Automating Referrals: the Next Step

Most HHAs have made the move to electronic medical records, or have at least made the decision to do so. The majority of hospice and HHAs still operate in “paper-mode” when it comes to referrals, however, relying on manual processing of referrals through faxes, phone calls, or emails.

Not surprisingly, the benefits of automated referrals mirror the benefits of interoperability in general. In fact, automating your agency’s referral process alone might be reason enough to put EMR interoperability at the top of your priority list.

Complete Patient Data: All necessary and relevant patient data is accessible when needed. This includes vital health and medical data such:

  • demographics and medical history
  • admission, discharge and transfer notes
  • medications and immunizations
  • allergies and advance directives
  • diagnoses, care plans, and cognitive functioning
  • lab results and prescriptions

Timely Data Access: Referral data is accessible at the time of referral—no waiting for data input. This means it is immediately available to all authorized agency staff and clinicians.

Data Integrity:  Automating referrals can reduce or eliminate data entry errors and omissions; the data in your system is the same as the data from your referral source..

Secure Data Transfer: Automating your referral process means fewer paper documents to file, store, or shred. And while cybersecurity concerns can’t be ignored, there are even more security issues inherent in telephone, fax, and email communication.

Reduced Cost and Increased Productivity: Think about the referral process and the bulk of information necessary for Start of Care (SOC). Automated referrals can reduce or even eliminate the time spent gathering information (often by clinical staff) and inputting patient data. This means less tedious data entry––and a reduction in the associated employee costs––and more time for patient care.

Enhanced Referral Relationships: Developing your referral network and nurturing your referral stream are crucial. An automated referral process doesn’t benefit just the hospice or HHA; productivity, cost, and data security issues are relevant to referral sources, as well. Referral source providers are beginning to expect—and even demand—automation from their referral partners.

How Do Automated Referrals Work?

Automated referrals used to work by establishing a VPN (virtual private network) interface between two sources; that is, between the EMR or software systems at the referring and the referral provider organizations. This interface created a tunnel of data flow from one provider system to another.

While the VPN connection is still an option, the issue becomes one of quantity and cost-effectiveness. Most hospices and HHAs, even those affiliated with a hospital or health system, receive referrals from multiple sources such as acute care and rehabilitation hospitals, and assisted living and skilled nursing facilities. How many tunnels do you want to build?

Down the road, providers may turn more to HIEs and data leveraging organizations like CommonWell and CareQuality for their automated referral communication. But for now, Direct Messaging (DM) is perhaps the simplest answer to automating referrals.

For the vast majority of hospital and health system-based agencies, the ability to “talk” already exists; the hospital or health system is already pushing data to the agency every day, through DM and C-CDA/CCD documents. This makes referral automation easier for these agencies, because most of their referrals come from the affiliated hospital or other health system.

But DM can be the simplest and easiest approach for any hospice or HHA. It can be affordable and accessible to any agency with a certified EMR system, regardless of size or affiliatio