Health Care Administration and Organization

BACKGROUND: Information exchange is essential for transitioning high-quality care between care settings. Inadequate or delayed information exchange can result in medication errors, missed test results, considerable delays in care, and even readmissions. Unfortunately, long-term and postacute care facilities often lag behind other health care facilities in adopting health information technologies, increasing difficulty in facilitating care transitions through electronic information exchange. The research gap is most evident when considering the implications of the inability to electronically transfer patients’ health records between these facilities. OBJECTIVE: This study aimed to design and evaluate an open standards-based interoperability solution that facilitates seamless bidirectional information exchange between acute care and long-term and postacute care facilities using 2 vendor electronic health record (EHR) systems. METHODS: Using the design science research methodology, we designed an interoperability solution that improves the bidirectional information exchange between acute care and long-term care (LTC) facilities using different EHR systems. Different approaches were applied in the study with a focus on the relevance cycle, including eliciting detailed requirements from stakeholders in the health system who understand the complex data formats, constraints, and workflows associated with transferring patient records between 2 different EHR systems. We performed literature reviews and sought experts in the health care industry from different organizations with a focus on the rigor cycle to identify the components relevant to the interoperability solution. The design cycle focused on iterating between the core activities of implementing and evaluating the proposed artifact. The artifact was evaluated at a health care organization with a combined footprint of acute and postacute care operations using 2 different EHR systems. RESULTS: The resulting interoperability solution offered integrations with source systems and was proven to facilitate bidirectional information exchange for patients transferring between an acute care facility using an Epic EHR system and an LTC facility using a PointClickCare EHR system. This solution serves as a proof of concept for bidirectional data exchange between Epic and PointClickCare for medications, yet the solution is designed to expand to additional data elements such as allergies, problem lists, and diagnoses. CONCLUSIONS: Historically, the interoperability topic has centered on hospital-to-hospital data exchange, making it more challenging to evaluate the efficacy of data exchange between other care settings. In acute and LTC settings, there are differences in patients’ needs and delivery of care workflows that are distinctly unique. In addition, the health care system’s components that offer long-term and acute care in the United States have evolved independently and separately. This study demonstrates that the interoperability solution improves the information exchange between acute and LTC facilities by simplifying data transfer, eliminating manual processes, and reducing data discrepancies using a design science research methodology.

Social workers have been at the forefront of research and advocacy to improve nursing home care for several decades. However, United States (U.S.) regulations have not kept pace with professional standards, as nursing home social services workers are still not required to have a degree in social work and many are assigned caseloads that are untenable for providing quality psychosocial and behavioral health care. The National Academies of Sciences, Engineering, and Medicine (NASEM)’s recently published interdisciplinary consensus report, The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Families, and Staff (NASEM, 2022) makes recommendations for changing these regulations, reflecting years of social work scholarship and policy advocacy. In this commentary, we highlight the NASEM report recommendations for social work and chart a course for continuing scholarship and policy advocacy to improve resident outcomes.

This article explores views about older people and aging underpinning practices and perceptions of development and implementation of Artificial Intelligence (AI) in long-term care homes (LTC). Drawing on semi-structured interviews with seven AI developers, seven LTC staff, and four LTC advocates, we analyzed how AI technologies for later life are imagined, designed, deployed, and resisted. Using the concepts of “promissory discourse” and “aging anxieties”, we investigated manifestations of ageism in accounts of AI applications in LTC. Despite positive intentions, both AI developers and LTC staff/advocates engaged in simplistic scripts about aging, care, and the technological capacity of older people. We further uncovered what we termed sociotechnical ageism-a form that is not merely digital but rests on interacting pre-conceptions about the inability or lack of interest of older people to use emerging technologies coupled with social assumptions about aging, LTC, and technological innovation.

Issue: The high cost of long-term care puts financial pressure on families and worsens inequities in many developed countries. But compared with the United States, many other high-income nations have adopted more comprehensive approaches to financing long-term care services.
Goal: To understand how different countries and U.S. states finance long-term care.
Methods: Analysis of long-term care cost data in the U.S. and spending data from the Organisation for Economic Co-operation and Development for 12 high-income countries.
Key Findings and Conclusion: U.S. spending on long-term care is proportionally the lowest among high-income countries, and there is no single approach to funding this care. In many of these countries, and in certain U.S. states, there is broad eligibility for long-term care benefits or substantial financial assistance, paid mostly through the government or social insurance programs. Common approaches to financing include social insurance, universal comprehensive coverage, residual (or means-tested) systems, and hybrid strategies. Insights from international models and from innovative funding mechanisms being tested by some U.S. states could inform future efforts to reduce the financial burden of long-term care on U.S. families while reducing income- and race-based inequities.