INDIANAPOLIS – Approximately one in five older adults in the U.S. is transferred to a nursing home following a hospital stay. For many of these patients, an accessible medical record does not accompany them, often negatively affecting the care they receive at the nursing home. This poor information sharing is a significant problem contributing to the adverse events within 45 days of hospital discharge experienced by nearly 40 percent of nursing home residents.

Regenstrief Institute research scientists Kathleen Unroe, M.D., MHA, and Joshua Vest, PhD, MPH, and colleagues from Probari, a start-up company founded by Dr. Unroe and Russell Evans, R.N., MHA, are focusing on improving the quality of nursing home care and have developed and demonstrated the feasibility of a prototype nursing home facing computer application (app) targeting improved information exchange and better care for these high-risk transitions.

The app is tailored to the needs of end-users -- nursing home nurses -- for robust, timely and accessible health record data as a transfer from a hospital to a nursing home takes place. The app enables provision of information to support a seamless transition of care across settings no matter what electronic medical record systems the discharging hospital or the receiving nursing home use and is FHIR^® compliant.

Pronounced “fire,” FHIR stands for Fast Healthcare Interoperability Resources and standardizes how healthcare information is exchanged between different computer systems regardless of how it is stored in these systems.

“The challenge we are addressing with the creation of our app is that healthcare is a very diverse landscape of institutions. Hospitals and nursing homes typically run different information systems, so information sharing, which is critically important for optimal care of the nursing home resident, is problematic,” said Dr. Vest, an informatician who has deep interest in both interoperability and social determinants of health. “We built a computer application to leverage existing technology infrastructure to pull information in a systemized, organized and appropriate format to fit workflow needs in nursing homes.

“One of the more revealing findings we learned from our end users was their need for sharing of both clinical and social data, clearly reflecting that we're talking about care for individuals who live in nursing homes,” said Dr. Vest. “So, when we talk about the information moving from a hospital to a nursing home, it really has to encompass not only what they -- nursing home residents -- need for care, but what they also need for daily living and what they need to live their lives ongoing, which was a new kind of twist from this study. And that’s what we built into our app.”

To develop the app, the researchers surveyed nurses and other stakeholders at multiple nursing homes on their information needs and usability requirements.

In 2022 the National Academy of Sciences, Engineering, and Medicine's “The National Imperative to Improve Nursing Home Quality” stated: “Poor communication between nursing homes and hospitals is one of the key barriers to safe and effective care transitions.”

“To provide high quality care for a new or returning resident, nursing homes need to know many things – including blood pressure, pulse, temperature at time of discharge,” said Dr. Unroe, a geriatrician who cares for nursing home patients and has led successful, high impact research studies on avoidable hospitalizations of nursing home residents. “What medicines were administered during the hospital stay and what was the most recent time each was given? Is the patient cognitively impaired?  What was the living situation when the person entered the hospital? Our app transfers that information to the resident’s nursing home care team.

“It matters not only that nurses at nursing homes have access to up-to-date information about what happened during the hospital stay. Access to this information has to be at their fingertips so it is in front of them when and where they need it in order to provide care for that resident,” she added. “It is inefficient and it's dangerous to be distracting the clinical people at the resident’s bedside by expecting the staff member to go into another room and locate often incomplete paperwork or dig into voluminous computer records trying to find basic pieces of information.”

The app performed well and was well received by the potential users surveyed. The next step will be development of the prototype into a fully functioning hospital to nursing home transfer app. The researchers plan to test it in real time with actual transfers to confirm that it will support nursing home nurses to efficiently and safely admit patients as well as to ensure that there is no disruption in the clinical care plan created by the hospital due to transition to a nursing home. 

“Information Needs and Design Requirements for an Application Supporting Safe Transitions Into Skilled Nursing Facilities” is published in The Journal of Post-Acute and Long-Term Care Medicine (JAMDA).

Authors and affiliations:

Joshua R Vest¹, Russell Evans², Kellen Drew², Kathleen T Unroe³

¹Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA; Regenstrief Institute, Inc, Indianapolis, IN, USA.

²Probari, Inc, Indianapolis, IN, USA.

³Probari, Inc, Indianapolis, IN, USA; Division of General Internal Medicine and    Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc, Indianapolis, IN, USA.

This work was supported by a Small Business Innovation Research grant from the National Institutes of Health’s National Institute of Nursing Research.

About Joshua Vest, PhD, MPH
In addition to his roles as Regenstrief research scientist and Fairbanks School of Public Health professor, Joshua Vest, PhD, MPH, is also the director of the Center for Health Policy at the Fairbanks School of Public Health.

About Kathleen T. Unroe, M.D., MHA
In addition to being a research scientist at Regenstrief Institute, Kathleen T. Unroe, M.D., MHA, is an associate professor of medicine at Indiana University School of Medicine and a practicing geriatrician.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform clinical practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About the IU Richard M. Fairbanks School of Public Health
Located on the IUPUI and Fort Wayne campuses, the IU Richard M. Fairbanks School of Public Health is committed to advancing the public’s health and well-being through education, innovation, and leadership. The Fairbanks School of Public Health is known for its expertise in biostatistics, epidemiology, cancer research, community health, environmental public health, global health, health policy, and health services administration.

Indiana University School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

About Probari

Probari is an Indiana based small business founded by experts in nursing home care. Probari’s team of nurses specialize in utilizing electronic health records to improve clincal care in nursing homes. www.probarisystems.com