Hospital Readmissions from a Health Information Exchange Perspective

With concern on readmission penalties and frequency of patient readmission to a variety of hospitals, it seems that health information exchange offers both needed information and reduction – or elimination – options for readmission penalties.

The First Version of the Readmission Report

The team at the Nebraska Health Information Initiative connected with a quality manager at a participating facility in 2013; we developed a simple readmission report to share readmission information with hospital participants.
The first draft of the report was simplistic and only revealed data on patients readmitted to that facility within a rolling 30-day timeframe. The report also listed patients readmitted to another facility, but with cumbersome viewing parameters. To view the name of the facility where the admission occurred, the quality nurse had to:

  • log into the HIE, and
  • perform a patient-specific query.  

This approach seemed worth the effort to those managing the numbers. 

Even with this rudimentary first version, the quality manager quickly realized the attrition rate was higher than expected. She recognized that understanding that piece of the puzzle was vital to solving the readmission mystery.

Review of and Updates to the Report

After using the report for more than two years, NeHII’s Privacy/Security Committee validated the following points.

  • The report qualified under healthcare operations, and therefore,
  • We could share data on the patients who sought care at a different facility with case managers and care coordinators.

NeHII also added two additional fields to the report indicating the discharge disposition and discharge location to improve the previous cumbersome process flow for those working the data.  Of course, the report never includes information from patients who have opted-out.
Even with this information at the quality team’s fingertips, the data and processes require additional effort for opportunities to reduce hospital readmission penalties. We frequently heard, “This is nice to have, but what do I do with it?” 

The opportunities for improvement are not always obvious, because:

  • Easily implemented processes and opportunities can change quickly.
  • The formulas for risk-based payments models are complex and evolving. 

Sometimes, the challenges are not so much the data in the report. Instead, our hurdles can be as simple as getting the report to the right person at the facility or re-evaluating an internal hospital coding process for correct ICD-10.

Ultimately, we have found that the passion of the person working the report and his/her knowledge of what the numbers mean to everyday practice improvement at their facility connects to a higher success rate in reducing their readmission penalties.

Comments from Those Working the Data

These seven summary points demonstrate that no standard approach appears for addressing readmission data from hospital to hospital. In addition, the value realized from the data varies from system to system.  In addition, gaps in data caused by those hospitals not participating in the HIE remain a challenge.

  1. The interdisciplinary readmissions team that looks at all of our readmissions reviews data from the NeHII readmission report.
  2. The NeHII readmission report has alerted us to several patients readmitted to hospitals in Omaha and unknown to us.
  3. Our facility first investigates the level of care, when we review the readmission report from NeHII. Some readmissions are in the skilled level of care vs acute care. We track all 30-day readmissions in the acute-care setting with charts reviewed and information pulled to access how we may have assisted the patient to remain out of the hospital.
  4. We have several staffers reviewing charts and watching for 30-day readmissions, so NeHII may affirm what we already know or give us information we may have missed.
  5. We review the patient data from the NeHII readmission report in the hospital Quality Assurance and Performance Improvement (QAPI) meetings.
  6. We find the NeHII readmission report beneficial for readmissions, because we cannot capture data when a patient readmits to another hospital, but we can receive this information, if the facility is participating in NeHII.
  7. The value of receiving this report exists – and would increase, if more hospitals in our region were submitting data to NeHII. 
Contact the HIE that serves your region today to sign up and receive the readmission report for your facility.”  You may be surprised by what you find!