Supporting Nurses’ Work via Promoting Interoperability: The Post-Acute Care InterOperability (PACIO) Project

Purpose: To describe how the post-acute care interoperability (PACIO) project can support nursing care.

Description: Nurses supporting patient care in acute and post-acute care (PAC) settings rely on EHR data to support patient care. However, there is currently an imbalance in what data are available – while interoperability is relatively common across acute care settings, a 2023 report from the assistant secretary for planning and evaluation found that interoperable systems are not often available or used across PAC settings. This means that those receiving PAC-based care have a hole in their record as they move from one facility to another or between acute care and PAC facilities. Lack of access to data can impact nurses’ ability to support patients’ care, leading to unnecessary burden of repeating assessments and tests that have already been completed elsewhere and medical errors, among other negative outcomes. The Centers for Medicare & Medicaid (CMS) has recognized this issue of interoperability and has supported policies and projects to improve interoperability, which in turn support clinicians and reduce burden.

Evaluation/outcome: CMS has sponsored the post-acute care interoperability project (PACIO), which is establishing a framework for the development of health level-seven (HL7®) fast healthcare interoperability resources (FHIR®)* implementation guides (IGs) to facilitate health information exchange between PAC and other entities. PACIO has applied user-centered design and evidence-based approaches to develop a PFE-specific HL7® FHIR® implementation guide (IG). PACIO has solicited perspectives from PAC practitioners, including nurses, and EHR implementers; integrated existing HL7 FHIR IGs; identified health data terminologies and standards; and mapped concepts to the World Health Organization (WHO) international classification of functioning, disability, and health (ICF) to address PAC data quality issues. In partnership with EHR and health information exchange (HIE) vendors and using synthetic patient data generated based on a scenario with an exemplar patient, PACIO has tested the PFE IG in multiple connectathons hosted by CMS and HL7. The connectathon results have demonstrated the technical capabilities of the IGs, provided opportunities to identify potential issues that implementers may face, and built a community among stakeholders who support PAC data quality. Next steps for PACIO include efforts to develop new use cases and improve the existing PFE IG through continued connectathon participation. PACIO welcomes ANIA members to participate in any PACIO work and events, as well as host a pilot at their institution.