SJR1: Resolution would pave way for grant to improve communication about older patients


A Utah Legislature joint resolution aims to improve communication between physicians and health care workers about older Utahns as they transition from hospital care to home health care.

Sponsored by Sen. Jani Iwamoto, D-Salt Lake, SJR1 calls for support of the Utah Falls Prevention Alliance submitting a grant for the centers for Medicaid and Medicare Services. The measure passed a Senate committee and is waiting for full Senate approval.

The grant will fund an electronic home health hub to be built within the Utah Health Information Network and will enable primary care physicians to process home health orders more efficiently. The Utah Fall Prevention Alliance is a network of healthcare providers, government agencies, community organizations, and emergency medical service providers working to reduce older adult falls and injuries. The group’s aim is to prevent falls, which can cause serious injuries to seniors. The bill, however, speaks to a broader problems with communication about seniors’ transition from hospitals to home health care.

Iwamoto said, “Hospital readmissions cost $41 million annually in the United States, and home health services can reduce the number of readmissions by 50% to 80%. This joint resolution is meant to improve timely and streamlined communication between health care providers to prevent hospital complications and ensure smooth transitions from hospice to home care.”

Older adults who have been discharged from hospitals have an increased risk of medical complications and rehospitalization. “The current system’s communication between home health care services for older adults and primary care providers is paper based,” said Iwamoto. “It’s not in sync with electronic health record systems used by 80% of these Utah hospitals and clinics.”

“A prominent gap in communication between healthcare providers is when a person is discharged from the hospital and then starts receiving services for home care,” said Sally Aerts, co-chair of the Utah Fall Prevention Alliance. “A home health hub would provide an efficient, secure electronic communication system that would replace our current system that is time consuming and based on phone calls and faxes.”

In order to build a home health hub, the Falls Prevention Alliance is applying for a technology grant from the Centers for Medicare and Medicaid Services. They are asking the state of Utah to contribute $55,000. That is 10% of the $550,000 total they need. The joint resolution is a one time request, and no ongoing funding from the state will be required.

Clay Watson, past president of the Utah Home Health and Hospice Association, said, “One full year of home health services cost less than one hospital stay.”

The Utah Home Health and Hospice Association’s goal for in-home care is to take care of people so they don’t need to go back to the hospital. After a person has left the hospital and returned home, they make a clinical assessment and call the physician to confirm the treatments. “That’s where it gets tricky because it’s difficult to connect with the primary care provider,” Watson said. “It ends up being very long in our extensive process.”

Home health agencies reported they aren’t able to follow through with care because they’re unable to get signatures from physicians. “It really is about that patient access and being able to initiate care and continue care as soon as possible,” said Matt Hansen, executive director of the Utah Home Health and Hospice Association. “Another problem that we have is with the current use of fax machines. Orders that are faxed can get lost, which has privacy implications.”

Sending information in a way that lands right in front of the physician to integrate into their workflow could speed up the process. Orders could go through a home health order hub, with records being digitized and sent through the existing infrastructure in place for the health information exchange.

“A physician would have all of the information they need in front of them to be able to sign that and get it back as soon as possible,” said Dr. Matt Hoffman, chief medical officer for the Utah Health Information Network. “It would save a lot of time from running around home health agencies. This new system will improve the home health care providers’ ability to get reimbursement for the care they’re giving.”

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