HIE: A Promising Strategy for Helping Senior Housing Residents Stay Out of the Hospital

Robyn's Read | November 22, 2015

An invisible electronic network called a Health Information Exchange (HIE) holds great promise for facilitating aging in community, even though few older adults have ever heard of it and none will ever use it directly.

Many technology solutions are designed to foster aging in community by making it easier for older adults to take their medications without assistance, manage their chronic conditions, avoid falls, and reduce isolation.

I appreciate the value of these technologies to help older adults remain in their homes and communities. However, I also believe that an invisible electronic network called a Health Information Exchange (HIE) holds great promise for facilitating aging in community, even though few older adults have ever heard of it and none will ever use it directly.

How HIEs Work

A growing number of health providers use regional or state HIEs to share information about patients they treat in common. When an individual consents to this data sharing, members of that individual’s health care team can log onto the HIE, view the person’s electronic health record, and get a full picture of his or her medical and medication history.

Sharing information like this helps health practitioners deliver care that is much more coordinated and person-centered. And that kind of care leads to healthier, happier, and more independent older adults.

Great idea, right?

But just think of the added health benefits that could accrue to older adults if their health care providers started sharing information with their housing providers, and vice versa. Both providers would be so much better equipped to help their patients and residents stay healthy and avoid costly medical interventions.

The Camden Experience

At the Center for Applied Research, we’ve seen this type of data sharing make a real difference in the lives of older people living in affordable senior housing properties.

During a research project funded by the John D. and Catherine T. MacArthur Foundation, our Center for Housing Plus Services conducted a case study of Northgate II, a subsidized housing community for older adults and adults with disabilities in Camden, NJ. Northgate II has an impressive social services staff, including 2 service coordinators and a community health worker who collaborate with a variety of community-based partners to deliver a menu of services to the building’s 340 older residents.

One of Northgate II’s community partners is the Camden Coalition of Healthcare Providers, a consortium of health care professionals and entities that work to improve the care and coordination of health care for Camden residents while decreasing health care costs.

In addition to helping Northgate II coordinate onsite health care services for residents, the Camden Coalition has also given Northgate II staff limited access to the Camden Health Exchange, an HIE that the coalition launched in 2010.

I say “limited access” because there is only one piece of information Northgate II can get from the HIE, with permission from the resident. The property’s services staff log onto the HIE each morning to find out whether any Northgate II residents have visited the Emergency Department or been admitted to the hospital in the previous 24 hours.

This may not seem like a lot. But that tiny bit of information has made a big difference at Northgate II. 

That data allows the property’s service coordinators to jump into action with needed support when a resident returns home from the hospital. That support can help the resident avoid health complications and a costly hospital readmission.

It also helps the service coordinators target special attention to high-risk elderly residents who could benefit from intensive care management and health education.

The Potential of Data Sharing

Northgate II’s experience illustrates the potential that data-sharing networks could have for affordable senior housing properties, especially those using their buildings as platforms to deliver needed services and supports to vulnerable older residents.

But housing properties around the country could be doing so much more to take full advantage of the benefits that HIEs offer.

I’d like to see health care and housing providers share a lot more information, with resident’s permission. If data could flow to and from both types of providers, everyone would benefit.

Consider, for example, all the valuable information that health care providers could get from housing providers.

The services teams in these housing properties know their residents well, and have important insights to share about residents’ functional status and well-being. Some teams help residents set and work toward personal health goals. They often help residents understand and follow a doctor’s instructions while alerting physicians when a resident’s health concern deserves attention. 

And, because members of the services staff work where older people live, they are able to actually see the social and physical environments and circumstances that may contribute to an older adult’s physical or mental health problems.

Connecting with housing properties in real-time through an HIE would give physicians and other health care providers a much more holistic view of the patients they see only briefly during office visits. That same connection would give a housing property’s services team an important tool to monitor a resident’s well-being, especially after a transition from hospital to home.

Of course, any type of service interaction in independent housing—including data sharing through an HIE—must be voluntary and requires the informed consent of the resident.

A Promising Technology

We have a long way to go before every interested affordable senior housing property in the nation is connected to health care providers in this way.

Forging these connections will involve bringing broadband connectivity to every community, and connecting our affordable housing infrastructure to the Internet. It will also require a lot of work to build housing/health partnerships—and to negotiate privacy-related restrictions associated with the Health Insurance Portability and Accountability Act.

Breaking down these barriers won’t be easy. But we have to try, so the benefits of health information exchange -- and the housing/health collaborations it facilitates -- reach all older adults, even those whose economic status or geographic location now keeps any kind of technology out of their reach.