Coeus: An information tool to support safe admission to the nursing home

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Abstract More than 28 million patients are discharged from the hospital to a nursing home (NH) each year. The transition from hospital to NH is fraught with difficulties and is disruptive to residents’ care and well-being. A review of recent hospital to NH transfers found that nearly 40% of residents experienced an adverse event within 45 days of discharge. NH staff rely on information collected in these acute care settings to safely admit and initiate care for patients. However, unfortunately the transition process is plagued by poor information exchange. Discharge paperwork often lacks key information such as imaging study results or antibiotic stop dates, includes out of date information and is not organized to support decision making in the NH. There is a critical need to develop a solution that provides key information to NH providers at the time of admission. Probari, an Indiana-based small business dedicated to improving the quality of NH care through supportive clinical solutions, and its partners at Indiana University’s Regenstrief Institute, are developing Coeus, a NH-facing transfer application to fill this significant gap in the market. Using the national Fast Health Interoperability Resources (FHIR) standards for querying and sharing health data and the Substitutable Medical Applications and Reusable Technologies (SMART) platform, Coeus will be integrated into NHs’ electronic health records (EHRs) to fit within provider workflows and to support commercial distribution and will quickly gather and display relevant information from recent acute care admissions. Once developed, Coeus will increase NH efficiency, increase staff and provider satisfaction, and improve resident safety including impacting quality metrics such as reduced hospital readmissions. This Phase I project will demonstrate feasibility with the following Aims: Aim 1. Establish the information and design requirements for a user-centered FHIR-based transfer application in a NH setting. NH staff will participate in discussions and a multi-disciplinary design workshop to determine how best to organize information to support decision making and functional requirements. Aim 2. Implement end-user design requirements and build the Coeus prototype. Aim 3. Establish the usability of the Coeus prototype. Probari will deploy the Coeus prototype in a simulated EHR sandbox environment and assess its usability among end users. At the end of Phase I, Probari will have demonstrated the overall feasibility and usability of Coeus among potential NH end users. Phase II will focus on deployment of a minimally viable product into a clinical workflow to evaluate potential impact in preparation for commercialization. Coeus meets a clinical care need and has market opportunity by supporting NH-based healthcare providers’ access to the information that enables higher quality care. Once fully commercialized, Coeus’ primary market will be the 15,600 NHs in the US.