Implementing an Internet-based communication network for use during skilled nursing facility to emergency department care transitions: challenges and opportunities for improvement.

OBJECTIVES To explore the feasibility of implementing an Internet-based communication network for communication of health care information during skilled nursing facility (SNF)-to-ED care transitions, and to identify potential barriers to system implementation. METHODS Qualitative. SETTING The largest SNF affiliated with the ED of an urban tertiary care center. PARTICIPANTS Consecutive sample of all patients transferred from SNF to ED over 8 months between June 2007 and January 2008; ED and SNF care providers. INTERVENTION The development and implementation of an Internet-based communication network for use during SNF-to-ED care transitions. This network was developed by adapting a preexisting Internet-based system that is widely used to facilitate placement of hospitalized patients into SNFs. Internet-based SNF and ED surveys were used to help identify barriers to implementation. RESULTS There were 276/276 care transitions reviewed. The Internet-based communication network was used in 76 (28%) care transitions, with usage peaking at 40% near the end of the study. Barriers to success that were identified included lack of an electronic medical record (EMR) at the SNF; pervasive negative attitudes between ED and SNF personnel; time necessary for network use during care transitions; frustration by emergency physicians at low system usage rates by SNF personnel; and additional login requirements by ED personnel. CONCLUSIONS Although implementing an Internet-based network for nursing home to ED communication may be feasible, significant barriers were identified in this study that are likely generalizable to other health care settings. Understanding such barriers is an essential first step toward building successful electronic communication networks in the future.