Search and Study Selection

The search terms and applicable Boolean terms were as follows: (“health information exchange” OR “healthcare information exchange” OR “HIE”) AND (“long term care” OR “long-term care” OR “nursing home” OR “nursing facility” OR “skilled nursing facility” OR “SNF” OR “residential care” OR “assisted living”). These terms were deliberately chosen by examining the index list in the MeSH. Search parameters included English articles published from January 2010 to December 2017. This timeframe was selected because it was post-HITECH Act. While there were many HIE efforts prior to HITECH, the EHR adoption rates significantly increased afterward due to the meaningful-use incentives. Organizations with EHRs exchange clinical data through HIE two and a half times more than their non-EHR counterparts. 5 Therefore, it was imperative to observe HIE activity during this catalyst stage of EHR adoption. Fig. 2 demonstrates the literature review search process that shows the inclusive and exclusion criteria.

Search criteria with inclusive and exclusion criteria.

The initial search resulted in 210 articles. We filtered the search for the last 7 years as well as full-text, English-only, and academic journals (to maintain quality of results). This removed all but 39 results. These 39 results were entered on piloted forms for consistency of review. Using a technique from AMSTAR, we assigned abstracts of these 39 articles to all group members in way that ensured each abstract was assessed for its germane nature by at least two reviewers. This process removed an additional 14 articles. Our final group for analysis was 22 articles.