Natick Walpole VNA uses Mass HIway to receive discharge summaries from Maples Nursing Facility

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Natick Walpole Visiting Nurse Association (VNA) is a not-for-profit certified home health agency. Natick Walpole VNA strives to provide quality home health care and resource information to the community. The agency has three main goals when providing service to its community:

  • To improve the care experience for their patients,
  • To improve the health of the community at large, and
  • To ensure efficiency of tailored services provided to their patients.
Natick Walpole VNA provides a variety of medically supervised services within patients’ homes, including but not limited to: nursing, physical therapy, speech therapy, palliative care, and maternal child services.
Since its creation over a hundred years ago, Natick Walpole VNA has become a leading provider of public health, visiting nurse, and community-based certified home health care in the region. Natick Walpole VNA strives to build trusting and lasting relationships with patients, their caregivers, and their entire healthcare team.


Natick Walpole VNA regularly receives discharge summaries for patients from various trading partners. In the past, those summaries were faxed between all facilities. However, the process isn’t always foolproof, and with faxed discharge summaries there is a risk that they may not be received in a timely fashion. To combat these issues, some of their trading partners have begun migrating away from faxed documents. Wanting to maintain an uninterrupted workflow, Natick Walpole VNA began to search for solutions.


One of these trading partners, Maples Rehabilitation and Nursing Center, initiated a strategic project to transition from faxing to Direct messaging via the Mass HIway, the Massachusetts Health Information Exchange, for their discharges. Natick Walpole VNA receives approximately 50 discharge summaries a month from Maples. To continue to serve Maples’ patients after discharge, Natick Walpole VNA needed to switch to receiving discharge summaries electronically. The VNA facility implemented a new workflow to phase out faxing of the patient transfers from this partner. Using the Mass HIway, Maples now sends the discharge summaries electronically to Natick Walpole VNA via Direct messages. Natick Walpole VNA sends a clinician as a liaison to Maples. This liaison then works with Maples’ discharge planner to determine which patients will need home care upon their discharge from Maples. A medical records clerk at Maples then sends demographic and physical information and the patient’s history via the Mass HIway to Natick Walpole VNA. Once Natick Walpole VNA receives a discharge summary, the paperwork is inspected for completeness before being uploaded to a common drive. Natick Walpole VNA will then accept the patient for a Start of Care (SoC) visit, and attach the summary to the patient’s electronic chart. The discharge summary is utilized by providers at Natick Walpole VNA in their assessment when visiting patients for the SoC, as well as coders in the reimbursement process.

Implementation Challenges

Natick Walpole VNA experienced only a few issues when implementing the new workflow. The main challenge was the need to create assigned Mass HIway login credentials for all intake staff. This required additional steps to ensure all staff could access the electronically-sent discharge summaries as needed, which was accomplished with support from the Mass HIway.

Furthermore, while electronic exchange is a strategic priority for Maples, not every staff member at Maples is yet able to send discharge summaries electronically. Floor nurses and clerks only have the capability to fax the information. The discharge planners typically leave for the day at 5pm. If a patient is discharged after that time, Maples will not have anyone who can send the paperwork via the Mass HIway. If this happens, the staff at Maples sends the discharge summary using a fax machine and Natick Walpole VNA staff then need to input this information into the electronic health record manually as they did before implementing the new workflow.

Support from the Mass HIway

Natick Walpole VNA receives assistance from the Mass HIway when they need to set up new login credentials for staff, and to troubleshoot any issues. Additionally, an assigned Mass HIway Account Manager maintains regular contact to aid the VNA facility with any additional challenges. HIway account management is provided by MeHI, the Massachusetts eHealth Institute, under contract with the Mass HIway.


Since implementing the new workflow with Maples, Natick Walpole VNA has been able to move away from faxed discharge summaries for this partner organization, except in situations where a patient is discharged after the discharge planner has left for the evening. Receiving the summaries electronically has reduced the risk of overlooking faxed paperwork. This ensures that the Natick Walpole VNA’s providers can provide the home health care that each patient needs.


A main benefit of receiving electronic discharge summaries as opposed to faxed copies is that the electronic versions are much more legible. In addition, receiving the electronic summaries reduces the risk of not receiving or not seeing a faxed copy, making it easier to provide quality care to all patients.

Our workflow has improved with the communication between The Maples and Natick Walpole VNA utilizing the Mass HIway, as we have legible paperwork to rely on when visiting patients for the first time.” -- Kelly O’Malley, Director of Intake

Expanding Electronic Health Information Exchange

Natick Walpole VNA regularly connects with ten to twelve other rehabilitation providers to coordinate home health care for patients. The VNA facility also receives phone calls on an as needed basis from an additional 50 medical offices within the community. Because the electronic exchange with Maples works so well, the VNA is working hard to expand this capability to cover more partners.

With differing needs and capabilities of the provider partners, it will take time for Natick Walpole VNA to implement an electronic workflow to receive discharge summaries from all partners. For instance, some partners already use Direct Messaging via the Mass HIway or another HISP, while other partners still fax and first need to establish a HIway or other HISP connection. Natick Walpole VNA looks forward to using this new workflow with additional partners in the future.