Care coordination between healthcare settings can have a significant impact on patient care.
Strong care coordination is particularly necessary for providers delivering care to high-risk patients.
Transitions of care and chronic disease management often require providers to straddle the space between hospitals or pharmacies and long-term post-acute care (LTPAC), home health, and ambulatory care settings.
EHR use and timely patient health data access can be pivotal to improving provider communication and ensuring providers have all the information they need to deliver appropriate patient care in collaborative environments.
The information contained within patient EHRs can be helpful in reducing adverse drug reactions, hospital readmissions, and threats to patient safety for providers under pressure to make fast clinical decisions.
EHR use benefits care coordination in the following three ways:
Improved clinical decision-making for EMS organizations
First responders understand the weight of appropriate clinical decision-making and the value of coordinated care.
At the scene of an emergency, these care providers must act fast to keep patients in a stable condition until their safe transport and hand-off to providers at receiving hospital emergency departments (ED).
Despite the importance of well-informed clinical decision-making during these high-stakes transitions of care, many EMS organizations lack access to patient health records..
Federal organizations are starting to take note and are pushing for improved patient EHR access for first responders.
This year, ONC published a guide to assist Emergency Medical Services (EMS) organizations in EHR integration to improve patient care through the Search, Alert, File, and Reconcile (SAFR) model for health information exchange (HIE) between EMS and ED personnel.
The ONC SAFR model is designed to improve transitions of care and care coordination for first responders.
By using the SAFR model, EMS personnel can utilize their HIE connection to access patient EHRs for better-informed prehospital clinical decision-making that can have a significant impact on patient health outcomes.
“Access to patient information from an HIE organization is especially important to field paramedics and emergency department (ED) staff,” stated the guide. “Patients or their families may be unable to provide reliable information that can affect initial care decisions and long-term outcomes.”
The SAFR model emphasizes that many EMS providers presently do not have access to longitudinal patient EHRs because they are not connected to an HIE organization.
The guide outlines ways health data exchange capabilities can optimize EMS services by offering crucial information regarding hospitalizations, medications, end-of-life decisions, and medical conditions during transitions of care.
By equipping EMS personnel with access to patient EHRs through an HIE connection, hospitals can ensure better care coordination during the pivotal timeframe when patients are being transported from the site of an emergency to the receiving hospital. In some cases, appropriate pre-hospital care can mean the difference between life and death.
Developed in part by the State of California Emergency Medical Services Agency, (EMSA), the guide is one example of the importance of streamlining care coordination across care settings to drastically affect patient health outcomes.
The benefits of EHR access in the field have gained traction among EMS organizations nationwide.
An EMS organization in Orange County began engaging with the model in May to achieve EHR data access at the scene of an emergency and cut down on serious threats to patient harm during initial care.
"Providing patients' current medical information to all medical providers is essential to provide accurate and high quality care,” said EMSA Director Howard Backer, MD. “EMS must often make rapid treatment decisions on the streets or in homes and need access to critical medical history to provide the best care.”
EHR access can reduce the threat of significant patient harm during rapid clinical decision-making during transitions of care outside of the hospital setting.
Access to critical patient information can also assist in streamlining coordinated care in slower-paced long-term post-acute care facilities.
Reduced adverse drug reactions, readmissions for LTPAC facilities
LTPAC facilities often meet the healthcare needs of the aging population. Patients in LTPAC facilities are often dealing with a host of chronic conditions, requiring providers to maintain a working, updated knowledge of a variety of medications and treatment plans.
To ensure appropriate treatment and optimal patient safety among the aging population, LTPAC providers need access to each patient’s full EHR and medication history.
Integrating patient EHRs and medication histories into LTPAC facilities allows for better coordinated care between providers and prescribers outside the clinical setting.
Recently, patient information access for LTPAC providers has been steadily improving.
In May, Surescripts expanded its real-time Medication History for Reconciliation (MHR) service to include LTPAC facilities to assist in optimizing patient health outcomes and improving patient safety.
In less than a year, Surescripts has already delivered over 200,000 patient medication histories to providers in LTPAC settings.
“As the aging population continues to grow, it is critical for long-term and post-acute care providers to have the most complete patient data possible,” said Surescripts Chief Product Officer Mike Pritts. “Many patients in LTPAC facilities and seniors with in-home care have multiple medications prescribed by several doctors. With Surescripts, providers can easily access their patients’ medication data, helping them make better-informed decisions that improve care and safety.”
Complete patient health and medication histories offer providers necessary information to improve care coordination by equipping providers with data regarding adverse drug reactions and associated readmissions.
Connecting to Surescripts can reduce or prevent the negative effects of medication errors for patients in the LTPAC environment.
Additionally, Surescripts has given LTPAC providers immediate access to year-long historical views of patient medication data taken directly from pharmacies to coordinate care between LTPAC facilities and prescribers.
Avoiding medication errors and coordinating care for LTPAC patients is especially important considering the high risk of costly hospital readmissions.
In 2013, ONC released an issue brief highlighting the problem in the LTPAC community with hospital readmissions following discharge from an acute care facility.
Of patients that received post-acute care in 2008, 15 percent were readmitted to an acute care hospital within 30 days.
This high rate of readmission was due in part to poor communication and care coordination during transitions of care leading to medication errors. According to ONC, 60 percent of medication errors occur during transitions of care.
With these troubling statistics in mind, health data exchange networks such as Surescripts are enabling safer patient care by putting relevant patient information in the hands of LTPAC providers in a timely manner.
Improved communication also makes a big difference in patient care delivery for primary and specialty care providers.
Improved collaboration, care management for specialty care physicians
Earlier this year, a study published in the Journal of the American Board of Family Medicine (JABFM) found that EHR use enables improved care coordination between primary care physicians and behavioral healthcare providers.
A research team found integrated primary and behavioral healthcare is increasing in popularity due to its benefits for those managing behavioral health disorders.
Specifically, EHR use is crucial to coordinating care between these care teams. Integrated EHRs can standardize and streamline collaboration and care delivery between providers.
To achieve maximum benefits, researchers suggested building the necessary infrastructure to enable thorough EHR integration.
“Establish standard processes and infrastructure necessary for your integrated care approach: workflows, protocols for scheduling and staffing, documentation procedures, and an integrated EHR,” wrote researchers.
Integrated EHR use and HIE adoption have also proved a boon for care coordination in other areas of specialty care.
A study last month found connecting to an HIE to improve EHR access can help providers fill information gaps in patient care and improve care coordination for end-stage renal disease (ESRD) patients requiring ongoing dialysis.
Like LTPAC patients, ESRD patients often deal with several chronic conditions.
“Many present with multiple chronic conditions that require a number of prescribed medications, treatment plans, and lab tests from multiple sources,” wrote authors Amber Paulus, RN and Nancy Armistead, MPA. “Dialysis providers are challenged by incomplete transfer of pertinent clinical data from patient hospitalizations, impeding safe care transitions.”
For ESRD patients, this is especially necessary: the patient population experiences a re-hospitalization rate of 34.6 percent, which is twice that of most Medicare beneficiaries without the disease.
“The disproportionate readmission rates of ESRD patients calls into question the communication and care coordination occurring as patients return to outpatient dialysis facilities from acute hospitalization,” noted authors.
Clinically integrating patient EHRs into workflows for ESRD care providers resulted in positive outcomes for patients and providers and yielded improvements in operational efficiencies, provider communication, and care coordination.
Across the continuum of care, EHR use and a strong HIE connection boosts patient health outcomes and offers providers pivotal patient information at the point of care.