- Health information exchanges (HIEs) can improve clinical efficiency for providers and equip healthcare facilities with vital patient information as individuals move across the continuum of care.
For ten years, the Utah Health Information Network (UHIN) has enabled the exchange of admit, discharge, and transfer (ADT) information between healthcare facilities to save hospitals money by reducing readmissions.
A recent editorial by UHIN President and CEO Teresa Rivera emphasized the value of ADT notification to improving care coordination while reducing hospital readmissions and their negative impact on both patients and hospital staff.
Rivera pointed out federal organizations including CMS have recognized and attempted to deter the potentially costly impact of hospital readmissions by penalizing hospitals with higher-than-average readmission rates for patients within 30 days of discharge.
“For those hospitals that post actual readmission rates greater than their predicted rates, the penalties can be stiff — as much as a 3 percent reduction in CMS payments for the new fiscal year,” wrote Rivera.
To avoid these payment penalties, Rivera recommended reducing readmissions by keeping care teams informed about each patient’s condition and status during transitions of care.
Payment penalties are not the only consequence of hospital readmissions. Equally troubling are the negative implications for patient health outcomes. Reducing hospital readmissions could correlate with improved quality of care, leading to better health outcomes and higher rates of patient satisfaction.
Rivera suggested providers can achieve this level of care coordination through HIE adoption and access ADT capabilities.
“This level of care coordination quite literally saves both lives and money,” she argued. “However, for it to be successful, all of Utah’s hospital systems must be willing to securely share their admission and discharge transactions with the appropriate health care community responsible for the patient’s care — including those outside their own system.”
Primary care physicians, care managers, and community hospitals that may have seen the patient previously or recently admitted the patient must connect to share ADT information across the care continuum to track a patient’s movement and progress.
“This secure and cost-effective method provides the patient’s entire medical team, regardless of where they work, with the important information they need to coordinate care,” wrote Rivera. “That coordination is important to reducing readmission rates, and helps health care professionals provide a better experience to patients.”
UHIN has also begun using ADT information in a new, more immediate way.
Recently, the HIE linked with three other HIEs to expand the use of ADT information exchange in the form of ADT notifications corresponding to individual patients visiting healthcare facilities across state lines.
UHIN also linked with the Idaho Health Data Exchange (IHDE), Nebraska Health Information Initiative (NeHII), and HealtHIE in Nevada to implement the Patient Centered Data Home (PCDH) for improved coordination of care.
PCDH was launched as part of the Heartland Project — a collaborative pilot program between ONC and the Strategic Health Information Exchange (SHIEC).
The initiative was first launched in the Midwest to boost the use of ADT notifications at other HIEs.
In the spring, the Great Lakes Health Connect (GLHC) in Michigan linked to six other HIEs to develop and test the PCDH project. Over the course of a year, participating HIEs received HHS funding to proliferate the use of ADT notifications and coordinate care across care facilities.
PCDH works in phases. First, participants identify which patients receiving care at Heartland Project-affiliated facilities are Michigan residents. Then, GLHC receives an ADT message corresponding with the identified patient that includes basic demographic information.
If the patient is not a Michigan resident, the ADT message is sent to the designated HIE for that state.
Information sent to GLHC through the program is stored in the Virtual Integrated Patient Record (VIPR), which community providers can access to retrieve patient EHRs of individuals they have a treatment, payment, or operations relationship with.
Since April of this year, GLHC has received 10,057 ADT messages and sent 57,690.
Pending exchange continues at this rate, the healthcare organizations will receive nearly 52,300 ADT messages and send about 300,000 to participating HIEs by April of 2018.
By incorporating ADT information into its exchange via direct messages between facilities, GLHC aims to improve coordinated care and cut costs for providers.
“This expanded capability supports our goal of reducing the time required and the financial burden of exchanging health information among healthcare providers and across communities,” said GLHC Executive Director Doug Dietzman.
ADT notifications are a way to ensure providers have the information necessary to navigate occasionally rocky transitions of care and stay up-to-date on a patient’s status for post-hospital follow-up, if needed.
By keeping providers aware of a patient’s condition as they move across the continuum of care, HIEs can enable better informed clinical decisions, reduce costs related to readmissions, and address potential health concerns or threats to patient safety as soon as possible.