Health Information Exchange in Transitions of Care
Role of Health Information Exchange in Enabling Transitions of Care
Transitioning a patient from one mode of care, whether from facilities, providers or home, to another is not only one of the most common activities in the U.S. healthcare system, it is also among the most critical. Yet this vital aspect of the care continuum is one of the most fraught with gaps and mistakes, and it is frequently in this transition where patient safety is most vulnerable. Effectively communicating critical clinical information directly between clinical teams during the transition of patients from one care setting to the next is challenging for a host of technical and organizational reasons, ultimately leaving the patient as his own clinical historian. These gaps can result in failed follow-up care, lack of awareness of medication changes or compliance, missed diagnosis transmittals, and costly readmissions.
The National Transitions of Care Coalition (NTOCC), reports that in the United States, patients–particularly the elderly and individuals with chronic illnesses–experience routine transitions in their care while leaving one care setting, such as a hospital, nursing facility, assisted living facility, primary care physician office, home health care, or specialist care, and moving to another. Every transition of care requires some level of care coordination, critical throughout this period. But care coordination is a broader process that typically encompasses the assessment of the patient’s needs, development and implementation of a care plan, as well as evaluation and certification of that care plan. This broader care coordination effort breaks down at the outset if effective communication is not facilitated during transitions in the care delivery process.
Connecting Gaps: the Key to Successful Transitions of Care
Lack of connectivity between providers in the healthcare system remains a stubborn problem. The Institute of Medicine (IOM) emphasizes that healthcare quality suffers not from a lack of effective treatments, but from inadequate healthcare delivery systems that fail to implement these treatments. Fragmented care leads to increased financial, clinical and safety costs. While adoption of technology in all other areas of our economy is accepted as a cost of doing business, healthcare continues to be slow to embrace the widespread use of technology that will enable improved care and reduced cost. While technology is very common in healthcare on the therapeutic and devices side, it has yet to be ubiquitously applied as a tool for providing high quality, safe and patient‐centered care decision making. While many providers are moving toward incorporating an HIT system, adoption rates still remain relatively low, due in part to high implementation costs, unclear return on investment, and fear of investing in a system that will not meet the provider’s needs in the long‐term or will become obsolete before the provider is able to recoup his investment.
Interoperability among various and disparate technology systems, including administrative, medical record, diagnostic, transcription, security and others, is a critical issue for transitions of care. Care coordination is a dynamic process that requires data movement across platforms and among service providers in real time. In today’s healthcare environment, many systems do not talk to each other, creating delays and decreasing the value of the systems, which adds cost and erodes quality and the timeliness of interventions.
Care coordination is intrinsically linked to transitions of care and is highly interdisciplinary. Facilitating communications between specialty physicians and primary care, acute and ambulatory care, as well as local and regional facilities, is of critical importance. Unfortunately, the medical language spoken by all care team members, and especially among patients, is not universal. There are important semantic differences between health professions that will need to be addressed as automated data exchange advances.
Into the Breach: Health Information Exchange
Health information exchange (HIE) may be the most direct interface to enable clinical data transference and exchange, thus ensuring the appropriate care coordination and transition of care to fill the gaps we have discussed above.
HIE is generally defined as the process of securely sharing clinical information among organizations and facilities for enabling the delivery of critical patient information within the exchange network to the point-of-care at the moment-of-need. HIE is one of the necessary constructions needed to buttress an electronic health information technology infrastructure for the purpose of sharing relevant healthcare information among clinicians in different health facilities and often throughout vast geographic areas to improve quality of care.
This exchange of information is deeply relevant to the care transition process in that, regardless of where the patient has been or where they are headed, their clinical information must accompany, if not precede, them. Access to this complete patient picture in clinical data is the foundation for accurate transitions of care information exchange and is the key to enabling clinicians and patients’ access to the highest quality of informed care possible.
Transitions of care are one of many areas in the current healthcare system that needs to be nurtured because it affects patient safety, clinical and financial efficiency, and most importantly health outcomes. Care transitions are also prime examples of a significant piece of the healthcare spectrum that would obviously benefit from the implementation of a more universal health information technology and exchange. As HIT and HIE become more integrated into the healthcare system, we will begin to see these issues in care transition diminish and disappear as patient records are more easily and securely tracked, reviewed and distributed. But we need to make more substantial strides in this direction in order to achieve the needed measurable milestones. Institute of Medicine, Priority Areas for National Action: Transforming Health Care Quality (2003). National Academies Press. Washington, D.C.  Institute of Medicine, Priority Areas for National Action: Transforming Health Care Quality (2003). National Academies Press. Washington, D.C.
John Smith is Director of Communications at ICA. This blog post was first published on ICA’s HITme Blog on May 9, 2012. John has over 20 years of experience in healthcare communications with a focus on health information technology, having served as Senior Vice President and Healthcare Practice Leader at several communications firms, including Fleishmann Hillard, Manning Selvage and Lee and Brodeur Worldwide.