Care coordination: Inspiring change from within

By Betty Jo Bomentre
08:52 AM

There has been a lot of press lately about care coordination, and how it will play a significant role in improving patient outcomes. But despite all of this positive coverage, inter-organizational care coordination is far from becoming a reality. Even large, well-regarded and technologically-savvy health organizations aren’t able to collaborate effectively within their own walls and networks. In order to move forward with true, inter-organizational information exchange, healthcare leaders need to first improve communication processes and coordination within their own organizations.

While the U.S. has made tremendous progress in adopting technology that will advance health exchange—the Centers for Disease Control and Prevention reports that more than 70 percent of physicians have adopted some type of EHR—there still remains work to be done. Interoperability of healthcare IT systems—the ability of these systems and devices to exchange and interpret shared data—lags behind other industry sectors such as banking and travel. So while the data is being stored electronically, most of it still remains inaccessible, locked in silos.

The clinical impact of this interoperability gap is measurable. The Department of Health and Human Services (HHS) estimates that 20 percent of preventable medical errors are caused by the lack of immediate access to health information. And nearly one in five Medicare patients are readmitted to hospitals within 30 days—the so-called revolving door syndrome—at a cost of $26 billion a year. All are the result of a fragmented system of care.

While the progress toward EHR adoption is good news, the reality is that it is only the first step toward inter-organizational information exchange. Moreover, not all provider organizations are equally prepared or equipped for a large-scale HIE integration project, which can be complex, time-consuming and costly. Before engaging in a community, state- or nation-wide exchange, healthcare organizations should first become experts at data exchange and care coordination by focusing on improving their internal communications through an automated system. Once an organization can communicate seamlessly within its own four walls, the groundwork is set to share information with entities outside those walls.

Reorganizing communications

Traditionally, clinicians have relied on a numeric paging system for hospital communications, which have proved to be difficult in contacting the correct physician, have limited capability as a one-way receiver of information, and represent frequent interruptions. All of these problems contribute to medical errors, not to mention increased frustration among providers. In fact, a recent study published by the Interactive Journal of Medical Research found that in a review of 14,000 hospital admissions, poor communication and collaboration practices were identified as the most common cause of preventable clinical errors.

Despite these challenging communications problems, hospitals are finding ways to help physicians collaborate. To overcome the problems associated with disparate IT systems, some organizations, including Ingalls Memorial Hospital, have implemented a rules-driven alerts system that interacts with diverse technologies, like the EHR and RIS. These tools can send real-time alerts for critical events as well as critical test results for improved, faster decision-making. With a programmable rules-driven engine all diagnostic results designated significant can be automatically picked up and pushed out to various members of the care team on their preferred device and in the preferred format. Equally important, providers can control what, when and how they receive information, thereby reducing alert fatigue and information overload. Many computerized notification systems today are customizable, device agnostic and far easier to use than most EHR technology already in place.

Moving to Mobile

Clinician engagement is a growing concern of many health networks, especially those with a high number of unaffiliated physicians. It is difficult for hospital staff to effectively notify independent physicians of changes in care. Communication of critical test results can be a great way to overcome incompatible EHRs among the unemployed community physicians. For those that are employed, many still rely on disparate IT systems that aren’t yet capable of direct communications. According to a recent Black Book Rankings survey poll, 89% of primary care and internal medicine doctors are using smart phones to communicate with staff. Reaching this group through their mobile devices offers a powerful new channel of communication and a means for realizing physician alignment.

In order to ensure physician devices are used to their potential, hospitals can use the same alert pushing system described earlier to communicate with unaffiliated physicians. This not only allows them to use their preferred device for communication, but it also reduces alert fatigue because of the whole rules thing.

Pushing for Patient Engagement

Historically, patients haven’t been involved in their own care. There hasn’t been any reason or motive to be engaged in their health. Some initiatives, such as Meaningful Use Stage 2, offer patients a larger role in managing their health, but it still isn’t enough to enable coordination on a larger platform.

But because patients today are more accustomed to a consumer-driven approach to other areas of their lives, the trend is rapidly shifting. While patient portals allow the opportunity for consumers to be active participants in their care, there is still something missing. Most EHR portals require patients to ‘pull’ information, meaning that in order to view results, schedule an appointment, or ask a health-related question, the consumer does so at his or her leisure, running the risk of not checking in at all. Communications technology with the ability to ‘push’ health information requires little effort from the patient, and is a much better enabler of coordination as notifications are timely, secure and direct. The more connected a patient feels the more they participate in their care and engage in self-management.

Automating outreach means patients no longer have to wait hours for discharge instructions. It can also remind them of appointments, alert them to the availability of test results and improve adherence to care plans. Engagement can be further enhanced with customizable content, such as educational materials and other information that the patient can use to make more informed decisions. Such a system enables physicians to engage patients around health, to display health-related information at just the right moment in just the right context, and to message patients in the moment with contextually relevant, motivating messages.

Starting Small for Big Results

The focus on care coordination needs to take a step back, and center on the individual hospital. Healthcare leaders need to first fix their internal processes with communication-enabling technologies that are simple and often overlooked. For many health organizations, an automated, intelligent communications platform offers a highly organized, mobile solution that streamlines clinical communication for physicians and their patients. Such a system is easy to use and cost-effective, enabling hospitals to reap the benefits of immediate local information exchange while they prepare for larger HIE projects. After the local problem has been fixed, we can start connection regionally, then nationally to provide true coordinated care.