The ability to access and communicate the right patient information, at the right time, in the right place, is critical. To illustrate this point, imagine an elderly woman, Betty, who lives alone and has two chronic medical conditions. She takes a number of medications and receives care from multiple specialists in addition to her primary care physician.
Betty’s specialists try their best to send test results and notes to her PCP in a timely fashion, but sometimes it can take several weeks to process the information. In the interim, Betty misunderstands her doctor’s instructions. She takes her medications incorrectly, prompting an issue that leads her to call 911.
Unfortunately, she has had three emergency department visits and two hospital admissions in the past six months. As this example illustrates, timely physician and provider communication are crucial to helping patients like Betty manage chronic conditions and avoid unnecessary hospital visits. Fortunately, the use of health information exchange and better technology can help to improve care coordination.
One place this type of technology is working well is Colorado. The Colorado Regional Health Information Organization, the largest regional HIE in the state, is leveraging technology from a population health solutions company. With its health information network, CORHIO has experienced triple digit growth in 2014, for the third consecutive year, increasing the number of participating health care users by 111 percent.
In 2011, CORHIO received a challenge grant from the Office of the National Coordinator for Health Information Technology. This grant increased connections with long-term and post-acute care facilities as well as post-acute rehabilitation hospitals, nursing homes, assisted living centers, home health care agencies and hospice.
Overcoming challenges with collaboration
Connecting with LTPACs and similar organizations can be particularly challenging for a variety of reasons:
· Slow adoption of interoperable electronic health records (EHR), largely due to LTPACs being excluded from Meaningful Use (MU) incentive, and
· Inconsistency in technology used by different providers and ancillary care groups.
Historically, faxes and phone calls have been the primary ways LTPAC providers have received information on their patients. In fact, it was common for LTPAC providers to receive 30- to 50-page faxes of information from one hospital visit to sort through. Stage 2 meaningful use encouraged many hospitals to replace faxes with electronic continuity of care documents via Direct messaging, but these documents can range from 30 and 200 pages long as well, so it wasn’t much improvement over faxing.
CORHIO and Medicity helped LTPAC providers overcome these challenges by providing them with secure, web-based access to the HIE’s query-based community health record system called PatientCare 360. With PatientCare 360, LTPAC caregivers now have the ability to get real-time access to their patients’ information regardless of whether they use an EHR or a non-interoperable clinical documentation system.
The importance of timeliness: Days to minutes
Prior to having access to the CORHIO HIE, it took 24-48 hours for LTPACs and home health care organizations to receive information about patients recently discharged from a hospital. The time lapse often created confusion as to what occurred during a hospital stay and which new medications the patient may need. The lag could lead to inefficient care or delays in administering recommended treatments. With CORHIO’s newly enabled network, access to consolidated patient histories and test results reduced this timeline to six minutes.
Now organizations have a more complete record of the care a patient received while hospitalized, and across the community. LTPACs can continue treatments that began during a hospitalization to ensure effective post-discharge treatment and compliance.
Through CORHIO, community health records are also being successfully accessed and used by emergency medical services, where speed is of the essence. A first responder or ED care team may have little information on a patient they’re treating. Access to patient health records dramatically increases the ability to provide faster, more effective care.
Keep it simple
CORHIO and Medicity have learned usability is crucial to success. Returning to our earlier example, LTPACs need to be able to send and receive critical information quickly and efficiently. The system’s ease of use helps simplify the process and leads to more effective training. In turn, this helps drive adoption and usage.
The snowball effect
CORHIO is starting to see a snowball effect with its HIE. As more LTPAC facilities and care providers use the system, there is more data and value for other users. As of early 2015, CORHIO had more than 140 long-term care and home health care organizations using its system.
During the start-up and grant periods, more than one million patient queries were processed. While the grant provided the financial resources to plan and implement the HIE expansion for LTPACs and other providers, the program didn’t end when the grant money ran out. Those enrolled in the program continue to use the tools to streamline the exchange of information and improve transitions of care. In a recent third-party survey, 81 percent of LTPACs said they would strongly recommend the HIE. Even better, 58 percent of users cited quality of care as the primary reason to use the network.
In the end, it’s really about providing better patient care through timelier exchange of health information. CORHIO’s ultimate goal is a complete community health record for each patient that includes a hospital system, affiliated physician groups and ancillary care providers.