HIE Bright Spots: Health Information Exchange as a Key Enabler of Care Coordination – Part 1

Erica Galvez | March 22, 2013

Let’s start with a story that is all-too-common: a patient goes to the emergency room, but the primary care doctor is left out of the loop. Today, that patient is Larry.

Several years ago Larry was diagnosed with Type II Diabetes, and he has a history of non-compliance. Complications relating to his diabetes resulted in a visit to his local emergency department after which he was discharged with:

  • a long list of instructions,
  • a few new prescriptions, and
  • a different dosage for one of his current medications.

Unfortunately, Larry’s primary care provider (PCP) was never notified that Larry visited the emergency department, and as a result wasn’t able to coordinate his care by performing a post-discharge check-up. Within just 20 days, Larry was right back in the emergency department, suffering from hypoglycemia.

Health Information Exchange as a Driver of Coordinated Care Transitions

Communication breakdowns often occur during these care transitions, that is, the movement of a patient from one health care provider or setting to another.  When transitions are unanticipated, as in Larry’s case, the risk of communication breakdowns is even greater.

Care coordination during unanticipated transitions requires smarter, automated ways for providers to get the health information they need to effectively deliver care. This is where health information exchange comes in: automated alerts and notifications that leverage health information exchange components—such as secure messaging systems and master patient indexes—help providers handle unanticipated transitions by providing them with the right information, about the right patient, at the right time.

In addition to notifying providers about care episodes that they might otherwise know nothing about, automated alerting tools allow them to put in motion follow-up actions and information sharing that can help patients stay healthy and avoid readmissions.

In Larry’s example, care coordination could help Larry’s PCP make sure he:

  • schedules a follow-up,
  • that his med list is updated,
  • that he understands his care plan, and
  • that he fills his prescriptions.

Many health information exchange teams are working with health care providers to support care coordination through automated alerts, and patients like Larry are beginning to reap the health rewards.

In simple terms, automated alerting to enable care coordination generally works like this:

  1. A health care provider signs up for alerts and chooses the patients he or she wants to be notified about.
  2. An event (admission or discharge from the hospital) triggers an Admit, Discharge, or Transfer (ADT) message to be sent from the facility to an alerting system (this may be a health information exchange entity or other intermediary).
  3. The alerting system uses information contained within the ADT message (such as patient demographic data and provider information) to associate the patient with his/her doctor or caregiver.
  4. The alerting system sends an electronic notification about the patient’s status based on rules within the system indicating who should receive the alert, what format the alert should be sent in (pdf, HL7, etc.) and routes it where it needs to go.

Where Are We Seeing Success?

The State Health Information Exchange Program Bright Spots initiativeExternal Links Disclaimer highlights several leaders in the automated alerting space and describes their efforts in its recent Care Coordination SynthesisExternal Links Disclaimer.

Over the coming weeks, we will discuss how Larry and his health care could benefit from a number of these Bright Spots through ONC’s Health IT Buzz Blog.  Stay tuned for more about:

  1. Maryland’s Chesapeake Regional Information System for our Patients (CRISP), which is using the Direct Project specifications to enable automated alerting in support of care coordination and to reduce health disparities among the state’s most vulnerable populations.
  2. New York’s Brooklyn Health Information Exchange (BHIX) and Maimonides Medical Center, which have teamed up to enable automated alerting that directly supports care for bipolar and schizophrenic patients.
  3. Indianapolis hospitals, Indiana University, the Regenstrief Institute and the Indiana Health Information Exchange (IHIE) that are using automated alerting to put a dent in hospital-acquired MRSA infection rates.

How has health information exchange improved care coordination for you? Let us know in the comments section below.