Health Information Technology

Health Information Exchanges Are Shifting Responsibility for Care Coordination From Patient to Provider

HIE event notification shows promise in solving healthcare challenges.

Primary care physicians recognize the need for better coordination and welcome health information exchange (HIE) event notifications as a way to improve patient care, according to a new study from U.S. Department of Veterans Affairs (VA), Regenstrief Institute, IUPUI, and Icahn School of Medicine at Mount Sinai researchers.

The study, “Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial,” appeared online ahead of print in the Journal of the American Medical Informatics Association (JAMIA).

In a healthcare system where individuals often receive medical care from more than one system, care coordination among providers after discharge from an emergency department or hospital in one system, while the patient’s primary care physician resides in another, poses many challenges and often fails to happen, according to the study. This incomplete sharing of clinical information can adversely affect health outcomes.

“While our study focused on patients whose primary care was provided in the VA system, this is an issue faced by patients and their providers in many, if not most, healthcare systems in the United States,” said study senior author Brian Dixon, PhD, MPA, the Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health at IUPUI director of public health informatics. Dixon is also a research scientist at Regenstrief and an associate professor of epidemiology at the Fairbanks School, as well as an affiliate scientist at the VA Health Services Research and Development Center for Health Information and Communication, located at the Richard L. Roudebush VA Medical Center.

Primary care doctors in the VA system typically have not been notified when their patients were seen at a non-VA emergency department, or hospitalized at a non-VA facility, the study reported. Thus, physicians can be unaware of the need for follow up, and only learn of the event months later from patients themselves. During these intervening months, patients typically are not receiving care from physicians primarily responsible for overseeing overall health.

“The majority of Americans rely on their primary care physician to coordinate care of medical specialists and hospitalizations,” Dixon said in the announcement of the study’s release. “They expect their doctor to know about their care, but most of the time that’s not happening. Our study is unique because we investigated primary care teams’ perspectives on utilization of an electronic foundation—health information exchange—to enable automatic notifications—for example, a primary care physician’s patient has been hospitalized for a heart attack—to remediate this problem and found positive reception.”

The study authors interviewed primary care team members, who considered electronic alerts (such as news that a patient was seen in the ED for chest pains and sent home when it was determined not to be a cardiac event) as both necessary and effective to support timely follow-up care, particularly for older adults at increased risk of such medical episodes.

The authors, in addition to Dixon, are Emily Franzosa, Morgan Traylor, Kimberly Judon, Vivian Guerrero Aquino, Ashley L. Schwartzkopf, and Kenneth S. Boockvar, all of the VA. Dr. Boockvar is also with Icahn School of Medicine at Mount Sinai.

Now that this qualitative study has demonstrated the perceived benefits and acceptability of electronic event notification by primary care physicians and their teams, Dixon and colleagues said they are working on a quantitative analysis, measuring the actual impact of these notifications on follow-up care, as well as preventing repeat emergency department visits and rehospitalizations.

This work was supported by U.S. Department of Veterans Affairs Health Services Research and Development Service (grants IIR-10- 146 and I01 HX001563; principal investigator K. Boockvar).

About Richard L. Roudebush Veterans Affairs (VA) Medical Center

Established in 1932, the Richard L. Roudebush VA Medical Center serves Veterans from across Indiana and western Illinois. The Roudebush VAMC is one of the largest and most complex medical centers in the Department of Veterans Affairs, and provides acute inpatient medical, surgical, psychiatric, rehabilitation, and neurological care to more than 60,000 Veterans annually. Some of the many services available to Veterans include emergency medicine, primary care, cardiac care, radiation oncology, audiology, community-based extended care and community VA clinics.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

Scott Mace is a contributing writer for HealthLeaders.