Most hospitals and providers have achieved a reasonable control over clinical and administrative functions by deploying Hospital information Systems (HIS) technologies within the hospital. Increasingly under scrutiny is their ability to manage and deliver healthcare across care settings that are not directly under their control. Among other things, care coordination entails physical movement of patients, medical records and cooperation of immediate family members rendering such an exercise a fairly complicated management task.
Importance of transitional care
In the US, the older adult population experiences >13 million transitions from hospital to home every year. The serious consequences of poor transitions and uncoordinated care for older adults include unnecessary nursing home admissions, caregiver stress and resulting poor health, deteriorating health status, medication errors, redundant diagnostic testing, compliance and continuity of care problems, increased health care costs, and re-hospitalizations.
According to an estimate, approximately 1 in 5 Medicare clients return to the hospital within 30 days of discharge, accounting for more than US$17 billion in annual Medicare spending Absence of a Care Manager who coordinates the patient movement across these care settings leads to desired outcomes not being achieved. Language, health literacy issues and cultural differences further exacerbate the problem.
Why do we need to bother?
Coordinated Care Transitions tremendously impact the population health outcomes and hence policy makers are quite keen. It enables them to develop performance measures, public reporting mechanisms and develop targeted health policies at the national level. By orientating healthcare services delivery to outcomes helps governments move up the value curve and focus on prevention instead of care. Further by focusing on convenience of these services being delivered, the overall health of the society can improved whilst simultaneously reducing costs – a win-win for all stakeholders. All these can be achieved by enabling Coordinated Care and managing transitions across care settings.
Who do governments worry about it? The US federal government aspires to save US$26 billion dollars in the coming years by leaning on hospitals to lower their preventable readmission rates. The Medicare Payment Advisory Commission estimates that up to 76% of these re-admissions may be preventable and the average cost to Medicare per preventable readmission is US$7,200. In Asia, Singapore, Japan and Australia in particular are increasing their allocations towards publicly funded healthcare. In Singapore, ACTION, a hospital-based transitional care program, significantly reduced acute care utilization for up to 6 months post discharge. Further, ACTION saved 6283 bed days of unplanned admissions over 6 months resulting in US$5 million in savings over a 6 months period
Technology innovation to the rescue of Care Transitions
Not surprisingly, innovation and application of technology to the Care Transition issues can yield a lot of benefits. Referral management solutions for example, can greatly enhance patient satisfaction and continuity during Care Transitions.
In the US, the Office of the National Coordinator for Health Information Technology (ONC for HIT) specifies Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology. Specifically under the Care Coordination and Patient Engagement certification category, Transition of Care/Referral summary, Data Portability, Ambulatory or Inpatient summary and Clinical Summary are defined in great detail. This serves as a reference platform for other countries that want to better manage Transitional Care in their Public Health systems. Vendors who provide Meaningful Use Stage 2 (MU2) certified solutions will be able to readily deploy a Care Coordination technology.
A study appearing in the March/April 2009 issue of the Journal of the American Medical Informatics Association (JAMIA) revealed that consultant recommendations were implemented 30 percent more often when there was electronic facilitation of recommendations. Boston Medical Center reported doubling of patients through referrals and a 90% reduction in turn around time for appointments.
A virtuous Loop needs to be created to ensure a well Coordinated Care and in that quest, technology can be a great facilitator.