Field Terry S, Garber Lawrence, Gagne Shawn J, Tjia Jennifer, Preusse Peggy, Donovan Jennifer L, Kanaan Abir O, Gurwitz Jerry H
Department of Medicine, University of Massachusetts Medical School, MA, USA.
Inform Prim Care. 2012;20(2):87-93. doi: 10.14236/jhi.v20i2.29.
With the adoption of electronic medical records by medical group practices, there are opportunities to improve the quality of care for patients discharged from hospitals. However, there is little guidance for medical groups outside integrated hospital systems to automate the flow of patient information during transitions in care.
To describe the technological resources, expertise and time needed to develop an automated system providing information to ambulatory physicians when their patients are discharged from hospitals to home.
Within a medical group practice, we developed an automated alert system that provides notification of discharges, reminders of the need for follow-up visits, drugs added during inpatient stays, and recommendations for laboratory monitoring of high-risk drugs. We tracked components of the information system required and the time spent by team members. We used USA national averages of hourly wages to estimate personnel costs.
Critical components of the information system are notifications of hospital discharges through an admission, discharge and transfer registration (ADT) interface, linkage to the group's scheduling system, access to information on pharmacy dispensing and lab tests, and an interface engine. Total personnel cost was $76,314. Nearly half (47%) was for 614 hours by physicians who developed content, provided overall project management, and reviewed alerts to ensure that only 'actionable' alerts would be sent.
Implementing a system to provide information about hospital discharges requires strong internal informatics expertise, cooperation between facilities and ambulatory providers, development of electronic linkages, and extensive commitment of physician time.
随着医疗集团采用电子病历，有机会提高出院患者的护理质量。然而，对于综合医院系统之外的医疗集团，在护理过渡期间自动化患者信息流方面几乎没有指导。
描述开发一个自动化系统所需的技术资源、专业知识和时间，该系统在患者从医院出院回家时向门诊医生提供信息。
在一个医疗集团内部，我们开发了一个自动警报系统，该系统可提供出院通知、随访需求提醒、住院期间添加的药物以及高风险药物实验室监测建议。我们跟踪了信息系统所需的组件以及团队成员花费的时间。我们使用美国全国平均时薪来估算人员成本。
信息系统的关键组件包括通过入院、出院和转科登记（ADT）接口进行出院通知、与集团调度系统的链接、获取药房配药和实验室检查信息以及一个接口引擎。人员总成本为76,314美元。近一半（47%）用于医生的614小时，这些医生负责开发内容、提供总体项目管理并审查警报，以确保只发送“可操作”的警报。
实施一个提供出院信息的系统需要强大的内部信息学专业知识、医疗机构与门诊提供者之间的合作、电子链接的开发以及医生大量的时间投入。
