Gutteridge David L, Genes Nicholas, Hwang Ula, Kaplan Benjamin, Shapiro Jason S
Icahn School of Medicine at Mount Sinai.
EGEMS (Wash DC). 2014 Aug 22;2(3):1095. doi: 10.13063/2327-9214.1095. eCollection 2014.
In a health care system where patients often have numerous providers and multiple chronic medical conditions, interoperability of health information technology (HIT) is of paramount importance. Regional health information organizations (RHIO) often provide a health information exchange (HIE) as a solution, which gives stakeholders access to clinical data that they otherwise would not otherwise have. A secondary use of preexisting HIE infrastructure is clinical event notification (CEN) services, which send automated notifications to stakeholders. This paper describes the development and implementation of a CEN service enabled by a RHIO in the New York metropolitan area to improve care coordination for patients enrolled in a geriatric emergency department care coordination program.
This operational CEN system incorporates several innovations that to our knowledge have not been implemented previously. They include the near real-time notifications and the delivery of notifications via multiple pathways: electronic health record (EHR) "in-baskets," email, text message to internet protocol-based "zone" phones, and automated encounter entry into the EHR. Based on these alerts the geriatric care coordination team contacts the facility where the patient is being seen and offers additional information or assistance with disposition planning with the goal of decreasing potentially avoidable admissions and duplicate testing.
During the nearly one-year study period, the CEN program enrolled 5722 patients and sent 497 unique notifications regarding 206 patients. Of these notifications, 219 (44%) were for emergency department (ED) visits; 121 (55%) of those notifications were received during normal business hours when the care coordination team was available to contact the ED where the patient was receiving care. Hospital admissions resulted from 45% of ED visits 17.8% of these admissions lasted 48 hours or less, suggesting some might potentially be avoidable.
This study demonstrates the potential of CEN systems to improve care coordination by notifying providers of the occurrence of specific events. Although it could not directly be demonstrated here, we believe that widespread use of CEN systems have potential to reduce potentially avoidable admissions and duplicate testing, likely leading to decreased costs.
在一个患者通常有众多医疗服务提供者且患有多种慢性疾病的医疗保健系统中，健康信息技术（HIT）的互操作性至关重要。区域健康信息组织（RHIO）通常提供健康信息交换（HIE）作为一种解决方案，使利益相关者能够获取他们原本无法获得的临床数据。预先存在的HIE基础设施的二次应用是临床事件通知（CEN）服务，该服务会向利益相关者发送自动通知。本文描述了纽约大都市地区的一个RHIO启用的CEN服务的开发与实施，以改善参与老年急诊科护理协调项目患者的护理协调。
这个可运行的CEN系统纳入了多项据我们所知此前尚未实施的创新。这些创新包括近乎实时的通知以及通过多种途径发送通知：电子健康记录（EHR）“收件篮”、电子邮件、发送到基于互联网协议的“区域”电话的短信，以及自动将会诊信息录入EHR。基于这些警报，老年护理协调团队会联系患者就诊的医疗机构，并提供额外信息或协助进行处置计划，目标是减少潜在的可避免住院和重复检查。
在近一年的研究期间，CEN项目登记了5722名患者，并就206名患者发送了497条独特的通知。在这些通知中，219条（44%）是关于急诊科（ED）就诊的；其中121条（55%）通知是在正常工作时间收到的，此时护理协调团队能够联系患者接受治疗的急诊科。45%的ED就诊导致了住院，其中17.8%的住院持续时间为48小时或更短，这表明有些住院可能是潜在可避免的。
本研究证明了CEN系统通过向医疗服务提供者通知特定事件的发生来改善护理协调的潜力。尽管在此无法直接证明，但我们相信CEN系统的广泛使用有潜力减少潜在的可避免住院和重复检查，可能会降低成本。
