Health Information Technology and Care Coordination:The Next Big Opportunity for Informatics?

Summary

The costs of care in the U.S. are very high, in part because canre is relatively uncoordinated. To begin to address this and other issues, health care reform was passed, including the notion of accountable care. Under acountable care arrangements, providers are at risk for the costs of the care they provide to groups of patients. Evaluation of costs has made it clear that a large proportion of these costs are in the post-acute setting, and also that many specific problems such as adverse events and unnecessary readmissions occur following transitions. However, the electronic health records of today do not provide a great deal of assistance with the coordination of care, and even the best organizations have relatively primitive systems with respect to care coordination, even though communication is absolutely central to better coordination of care and health information technology (HIT) is a powerful lever for improving communication. This paper identifies specific gaps in care coordination today, presents a framework for better coordinating care using HIT, then describes how specific technologies can be leveraged. Also discussed are the need to build and test specific interventions to improve HIT-related care coordination tools, and the key policy steps needed to accomplish this.

Keywords

Health information technology - electronic health records - meaningful use - quality - efficiency - accountable care organization

• References

• 1 Davins K, Stremikis K, Squires D, Schoen C. Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. The Commonwealth Fund;. 2014
• 2 Tricco AC, Antony J, Ivers NM, Ashoor HM, Khan PA, Blondal E. et al. Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis. CMAJ 2014; 186 (15) E568-78.
• 3 Schultz EM, Pineda N, Lonhart J, Davies SM, McDonald KM. A systematic review of the care coordination measurement landscape. BMC Health Serv Res 2013; 13: 119.
• 4 Landon BE, Keating NL, Barnett ML, Onnela JP, Paul S, O’Malley AJ. et al. Variation in patient-sharing networks of physicians across the United States. JAMA 2012; 308 (03) 265-73.
• 5 Mehrotra A, Forrest CB, Lin CY. Dropping the baton: specialty referrals in the United States. Milbank Q 2011; 89 (01) 39-68.
• 6 O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med 2010; 25 (03) 177-85.
• 7 Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaén C. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project. Health Aff (Millwood) 2011; 30 (03) 439-45.
• 8 Adler-Milstein J, Bates DW, Jha AK. A survey of health information exchange organizations in the United States: implications for meaningful use. Ann Intern Med 2011; 154 (10) 666-71.
• 9 Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff (Millwood) 2010; 29 (04) 614-621.
• 10 Samal L, Dykes PC, Greenberg J, Hasan O, Venkatesh AK, Volk LA. et al. The current capabilities of health information technology to support care transitions. AMIA Annu Symp Proc 2013; 2013: 1231.
• 11 Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS. et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med 2009; 169 (08) 771-80.
• 12 Poon E, Wang S, Gandhi T, Bates DW, Kuperman GJ. A Comprehensive Outpatient Results Manager with Decision Support: Design Considerations and Architecture. Proc AMIA Symp 2002
• 13 Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O. et al. A patient-centered longitudinal care plan: vision versus reality. J Am Med Inform Assoc 2014; 21 (06) 1082-90.
• 14 Cohen SB, Yu W. The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009. Rockville, MD: Agency for Healthcare Research and Quality; 2012
• 15 Sarkar U, Bates DW. Care partners and online patient portals. JAMA 2014; 311 (04) 357-8.
• 16 Fairchild DG, Wilcox CM. Comprehending coordinated comprehensive care: the devil is in the dollars. J Gen Intern Med 2007; 22 (03) 424-5.
• 17 Rudin RS, Bates DW. Let the left hand know what the right is doing: a vision for care coordination and electronic health records. J Am Med Inform Assoc 2014; 21 (01) 13-6.
• 18 Dalal AK, Dykes PC, Schnipper JL, Bates DW. Transforming the acute care environment: A web-based patient-centered toolkit. Vol 9: Journal of Hospital Medicine 2014
• 19 Walters P, Barley EA, Mann A, Phillips R, Tylee A. Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study. PLoS One 2014; 9 (06) e98342.
• 20 Ngandu T, Lehtisalo J, Levälahti E, Laatikainen T, Lindström J, Peltonen M. et al. Recruitment and baseline characteristics of participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)-a randomized controlled lifestyle trial. Int J Environ Res Public Health 2014; 11 (09) 9345-60.