A recent consensus report by The Commonwealth Fund emphasizes the role of health IT in care coordination, while asserting that today’s information technology is inadequate to the purpose.
“Anchoring the electronic health record (EHR) in the traditional visit-based care delivery model limits the potential of the medical home to generate paradigm-shifting care delivery transformation and the positive outcomes it promises…Health IT requires new functional capabilities, such as multiple team member access and permissions, care management workflow support, integrated personal health records, registry functionalities, clinical decision support, measurement of quality and efficiency, and robust reporting.”
The bulk of the technologies required to achieve these goals are already available. Among the reasons they’re not being properly deployed in most cases are these:
- Electronic health records are not designed to do population health management or care coordination.
- Registries tend to be focused on patients with particular conditions, rather than entire populations.
- Care management workflow support is still a relatively new concept, but one that more and more groups are embracing.
Group practices that are trying to transform themselves also have to manage a variety of other issues, including cultural barriers to change, potential infrastructure issues, and limited reimbursement for non-visit and non-physician care.
Key Building Blocks
Technology tools are also being used to improve communications across care settings, especially during transitions of care. These range from traditional point-to-point interfaces to physician and patient web portals to secure electronic messaging. Even computer faxing has its place as the industry moves from paper to electronic documentation of care.
The automated stratification of patients into different risk categories is also important to groups seeking to do population health management. For example, UNC Healthcare uses a health risk assessment (HRA) survey to find out how sick each of its patients with diabetes is. Then it uses an advanced patient registry and evidence-based algorithms to drive team-based care for each of those patients, depending on the severity of his or her condition.
Many practices use electronic registries to supplement their EHRs. These registries compile lists of subpopulations that need particular kinds of preventive and chronic care, such as annual mammograms for women over 40 or HbA1c tests at particular intervals for diabetic patients. The continuously updated data in the registries comes from EHRs, practice management systems, or a combination of the two. Evidence-based clinical protocols, which can be customized by physician practices, trigger alerts in the registries. When a registry is linked to an outbound messaging system, patients are notified by automated telephone, e-mail or text messages to contact their physician for an appointment. Some registries can also send actionable data to care teams prior to patient visits.
Care Coordination Leverages IT
The overall lesson to be drawn from the efforts to improve care coordination will require the use of information technology. The identification of patients with particular conditions, health risk assessments, the ability to send care gap alerts to providers, the care management of chronically ill patients, tailored patient education, and persistent reminders to patients to get the care they need—all of these interventions require some degree of automation to be performed in a timely, consistent, cost-effective manner.
The recent advances in health IT and further developments in this vital field will continue to support and enhance care coordination as it expands across the spectrum of care. Assuming that payment methods support coordinated care, we can look forward to a proliferation of new IT tools that will help turn the dream of affordable, high-quality healthcare for all into a reality.
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