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Quality & Governance News

EHRs Don’t Do Enough for Care Coordination, Docs Say

By Jennifer Bresnick

- Trying to improve patient care coordination and clinical communication through current EHR systems is frustrating and difficult, according to the majority of physicians in a new Spyglass Consulting Group survey, and healthcare organizations are making it worse by not investing adequately in health IT infrastructure. As patient-centered and team-based care begin to demand more from staff members and technology alike, organizational leaders must focus on EHR interoperability, health information exchange, and improved data governance structures that foster an environment of simple and secure communication.

“Efficient communications and collaboration between physicians, specialists, nurses and care team members is critical to enhance patient safety, and support the coordination and delivery of patient care across health settings,” said Gregg Malkary, Managing Director of Spyglass Consulting Group. Despite the ubiquity of smartphone adoption among physicians, many EHRs do not fully support mobile communications, and 70 percent of physicians believe that their executive leaders are not investing enough time and money in communications infrastructure.

The average hospital loses $1.7 million per year due to inefficient care coordination, a Ponemon Institute and Imprivata study found earlier this year. More than half of the time involved in patient admissions, transfers, and discharges – revolves around waiting for responses from other members of the care team, averaging more than half an hour of idleness per patient. An increase in the adoption of secure text messaging and mobile access to EHR data may help to reduce these lengthy wait times, but many organizations still rely on somewhat more old fashioned methods of sharing information.

“Smartphones are preferred because they are easier to use and provide more enhanced functionality than outdated communication options provided by hospital IT including pagers, overhead paging systems, landline phones and fax machines,” Malkary says.

The Spyglass survey found that 83 percent of physicians were frustrated and disappointed by poor EHR usability, a lack of interoperability, and insufficient integration between the EHR and messaging infrastructure. Finding the right clinical data to flag or send was equally difficult, which contributed to the overwhelming sense that physicians are simply unprepared and unmotivated to adopt the principles and processes of collaborative care.

“As we were developing our plans for improving communication among clinicians, we discovered that few hospitals were investing in communication‐driven workflow support, perhaps because meaningful use and HIPAA are consuming all the resources,” explained Steven Davidson, MD, MBA, the former CMIO at Maimonides Medical Center in New York. “Still, it seems many IT leaders hope the EHR – a tool poorly suited to the task –will suffice. In reality, overwhelmed nurses and doctors struggle accomplishing necessary communication through the EHR; instead implementing workarounds on their own devices.”

If physicians and other members of staff have such difficulty communicating between themselves, it is perhaps unsurprising that they have equal trouble ensuring that a patient’s information reaches his or her primary care provider after discharge to ensure that care coordination continues beyond the hospital’s walls. A recent study from the American Heart Association found that 7.3% of discharge summaries were not sent to primary care providers until more than thirty days after the patient left the hospital, and were often lacking significant chunks of clinical information when they did arrive.

While patient navigators and automated care coordination programs may help patients understand and meet their responsibilities, hospitals and healthcare organizations will need to move beyond the EHR by adopting mobile communication technologies that meets the expectations of their physicians and drive organizational transformation as the healthcare industry increasingly relies on solid communications to achieve the benefits of accountable care.


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