BACKGROUND Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. OBJECTIVES We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges. DESIGN, SETTING Semi-structured telephone interviews in 12 randomly selected communities. PARTICIPANTS Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. RESULTS Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). CONCLUSIONS There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

August 7, 2019

Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices

BACKGROUND Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. OBJECTIVES We examine whether and how practices use commercial EMRs to […]
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BACKGROUND Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. OBJECTIVES We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges. DESIGN, SETTING Semi-structured telephone interviews in 12 randomly selected communities. PARTICIPANTS Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. RESULTS Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). CONCLUSIONS There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.
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http://www.springerlink.com/content/j02w23143245j24r/

August 7, 2019

Identifying Post-Acute Medication Discrepancies in Community Dwelling Older Adults: A New Tool.

Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as […]
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Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as follows: nurses, 0.68; pharmacists, 0.50; and physicians, 0.64. Intrarater reliability ranged from 0.58 to 0.69. Conclusions: By capturing transition-related medication discrepancies, the MDT fills an important gap in national efforts to promote patient safety. MDT items are actionable at both the patient and system level, suggesting that this tool could be used to foster continuous quality improvement efforts.
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http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf

August 7, 2019

Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care.

Coleman EA, Berenson RA. Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care. Ann Intern Med. 2004; 140:533-536. http://annals.org/article.aspx?articleid=717858 . Accessed August 7, 2014. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients […]
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Coleman EA, Berenson RA. Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care. Ann Intern Med. 2004; 140:533-536. http://annals.org/article.aspx?articleid=717858 . Accessed August 7, 2014. Transitional care has been defined as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location. Transitional care, which primarily concerns the relatively brief time interval that begins with preparing a patient to leave one setting and concludes when the patient is received in the next setting, poses challenges that distinguish it from other types of care. Many transitions are unplanned, result from unanticipated medical problems, occur in “real time” during nights and on weekends, involve clinicians who may not have an ongoing relationship with the patient, and happen so quickly that formal and informal support mechanisms cannot respond in a timely manner. This article describes the challenges involved in and potential solutions for improving the quality of transitional care.
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http://www.annals.org/content/141/7/533.abstract?sid=e687968f-50f0-4a9c-bc8f-617558bc306d

August 7, 2019

CMS: Your Discharge Planning Checklist

Centers for Medicare & Medicaid Services (CMS). Your Discharge Planning Checklist. [Booklet/Form]. http://www.medicare.gov/publications/pubs/pdf/11376.pdf.Revised January 2012. Accessed July 25, 2014. The Centers for Medicare & Medicaid Services (CMS) has developed a checklist that prompts patients and caregivers to ask questions about key discharge planning topics including their likely care needs, the […]
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Centers for Medicare & Medicaid Services (CMS). Your Discharge Planning Checklist. [Booklet/Form]. http://www.medicare.gov/publications/pubs/pdf/11376.pdf.Revised January 2012. Accessed July 25, 2014. The Centers for Medicare & Medicaid Services (CMS) has developed a checklist that prompts patients and caregivers to ask questions about key discharge planning topics including their likely care needs, the options for continuing care, post-discharge care instructions, community-based resources, and more. The checklist is intended to encourage patients and caregivers to actively participate in the discharge planning process and reflects CMS' goal to achieve high-value, person-centered health care. Providers can make use of the checklist by: (1) making staff aware of the checklist; (2) including it in pre-administration and/or admission paperwork; and, (3) by encouraging staff to work with patients and caregivers to complete the checklist.
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http://www.medicare.gov/publications/pubs/pdf/11376.pdf

August 7, 2019

The Joint Commission, Speak Up: Planning Your Folow-Up Care

The Joint Commission and the Centers for Medicare & Medicaid Services. Speak UP: Planning Your Follow-up Care. Educational Brochure. http://www.jointcommission.org/Speak_Up_Planning_Your_Follow-up_Care/ Published April 2010. Updated July 8, 2013. Accessed July 25, 2014. The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign to urge patients […]
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The Joint Commission and the Centers for Medicare & Medicaid Services. Speak UP: Planning Your Follow-up Care. Educational Brochure. http://www.jointcommission.org/Speak_Up_Planning_Your_Follow-up_Care/ Published April 2010. Updated July 8, 2013. Accessed July 25, 2014. The Joint Commission, together with the Centers for Medicare and Medicaid Services, launched a national campaign to urge patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team. The program features brochures, posters and buttons on a variety of patient safety topics.
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http://www.jointcommission.org/PatientSafety/SpeakUp/speak_up_recovery.html

August 7, 2019

Ask Me 3

Ask Me 3. National Patient Safety Foundation. Http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/ Accessed July 25, 2014. Ask Me 3 is a patient education program designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes. The program encourages patients […]
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Ask Me 3. National Patient Safety Foundation. Http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/ Accessed July 25, 2014. Ask Me 3 is a patient education program designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes. The program encourages patients to ask their health care providers three questions: What is my main problem? What do I need to do? Why is it important for me to do this?
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http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/

August 7, 2019

Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians

Weiss B. Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. [Booklet]. Http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf Published May 2007. Accessed July 25, 2014. In the pages that follow, this manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes […]
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Weiss B. Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians. [Booklet]. Http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf Published May 2007. Accessed July 25, 2014. In the pages that follow, this manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy. The manual then provides practical tips for clinicians to use in making their office practices more “user friendly” to patients with limited literacy, and gives suggestions for improving interpersonal communication between clinicians and patients. Finally, the manual concludes with several “case discussions” based on vignettes in the accompanying instructional video.
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http://med.fsu.edu/userFiles/file/ahec_health_clinicians_manual.pdf

August 7, 2019

Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission

BACKGROUND This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. METHODS Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting […]
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BACKGROUND This study was designed to determine risk factors and potential harm associated with medication errors at hospital admission. METHODS Study pharmacist and hospital-physician medication histories were compared with medication orders to identify unexplained history and order discrepancies in 651 adult medicine service inpatients with 5,701 prescription medications. Discrepancies resulting in order changes were considered errors. Logistic regression was used to analyze the association of patient demographic and clinical characteristics including patients' number of pre-admission prescription medications, pharmacies, prescribing physicians and medication changes; and presentation of medication bottles or lists. These factors were tested after controlling for patient demographics, admitting service and severity of illness. RESULTS Over one-third of study patients (35.9%) experienced 309 order errors; 85% of patients had errors originate in medication histories, and almost half were omissions. Cardiovascular agents were commonly in error (29.1%). If undetected, 52.4% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 11.7% were rated as potentially harmful. In logistic regression analysis, patient's age > or = 65 [odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-4.30] and number of prescription medications (OR, 1.21; 95% CI, 1.14-1.29) were significantly associated with errors potentially requiring monitoring or causing harm. Presenting a medication list (OR, 0.35; 95% CI, 0.19-0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at admission was beneficial. CONCLUSION Over one-third of the patients in our study had a medication error at admission, and of these patients, 85% had errors originate in their medication histories. Attempts to improve the accuracy of medication histories should focus on older patients with a large number of medications. Primary care physicians and other clinicians should help patients utilize and maintain complete, accurate and understandable medication lists.
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http://psnet.ahrq.gov/resource.aspx?resourceID=17753

August 7, 2019

Improving Care Transitions: A Key Component of Health Care Reform

Blog by Eric Coleman and Amy Berman The Community-Based Care Transitions Program, a provision of the newly enacted Patient Protection and Affordable Care Act (Section 3026 of HR 3590), provides $500 million to collaborative partnerships between hospitals and community-based organizations designed to meet the goal of implementing evidence-based care transitions […]
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Blog by Eric Coleman and Amy Berman The Community-Based Care Transitions Program, a provision of the newly enacted Patient Protection and Affordable Care Act (Section 3026 of HR 3590), provides $500 million to collaborative partnerships between hospitals and community-based organizations designed to meet the goal of implementing evidence-based care transitions services for Medicare beneficiaries at high risk for hospital readmission.
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http://healthaffairs.org/blog/2010/04/29/improving-care-transitions-a-key-component-of-health-reform/

August 7, 2019

Advance Care Planning: Preferences for Care at the End-of-Life

Agency for Healthcare Research and Quality. Advance Care Planning: Preferences for Care at the End-of-Life. http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/endria.pdf. Published March 2003. Accessed July 25, 2014. Research can help physicians and other health care professionals guide patient decision making for care at the end of life. Findings resulting from research funded by the […]
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Agency for Healthcare Research and Quality. Advance Care Planning: Preferences for Care at the End-of-Life. http://www.ahrq.gov/research/findings/factsheets/aging/endliferia/endria.pdf. Published March 2003. Accessed July 25, 2014. Research can help physicians and other health care professionals guide patient decision making for care at the end of life. Findings resulting from research funded by the Agency for Healthcare Research and Quality are discussed.
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http://www.ahrq.gov/research/endliferia/endria.pdf