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Joseph S, Tomaschek R, Hug BL, Beeler PE. Enhancing communication and care coordination: A scoping review of encounter notification systems between emergency departments and primary care providers. Int J Med Inform 2024; 191:105579. [PMID: 39127014 DOI: 10.1016/j.ijmedinf.2024.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/20/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE This scoping review aims to explore the current state of encounter notification systems (ENS) between emergency departments (EDs) and primary care providers (PCPs), focusing on their mechanisms, effectiveness, impacts, and challenges in healthcare settings. METHODS A systematic search was conducted using PubMed/MEDLINE and Google Scholar to identify relevant literature on ENS between EDs and PCPs. Eligible studies were selected based on predefined criteria, and data were synthesized narratively. RESULTS The initial search yielded 1,396 articles, with 29 included in the review. Studies highlighted the significance of encounter notifications in improving communication and care coordination between EDs and PCPs, leading to enhanced patient outcomes. However, challenges such as technological barriers, privacy concerns, and variations in healthcare settings were identified. CONCLUSION ENS play a crucial role in enhancing communication and care coordination between EDs and PCPs. Despite challenges, these systems offer substantial benefits and opportunities for improving patient care in the ED-primary care continuum. Future research should focus on addressing implementation barriers and evaluating long-term impacts to optimize the effectiveness of ENS in this context.
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Affiliation(s)
- Staria Joseph
- Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Rebecca Tomaschek
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Balthasar L Hug
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland; Department of General Internal Medicine, Cantonal Hospital Lucerne, Switzerland
| | - Patrick E Beeler
- Center for Primary and Community Care, Faculty of Health Sciences and Medicine, University of Lucerne, Switzerland.
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Errea RA, Garcia PJ, Pace LE, Galea JT, Franke MF. Understanding linkage to biopsy and treatment for breast cancer after a high-risk telemammography result in Peru: a mixed-methods study. BMJ Open 2022; 12:e050457. [PMID: 35487706 PMCID: PMC9058697 DOI: 10.1136/bmjopen-2021-050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This mixed-method study aimed to understand the effectiveness of linkage to biopsy and treatment in women with a high-risk mammography result (Breast Imaging Reporting and Data System, BI-RADS 4 and 5) in the national telemammography programme and to explore women's experiences during this process. SETTING Quantitative component: we collected and linked health data from the telemammography reading centre, the national public health insurance, the national centre for disease control and the national referral cancer centre. Qualitative component: we interviewed participants from different regions of the country representing diverse social and geographical backgrounds. PARTICIPANTS Quantitative: women who underwent telemammography between July 2017 and September 2018 and had high-risk results (BI-RADS 4-5) were collected. Qualitative: women with a high-risk telemammography result, healthcare providers and administrators. OUTCOMES MEASURES Quantitative: we determined biopsy and treatment linkage rates and delays. Qualitative: we explored barriers and facilitators for obtaining a biopsy and initiating treatment. RESULTS Of 126 women with high-risk results, 48.4% had documentation of biopsy and 37.5% experienced a delay of >45 days to biopsy. Of 51 women diagnosed with breast cancer, 86.4% had evidence of treatment initiation, but 69.2% initiated treatment >45 days after biopsy. Travelling to major cities for care, administrative factors and breast cancer misconceptions, among other factors, impeded timely, continuous care for breast cancer. A multidisciplinary and culturally tailored patient education facilitated understanding of the disease and prompt decision making about subsequent medical care. CONCLUSIONS Strengthened breast cancer care capacity outside the capital city, standardised referral pathways, ensured financial support for travel expenses, and enhanced patient education are required to secure linkage to the breast cancer care continuum. Robust information systems are needed to track patients and to evaluate the programme's performance.
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Affiliation(s)
- Renato A Errea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lydia E Pace
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- School of Social Work and College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Wang G, Wignall J, Kinard D, Singh V, Foster C, Adams S, Pratt W, Desai AD. An implementation model for managing cloud-based longitudinal care plans for children with medical complexity. J Am Med Inform Assoc 2021; 28:23-32. [PMID: 33150404 DOI: 10.1093/jamia/ocaa207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). MATERIALS AND METHODS We conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. During audio-recorded sessions, we asked participants to walk through role-specific scenarios of how they would create, review, and edit an LCP using a cloud-based prototype, which we concurrently developed. Between sessions, we reviewed audio recordings to identify strategies that would mitigate barriers that participants reported relating to 4 processes for managing LCPs: (1) taking ownership, (2) sharing, (3) reviewing, and (4) editing. Analysis informed iterative implementation model revisions. RESULTS We conducted 30 design sessions, with 10 caregivers and 20 providers. Participants emphasized that cloud-based LCPs required a team of owners: the caregiver(s), a caregiver-designated clinician, and a care coordinator. Permission settings would need to include universal accessibility for emergency providers, team-level permission options, and some editing restrictions for caregivers. Notifications to review and edit the LCP should be sent to team members before and after clinic visits and after hospital encounters. Mitigating double documentation barriers would require alignment of data fields between the LCP and electronic health record to maximize interoperability. DISCUSSION These findings provide a model for how we may leverage emerging Health Insurance Portability and Accountability Act-compliant cloud computing technologies to support families and providers in comanaging health information for CMC. CONCLUSIONS Utilizing these management strategies when implementing cloud-based LCPs has the potential to improve team-based care across settings.
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Affiliation(s)
- Grace Wang
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Julia Wignall
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Dylan Kinard
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Vidhi Singh
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Carolyn Foster
- Division of Academic General Pediatrics, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sherri Adams
- Division of Paediatric Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, Washington, USA.,Biomedical and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Arti D Desai
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Wiley KK, Hilts KE, Ancker JS, Unruh MA, Jung HY, Vest JR. Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange. JAMIA Open 2020; 3:611-618. [PMID: 33623895 PMCID: PMC7886547 DOI: 10.1093/jamiaopen/ooaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/04/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. MATERIALS AND METHODS We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations' event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. RESULTS Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P < 0.001) higher among respondents who reported event notifications fit within their organization's existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P < 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P < 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. DISCUSSION AND CONCLUSION Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.
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Affiliation(s)
- Kevin K Wiley
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Katy Ellis Hilts
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Jessica S Ancker
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Mark A Unruh
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Hye-Young Jung
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Conversations and connections: improving real-time health data on behalf of public interest. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Unruh MA, Jung HY, Kaushal R, Vest JR. Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York. J Am Med Inform Assoc 2018; 24:e150-e156. [PMID: 28395059 DOI: 10.1093/jamia/ocw139] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/23/2016] [Indexed: 11/14/2022] Open
Abstract
Objective Follow-up with a primary care provider after hospital discharge has been associated with a reduced likelihood of readmission. However, primary care providers are frequently unaware of their patients' hospitalizations. Event notification may be an effective tool for reducing readmissions by notifying primary care providers when their patients have been admitted to and discharged from a hospital. Materials and Methods We examined the effect of an event notification system on 30-day readmissions in the Bronx, New York. The Bronx has among the highest readmission rates in the country and is a particularly challenging setting to improve care due to the low socioeconomic status of the county and high rates of poor health behaviors among its residents. The study cohort included 2559 Medicare fee-for-service beneficiaries associated with 14 141 hospital admissions over the period January 2010 through June 2014. Linear regression models with beneficiary-level fixed-effects were used to estimate the impact of event notifications on readmissions by comparing the likelihood of rehospitalization for a beneficiary before and after event notifications were active. Results The unadjusted 30-day readmission rate when event notifications were not active was 29.5% compared to 26.5% when alerts were active. Regression estimates indicated that active hospitalization alert services were associated with a 2.9 percentage point reduction in the likelihood of readmission (95% confidence interval: -5.5, -0.4). Conclusions Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations.
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Affiliation(s)
- Mark Aaron Unruh
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Hye-Young Jung
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Department of Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Joshua R Vest
- Department of Healthcare Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, Affiliated Scientist, Regenstrief Institute, Inc., Indianapolis, IN, USA
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Abstract
Background: In June 2014, the Office of the National Coordinator for Health Information Technology published a 10-year roadmap for the United States to achieve interoperability of electronic health records (EHR) by 2024. A key component of this strategy is the promotion of nationwide health information exchange (HIE). The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided significant investments to achieve HIE. Objective: We conducted a systematic literature review to describe the use of HIE through 2015. Methods: We searched MEDLINE, PsycINFO, CINAHL, and Cochrane databases (1990 – 2015); reference lists; and tables of contents of journals not indexed in the databases searched. We extracted data describing study design, setting, geographic location, characteristics of HIE implementation, analysis, follow-up, and results. Study quality was dual-rated using pre-specified criteria and discrepancies resolved through consensus. Results: We identified 58 studies describing either level of use or primary uses of HIE. These were a mix of surveys, retrospective database analyses, descriptions of audit logs, and focus groups. Settings ranged from community-wide to multinational. Results suggest that HIE use has risen substantially over time, with 82% of non-federal hospitals exchanging information (2015), 38% of physician practices (2013), and 17-23% of long-term care facilities (2013). Statewide efforts, originally funded by HITECH, varied widely, with a small number of states providing the bulk of the data. Characteristics of greater use include the presence of an EHR, larger practice size, and larger market share of the health-system. Conclusions: Use of HIE in the United States is growing but is still limited. Opportunities remain for expansion. Characteristics of successful implementations may provide a path forward.
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Vest JR, Ancker JS. Health information exchange in the wild: the association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care. J Am Med Inform Assoc 2016; 24:39-46. [PMID: 27107436 DOI: 10.1093/jamia/ocw040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/14/2016] [Accepted: 02/17/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Event notifications are real-time, electronic, automatic alerts to providers of their patients' health care encounters at other facilities. Our objective was to examine the effects of organizational capability and related social/organizational issues upon users' perceptions of the impact of event notifications on quality, efficiency, and satisfaction. MATERIALS AND METHODS We surveyed representatives (n = 49) of 10 organizations subscribing to the Bronx Regional Health Information Organization's event notification services about organizational capabilities, notification information quality, perceived usage, perceived impact, and organizational and respondent characteristics. The response rate was 89%. Average item scores were used to create an individual domain summary score. The association between the impact of event notifications and organizational characteristics was modeled using random-intercept logistic regression models. RESULTS Respondents estimated that organizations followed up on the majority (83%) of event notifications. Supportive organizational policies were associated with the perception that event notifications improved quality of care (odds ratio [OR] = 2.12; 95% CI, = 1.05, 4.45), efficiency (OR = 2.06; 95% CI = 1.00, 4.21), and patient satisfaction (OR = 2.56; 95% CI = 1.13, 5.81). Higher quality of event notification information was also associated with a perceived positive impact on quality of care (OR = 2.84; 95% CI = 1.31, 6.12), efficiency (OR = 3.04; 95% CI = 1.38, 6.69), and patient satisfaction (OR = 2.96; 95% CI = 1.25, 7.03). CONCLUSIONS Health care organizations with appropriate processes, workflows, and staff may be better positioned to use event notifications. Additionally, information quality remains critical in users' assessments and perceptions.
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Affiliation(s)
- Joshua R Vest
- Department of Health Care Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI .,Regenstrief Institute, Inc. Indianapolis, IN, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research Division of Health Informatics, Weill Cornell Medical College, 425 E 61st St, Suite 301, New York, NY 10065, USA
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Gutteridge DL, Genes N, Hwang U, Kaplan B, Shapiro JS. Enhancing a geriatric emergency department care coordination intervention using automated health information exchange-based clinical event notifications. EGEMS 2014; 2:1095. [PMID: 25848622 PMCID: PMC4371432 DOI: 10.13063/2327-9214.1095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose: 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. Innovation: 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. Findings: 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. Conclusions and Discussion: 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.
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Affiliation(s)
| | | | - Ula Hwang
- Icahn School of Medicine at Mount Sinai
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