Abstract
Background/Aims With the adoption of electronic medical records (EMR) by medical group practices, there are opportunities to improve the quality of care for patients who are discharged from hospitals and intermediate care facilities. While transitions within vertically-integrated healthcare systems are amenable to EMR-based transition interventions, there is little guidance for medical groups without integrated hospital-EMR access who wish to automate the flow of patient information during critical transitions in care. Our aim was to describe the technological resources, expertise and time needed to develop and implement an automated system providing critical information and alerts to primary care physicians when their patients transition from hospitals or skilled nursing facilities to home.
Methods Within a large medical group practice with an EMR, we developed and implemented an automated alert system that provides notification of discharges, reminders of the need for follow-up visits, new drugs added during the in-patient stay, warnings about drug-drug interactions, and recommendations for dosing changes and laboratory monitoring of high risk drugs. We tracked components of the information system required to accomplish this as well as the time spent by team members. We used US national averages of relevant hourly wages to estimate personnel costs.
Results Critical components of the information system are notifications of hospital discharges through an admission, discharge and transfer registration (ADT) interface, linkage to the group practice scheduling system, timely access to information on pharmacy dispensing and lab tests, and an interface engine to direct messages to specific physicians and staff. Total personnel cost was $76,314. Nearly half (47%) was for 614 hours by physicians who developed content, provided overall project management, and reviewed alerts during a test period to ensure that only “actionable” alerts would be sent.
Discussion Implementing a system to provide a flow of critical information about patient transitions requires strong internal informatics expertise, cooperation between facilities and ambulatory providers, development of a number of electronic linkages, and extensive commitment of physician time.
