Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review

Abstract

BackgroundHealth information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States.MethodsWe performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care.ResultsWe enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management.ConclusionsSignificant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients’ self-management goals, and tools to link patients and their caregivers with community resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1373-y) contains supplementary material, which is available to authorized users.

Interoperability and Patient Electronic Health Record Accessibility: Opportunities to Improve Care Delivery for Dialysis Patients

“…5 Substantial care coordination gaps exist due to lack of interoperability, resulting in barriers in our ability to transfer information and facilitate transitions, essential elements in care delivery for dialysis patients. 6 Treating patients without complete information can increase the opportunity for medical errors, duplicative laboratory tests and procedures, and increased health care costs. 7 The opportunities to improve care through health information exchange (HIE) were noted in the mid-2000s when a focus on health information technology began to take hold.…”

Perspectives from oncology patient navigation programs on information management practices and needs: a descriptive study

“…Low data entry burden, high accessibility of entered data, customizability, affordability, and interoperability were identified as important characteristics for ease of use. Our finding that PN programs desired but lacked interoperable systems was echoed in past health information technology research [24]. The discovery of diverse data needs was unsurprising, since PN programs arise out of diverse contexts to meet needs specific to their institutions and patient populations.…”

Emergency Department Visits for Adverse Drug Reactions Involving Alcohol: United States, 2005 to 2011

“…The time constraints of clinician visits have been reported as a barrier to implementing alcohol screening in medical settings, which may be overcome using technology‐based tools (Harris and Knight, ). Further improvements in health information technology will also be needed to improve medication safety (Kuperman et al., ) as well as bridge the gaps in care coordination and interoperability between the specialists’ electronic health records (Samal et al., ). These improvements can prevent potential interactions between drugs prescribed by different healthcare professionals, and increase capabilities of monitoring patients’ medical histories and medication uses and side effects over time.…”