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

Kelly, Yvelynne P.; Kuperman, Gilad J.; Steele, David; Mendu, Mallika L.

doi:10.1053/j.ajkd.2019.11.001

Cited by 19 publications

(20 citation statements)

References 12 publications

(12 reference statements)

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“…The potential harms of uncoordinated, fragmented care are expansive, ranging from gaps in care, to duplicative care, discordant care, unsafe care, and values-discordant care. 15 For example, a patient who starts relying on their nephrologist for their primary care (rather than their primary care provider [PCP]) after initiating dialysis might receive some but not all of the guideline-based preventive procedures that are required for optimal healthcare delivery. In some cases, this new reliance on a nephrology provider may occur without the PCP's knowledge, further creating a potential for missed opportunities in the diagnosis, evaluation, and management of other non-kidney related conditions.…”

Section: Why Is Care Fragmentation Important?mentioning

confidence: 99%

“…Finally, fragmented care can threaten continuity of care with trusted providers, thereby decreasing the likelihood that physicians and patients develop a shared understanding of patients’ values. As a result, care may be misaligned with patient values and preferences (e.g., delays in transplant listing, home‐based dialysis or conservative non‐dialysis care) potentially leading to increased healthcare utilization, increased costs, and worse outcomes 9,15 …”

Section: Introductionmentioning

confidence: 99%

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Fragmentation of care as a barrier to optimal ESKD management

Sloan

Zhong

Mohottige

et al. 2020

Seminars in Dialysis

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Caring for patients with end-stage kidney disease (ESKD) in the United States is challenging not only because the epidemiology of the disease's progression is complex, but also because treatment delivery occurs within social and environmental contexts that can be difficult to navigate. Chronic kidney disease (CKD) often results from other conditions, such as hypertension and diabetes. In turn, CKD can contribute to a cascade of new chronic conditions, such as anemia and cardiovascular disease. Notably, 83% of US Medicare fee-for-service program enrollees with CKD have three or more comorbid chronic conditions. 1 As CKD progresses toward ESKD, the number of comorbidities increases, care becomes much more complex and the potential for adverse outcomes increases. 2,3 As a result, care for individuals with ESKD typically involves multiple healthcare providers from multiple subspecialties. In the context of a US healthcare delivery system that has been historically siloed by provider specialty, organization, payment system, and administration,

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Section: Why Is Care Fragmentation Important?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fragmentation of care as a barrier to optimal ESKD management

Sloan

Zhong

Mohottige

et al. 2020

Seminars in Dialysis

View full text Add to dashboard Cite

show abstract

“…While the Centers for Medicare and Medicaid Services has incentivized coordination across dialysis stakeholders, it did does specifically target greater health information exchange between providers 5 . The current lack of interoperability between disparate EHRs prompted calls for increased investment in improved data exchange specifically for dialysis patients, similar to the work supported by CMS through the Promoting Interoperability programs in place for hospitals and clinicians 6,7 . This is particularly challenging in dialysis as large organizations frequently use their own proprietary EHRs, while smaller clinics rely on commercially available packages 8 .…”

Section: Introductionmentioning

confidence: 99%

“…and clinicians. 6,7 This is particularly challenging in dialysis as large organizations frequently use their own proprietary EHRs, while smaller clinics rely on commercially available packages. 8 Work is underway to create data exchange for dialysis centers 9 ; however, this work takes time and care fragmentation and its effect on patients with complex care needs is an urgent and pressing concern.…”

mentioning

confidence: 99%

Healthcare in the new age of transparency

DesRoches

2020

Seminars in Dialysis

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Similar to other areas of society, debates around access to and ownership of an individual's digital information have taken center stage in health care. A decade ago, the idea of offering patients ready access to their clinical notes was a fringe idea. Today, information transparency in health care has become a pressing legislative and regulatory issue in the United States and elsewhere. 1 The 21st Century Cures Act of 2016 requires that clinicians and health care organizations give patients electronic access to the information in their electronic medical records. Rules to enact this legislative priority promulgated by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid have substantially expanded the types of information that must be easily accessible to patients and readily exchanged among clinicians in electronic form. 2 These regulations around information blocking, which take effect on November 2, 2020, require health care organizations and clinicians to share the following eight note types: consultation, discharge summary, history & physical, imaging, laboratory, and pathology report narratives, procedure notes, and progress notes. 3 By 2022, patients will be able to access this information in their records through any third party app of their choosing. The hope is that this increased transparency will improve care and the delivery system for patients, families, and clinicians; that it will positively impact patient safety; and that it will contribute to health care value for all stakeholders. Patients receiving dialysis are at particular risk for fragmented care, given the complexity of their needs and the number of clinical sites and providers involved in their treatment. 4 While the Centers for Medicare and Medicaid Services has incentivized coordination across dialysis stakeholders, it did does specifically target greater health information exchange between providers. 5 The current lack of interoperability between disparate EHRs prompted calls for increased investment in improved data exchange specifically for dialysis patients, similar to the work supported by CMS through the Promoting Interoperability programs in place for hospitals

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“…For example, hepatitis B vaccination is more easily accomplished during a regularly scheduled visit to the dialysis unit, whereas planning for a colonoscopy, mammogram, or low-dose chest computed tomography (and follow-up to discuss results) is best done in the PCP office. Similarly, sharing electronic health record data is essential to ensuring that the PCP is aware of the care provided by the nephrologist and vice versa to reduce redundancy of care, avoid assumptions about care, and improve medication safety and adherence (9). The Centers for Medicare and Medicaid Services is leading efforts to advance electronic data exchange, but patients on dialysis have not been specifically referenced, which we recently highlighted as an important opportunity.…”

mentioning

confidence: 99%