Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Lipika Samal, Patricia C. Dykes, Jeffrey O. Greenberg, Omar Hasan, Arjun K. Venkatesh, Lynn A. Volk, David W. Bates

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

Health 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.

Methods

We 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.

Results

We 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.

Conclusions

Significant 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.
Appendix
Available only for authorised users
Literature
1.
Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff. 2013;32(1):63–8.CrossRef
2.
Samal L, Wright A, Healey MJ, Linder JA, Bates DW. Meaningful use and quality of care. JAMA Intern Med. 2014;174(6):997–8.CrossRefPubMed
3.
McDonald KM, Schultz E, Albin L, Pineda N, Lonhart J, Sundaram V, Smith-Spangler C, Brustrom J, Malcolm E. Care coordination atlas. Version 3. Rockville: AHRQ Publication; 2010.
4.
Samal L, Hasan O, Venkatesh AK, Volk LA, Bates DW. Health information technology to support care coordination and care transitions: Data needs, capabilities, technical and organizational barriers, and approaches to improvement. Washington D.C: National Quality Forum; 2012.
5.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA. 1999;281(7):613–20.
6.
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8.CrossRefPubMed
7.
Richesson RL, Krischer J. Data standards in clinical research: Gaps, overlaps, challenges and future directions. J Am Med Inform Assoc. 2007;14(6):687–96.CrossRefPubMedPubMedCentral
8.
Greenberg JO, Barnett ML, Spinks MA, Dudley JC, Frolkis JP. The "medical neighborhood": Integrating primary and specialty care for ambulatory patients. JAMA Intern Med. 2014;174(3):454–7.CrossRefPubMed
9.
Press MJ. Instant replay--a quarterback's view of care coordination. N Engl J Med. 2014;371(6):489–91.CrossRefPubMed
10.
Amarasingham R, Diener-West M, Weiner M, Lehmann H, Herbers JE, Powe NR. Clinical information technology capabilities in four U.S. hospitals: Testing a new structural performance measure. Med Care. 2006;44(3):216–24.CrossRefPubMed
11.
Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O, O'Malley TA, Venkatesh AK, Volk LA, Bates DW. A patient-centered longitudinal care plan: Vision versus reality. J Am Med Inform Assoc. 2014;4.
12.
van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, Austin PC, Forster AJ. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010 Apr 6;182(6):551–7.
13.
Gombeski Jr WR, Miller PJ, Hahn JH, Gillette CM, Belinson JL, Bravo LN, Curry PS. Patient callback program: A quality improvement, customer service, and marketing tool. J Health Care Mark. 1993;13(3):60–5.
14.
Peter S, Chaney G, Zappia T, Van Veldhuisen C, Pereira S, Santamaria N. Care coordination for children with complex care needs significantly reduces hospital utilization. J Spec Pediatr Nurs. 2011;16(4):305–12.CrossRefPubMed
15.
Cochran VY, Blair B, Wissinger L, Nuss TD. Lessons learned from implementation of postdischarge telephone calls at baylor health care system. J Nurs Adm. 2012;42(1):40–6.CrossRefPubMed
16.
Balaban RB, Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: A randomized controlled study. J Gen Intern Med. 2008;23(8):1228–33.CrossRefPubMedPubMedCentral
17.
Chen Y, Brennan N, Magrabi F. Is email an effective method for hospital discharge communication? A randomized controlled trial to examine delivery of computer-generated discharge summaries by email, fax, post and patient hand delivery. Int J Med Inform. 2010;79(3):167–72.CrossRefPubMed
18.
Graumlich JF, Novotny NL, Nace GS, Aldag JC. Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial. J Hosp Med. 2009;4(6):356–63.CrossRefPubMed
19.
Dalal AK, Poon EG, Karson AS, Gandhi TK, Roy CL. Lessons learned from implementation of a computerized application for pending tests at hospital discharge. J Hosp Med. 2011;6(1):16–21.CrossRefPubMed
20.
Olola CHO, Narus S, Nebeker J, Poynton M, Hales J, Rowan B, LeSieur H, Zumbrennen C, Edwards AA, Crawford R, Amundsen S, Kabir Y, Atkin J, Newberry C, Young J, Hanifi T, Risenmay B, Sorensen T, Evans RS. The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care. Int J Med Informatics. 2011;80(6):412–20.
21.
Ornstein K, Smith KL, Foer DH, Lopez-Cantor MT, Soriano T. To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people. J Am Geriatr Soc. 2011;59(3):544–51.CrossRefPubMed
22.
Zamora Z, McCall B, Patel L, Biese K, Lamantia M, Platts-Mills T, Naus N, Jerkewitz HP, Cairns CB, Busby-Whitehead J, Kizer JS. Implementation of a web-based system to improve the transitional care of older adults. J Nurs Care Qual. 2012;27(2):182–9.
23.
24.
Blobel B. Interoperable healthcare information system components for continuity of care. Br J Healthc Comput Inf Manage. 2003;20(7):22–4.
25.
Schoenborn NL, Arbaje AI, Eubank KJ, Maynor K, Carrese JA. Clinician roles and responsibilities during care transitions of older adults. J Am Geriatr Soc. 2013;61(2):231–6.CrossRefPubMed
26.
Amarasingham R, Moore BJ, Tabak YP, Drazner MH, Clark CA, Zhang S, Reed WG, Swanson TS, Ma Y, Halm EA. An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data. Med Care. 2010;48(11):981–8.
27.
Nguyen OK, Chan CV, Makam A, Stieglitz H, Amarasingham R. Envisioning a social-health information exchange as a platform to support a patient-centered medical neighborhood: A feasibility study. J Gen Intern Med. 2014;5.
28.
Metadata
Title
Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review
Authors
Lipika Samal
Patricia C. Dykes
Jeffrey O. Greenberg
Omar Hasan
Arjun K. Venkatesh
Lynn A. Volk
David W. Bates
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1373-y

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue

Research article

Technical analysis, contestation and politics in policy agenda setting and implementation: the rise and fall of primary care maternal services from Ghana’s capitation policy

Research article

A prospective evaluation of first people’s health promotion program design in the goulburn-murray rivers region

Research article

Maternal and child health voucher scheme in Myanmar: a review of early stage implementation

Research article

A qualitative analysis of the effect of a community-based primary health care programme on reproductive preferences and contraceptive use among the Kassena-Nankana of northern Ghana

Research article

China’s community-based strategy of universal preconception care in rural areas at a population level using a novel risk classification system for stratifying couples´ preconception health status

Research article

From personal crisis care to convenience shopping: an interpretive description of the experiences of people with mental illness and addictions in community pharmacies