Will 2012 be the year of better care transitions? Many of the pieces are in place to make that happen, although there is still much work to be done to remedy this persistent—and multi-faceted—problem.
A conference hosted by Kaiser Permanente in Washington, D.C., last October demonstrated the complexity of the care transitions problem. The meeting identified key areas of focus, including the discharge process, medication reconciliation, information flow, and patient and caregiver interaction. At the conference, Farzad Mostashari, M.D., national coordinator for health IT, urged the participants to embrace technology as a facilitator for improving care transitions, and he made a business case, as fee-for-service payment models are replaced by new models of payment.
Multi-Faceted Problem
Harry Greenspun, M.D., senior adviser for healthcare transformation and technology at the Deloitte Center for Health Solutions in Washington, D.C., notes that care management transitions are an area in which “the application of IT can improve quality, improve safety, and as a result can likely reduce costs.”
Harry Greenspun, M.D.Good patient care requires an enormous amount of information to be conveyed, both within care teams and from setting to setting, Greenspun says. IT collaboration tools can help coordinate teams, make clear where responsibilities lie, and help make sure that things don’t get dropped and are not duplicated, he says.He has observed increasing appreciation among provider organizations that transitions are actually a dangerous time for patients, which is being reflected in the changing nature of discharge summaries. “In the past, discharge summaries were focused on what happened, as opposed to here are the goals, here is what needs to be done and this is what has been done so far, and what information needs to be handed off to make the transition successful,” he says.Greenspun notes that there is no single solution to optimizing care transitions. The ability to pull information together from different sources and make sense of it is important. One problem in the industry has been that there are a lot of technology solutions directed at a narrow piece of the puzzle, but they haven’t been incorporated well into what Greenspun calls the “people-process-technology triad. You can solve one problem” he says, “like a great care coordination application. But if the data isn’t there, or people can’t access it, or it’s not easy for the clinician to use it as part of their daily routine, it’s not a real advance.”Erica Drazen, managing director at the Global Institute for Emerging Healthcare Practices at Falls Church, Va.-based CSC, notes that most provider organizations did not choose care transitions as part of their Stage 1 meaningful use attestation. She says care management transitions will become a front-burner issue with the emergence of accountable care and incentives to reduce readmissions.