BOSTON—One in three Rhode Islanders are participating in the state’s health information exchange (HIE)—CurrentCare—which makes it a good testing site for new processes, said Jonathan Leviss, MD, chief medical officer of the Rhode Island Quality Institute, at the AMDIS Fall Symposium.
Leviss discussed the organization’s experience in improving care coordination through the HIE. The state’s practices and accountable care organizations have a vested interest in knowing when their patients are admitted, discharged or seen in the emergency department of a hospital. “If providers know when their patients are admitted and discharged, they know what to do. By connecting the pieces, maybe we can reduce readmissions.”
They began an alert process where primary care providers are alerted, if the patient consents, about hospital care so they could follow up appropriately. Once they started, the providers said the messages weren’t helpful because they weren’t getting useful information.
Through an assessment of technology, people and processes, the organization found numerous problems. The admit, discharge and treatment systems are used across health systems for much more, including ambulatory care and lab results. “For every one message that would come across about hospitalization, they received 10 messages for these other items. They were getting an onslaught of Direct messages,” Leviss said.
They tweaked the subject line of the emails to include patient names which were originally hidden in the body of the message.
Aside from two large physician practices in Rhode Island, the rest are much smaller. “None of them knew how to use this technology,” he said. Secretaries used to take the calls from hospitals so they needed a process to get information from the Direct messages into the workflow of the provider.” A lot of practices thought RIQI was just making more work for them. So, they helped the practices recognize that they were missing 10 to 50 percent of admissions. “We could show them that we could give them this information in real time. That would often change the conversation.” It didn’t have to be the provider receiving the information.
That led to a focus on people. The alert system was originally called provider notification. Leviss said they decided to rebrand it to hospital alerts. The care team could address the problem and develop new workflows.
While the process has seen lots of changes, Leviss said “it really required us to engage in people, processes and technology. With minor tweaks, we made it work.” Patient satisfaction has increased and RIQI has found that for those primary care providers receiving these alerts, they have a 10 percent lower 30-day readmission rate. “That drop translates to avoiding 68 readmissions a month and $860,000 saved.” If CurrentCare and the hospital alert system expands to the rest of the state’s population, the same 10 percent drop in readmissions would save $7 million.