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

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

doi:10.1186/s12913-016-1373-y

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.

Highlights

Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms
As we have reported in a prior white paper, the literature on the use of HIT for care coordination only focuses on a few topics while care coordination literature in general focuses on nurse case management [4,5,6]
In order to describe the extent to which HIT is used for care coordination, we identified the overlap of the broad approach ‘HIT-enabled Coordination’ with each of the nine care coordination activities

Summary

Introduction

Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. 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. The goal of health information technology (HIT) is to improve the quality of healthcare and reduce healthcare costs, but evidence is mixed in the United States [1, 2]. The lack of interoperability between the specialists’ electronic health records (EHRs) may be a barrier to development of new HIT tools to support this domain of care coordination

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