Editor’s note: This is the first of two articles from SHM’s Health Information Technology committee offering practical recommendations for improving electronic health records (EHRs) to reduce readmissions, along with practice-based vignettes to support the recommendations.
Explore this issue:September 2014
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Despite limited support from the medical literature, hospital teams know that technology, specifically electronic health record (EHR) technology, can improve healthcare quality. Given 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act, the federal government is betting on this as well. These hospital teams, often led by hospitalists, are charged with creating workflows and EHR build that will affect measurable quality indicators. Hospital finances, tied to Medicare pay-for-performance incentives, hang in the balance.
As a hospitalist and chairperson of SHM’s IT Quality Subcommittee, I helped lead an effort to examine how technology and EHRs could be used to reduce readmissions. The subcommittee was composed of eight hospitalists from around the country and two mentors, Jerome Osheroff, MD, FACMI, of TMIT Consulting, and Kendall Rogers, MD, CPE, FACP, FHM, of the University of New Mexico. The goal of this effort was to create reproducible models of how EHR and technology in general could be leveraged to reduce readmissions.
Members of the committee initially were asked to evaluate all-cause, 30-day readmissions at their respective institutions. Any hospital with a readmissions rate less than 16% over the previous year was considered “high performing.” Members were asked to advocate for one technology/EHR intervention that had the most impact locally. Interventions were vetted within the committee and based on literature review.
Specific categories evaluated included:
- Readmission risk assessment;
- Communication with referring physicians;
- Medication reconciliation;
- Multidisciplinary rounds;
- Patient education;
- Discharge coaches;
- Patient-centric discharge paperwork;
- Post-discharge coordination of care; and
- Medication compliance.
These site-specific experiences could be considered “springboards” for randomized trials of likely successful interventions.
Recommendation: Use readmission risk assessment to apply resources to most appropriate patients.
Ned Jaleel, DO, MMM, CPE, a hospitalist and informaticist for Meditech Corp., and Maruf Haider, MD, a hospitalist and informaticist for INOVA Healthcare, have mapped implemented processes for real-time assessment of readmission risk stratification and “measurevention” based on this data.
Augusta Health in Fishersville, Va., uses Meditech EHR to extract relevant data about risk assessment and display this data to case managers using the LACE model (length of stay, acuity, comorbidities, ER visits). The modified LACE model included medication information to create a readmission risk score. Case managers can then determine which patients require the most care and attention from the multidisciplinary team.