“To reduce avoidable hospitalizations, you must have a meaningful flow of information.” These are extremely wise words we need to really think about.
They came in December at the National Transitions of Care Coalition Summit from Farzad Mostashari, MD, ScM, who serves as National Coordinator for Health Information Technology within the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
We spend approximately 17 billion Medicare dollars — that’s $17,000,000,000 — a year on transitions that probably shouldn’t happen. Actually, experts say at least 40% can be prevented.
If we could communicate better, wiser, and smarter and build a Healthcare Information Exchange System that “speaks” across systems, we can save approximately 6.8 billion healthcare dollars. I find it embarrassing that the United States is No. 1 in expense in healthcare but number 10 in delivery.
We have to do things smarter. Remember that the P in HIPAA stands for portability!!!! That means a meaningful, portable flow of information.
But what is a meaningful flow of information and what do we need to know, and why are we so often so willing to cave in and accept residents in our facilities when we don’t get it? (Could it be management is more concerned about filling beds then demanding that we get the information we MUST have to ensure we can safely and effectively care for the resident?)
What do we need to know, at a minimum? If the resident is coming from a hospital, we absolutely need to know the course of hospitalization, that is, what happened while she or he was in the hospital, what procedures were done, what the current disease states and diagnoses are, what medications were stopped, what were added (and why and what for), what treatments are current, what labs are current AND are any lab results or radiology results pending?
Repeat labs/radiology are a huge wasted expense. It’s also not good not having the results of a test PRIOR to the transfer — such as a positive biopsy, X-ray or occult blood — which is unfortunately comm. We also need to know if the patient has multi-drug resistant organisms; whether they were recently on antibiotics, and for what (helps us practice antibiotic stewardship), as well as other important information, such as who was the attending in the hospital and how can we reach them if there is a question in the transfer process.
The American Medical Directors Association does have a free downloadable Universal Transfer Form that was created with the input from transition experts within all areas of the continuum of healthcare. This will at least give us the minimum of necessary information exchange we need when accepting residents in our facilities.
One day, hopefully, there will be a system that allows us “talk” to each other in a meaningful way. I imagine a cloud system, a secure system where once registered, you input your patient’s (or your own) Social Security number and “ta-da!” you have access to all healthcare records.
No, it’s not perfect. All persons living in the United States do not have a Social Security number. But most do and your Social Security number does not change if you change your name or change your ZIP code, or change your insurance provider.
And a cloud system of this type would work with any software system so you don’t have to worry about buying an expensive program. (Maybe that’s why no one has developed it?) Face it: You can to the farthest reaches of Earth, stick in your ATM card and get meaningful, secure information about your bank accounts! (OK, my sad little bank accounts aren’t that complicated, but you get my drift!)
So why not with healthcare records?
Just keeping it real,
Nurse Jackie
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.
