Care Coordination and Interoperable Health IT Systems Unit 11: Supporting Patient-Driven Care Coordination Lecture d – Health IT-Supported Communication between Primary Care Provider and Specialist Welcome to Care Coordination and Interoperable Health IT Systems, Supporting Patient-Driven Care Coordination. This is Lecture d, which will cover health-IT supported communication between primary care provider and specialist. This material (Comp 22 Unit 11) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Health IT Workforce Curriculum Version 4.0

Supporting Patient-Driven Care Coordination Learning Objectives Objective 1: Explain the importance of patient-driven care coordination Objective 2: List ways a patient can use technology to drive care decisions Objective 3: Describe the concept of patient-initiated information exchange This unit will cover the following learning objectives: 1) explain the importance of patient-driven care coordination; 2) list ways a patient can use technology to drive care decisions; and 3) describe the concept of patient-initiated information exchange. This unit will explore the use of technology to support and enable patient driven coordinated care. Health IT Workforce Curriculum Version 4.0

Introduction Information must freely flow between all providers in order for effective care coordination to occur Primary care provider is coordinator of care for patient Over one-third of adult patients in the U.S. are referred to a specialist each year Over one-half of elderly patients are referred to a specialist each year Seamless information flow is essential for care coordination How is care coordination impacted when information is not shared between care providers? How can providers use technology to improve communication between primary care providers and specialists? Information must freely flow between all providers in order for effective care coordination to occur. The primary care provider functions as the coordinator of care for their patients. When the need arises, patients are sent to see specialists. In fact, over one-third of non-elderly and one half of elderly patients in the U.S. are referred to a specialist each year. Without the flow of information between primary care providers and specialists, coordination of patient care can suffer. Health IT Workforce Curriculum Version 4.0

Background When a patient is sent to see a specialist working in another health care system, information may not be shared between the two EHR systems Results of the consultation may have to be faxed, emailed, or mailed to the primary care provider Even when information can be sent sent electronically, the information from the consultation may not integrate into the primary EHR Ineffective information sharing can cause: Duplicative treatment Over-medication Increased health care costs Inefficiencies When a patient is sent to see a specialist working in another health care system, information may not be shared between the two EHR systems. Instead, the results of the consult may have to be faxed, emailed, or mailed to the primary care provider. Even when sent electronically, the information from the consult may not integrate into the primary EHR. As you can imagine, this creates an information void. When primary care physicians and specialists are not able to communicate all necessary details, the patient can end up with duplicative treatment and over-medication and the health care system can suffer increased health care costs and inefficiencies. Health IT Workforce Curriculum Version 4.0

Patient-driven care coordination The patient and primary care provider are partners in managing care Imagine the challenges associated with shared decision-making when the physician and the patient are missing important pieces of information after a consultation How can they efficiently and accurately develop a plan of care based on the information from the consultation? The patient and primary care provider are partners in managing care. Imagine the challenges associated with shared decision-making when the physician and the patient are missing important pieces of information after a consultation. How can they efficiently and accurately develop a plan of care, based on the information from the consultation? Health IT Workforce Curriculum Version 4.0

Information needs During the consultation process, the specialist may be lacking information that would help them, such as: Current medications Lab results Diagnostic test results Diagnoses Care plans During the consultation process, the specialist may be lacking information that would help them. In order to treat a patient referred to them, a specialist may need information such as current medications, lab results, test results, other diagnoses, and care plans. This information may or may not be sent to the specialist during the referral process. Health IT Workforce Curriculum Version 4.0

Technology tools Health information technology can provide tools for more efficient information sharing Interoperable health IT Email export of patient information from the EHR Health information exchange Electronic referral systems Telemedicine consultation Health information technology can provide tools for more efficient information sharing. These tools can include interoperable health IT, email export of patient information from the EHR, the use of a health information exchange, electronic referral systems, or telemedicine technology. Health IT Workforce Curriculum Version 4.0

Barriers Inability to select and send targeted information, resulting in information overload Mismatch in technology between sender and receiver Lack of consensus on what information is essential to share There are barriers to the use of health information technology for consultation communication. It can be difficult to select only the information in the EHR that is needed by the specialist, potentially resulting in information overload. The specialist or primary care provider may have different technology, causing an inability to send or receive information electronically. With or without technical barriers, care providers often disagree on what information is essential to share. Health IT Workforce Curriculum Version 4.0

Solutions Health information exchanges allow providers to select and view just the information that they want to see For more information on health information exchanges, see component 22 unit 8 Electronic referral systems are separate from the EHR and provide the means to send specific information, follow up, and provide a means for communication and care coordination Telemedicine virtual consults allow the primary provider and specialist to confer in real time, supporting care coordination For more information on telemedicine, see component 22 unit 9 Health information exchanges provide a potential solution to this issue, allowing providers to select and view just the information that they want to see. For more information on health information exchange, see component 22 unit 8. Electronic referral systems operate outside of the EHR and provide the means to send specific information, follow up on a consult, and provide a means for communication and care coordination. Telemedicine virtual consults allow the primary provider and consultant to confer in real time, coordinating care through this technology. For more information on telemedicine, see component 22 unit 9. Health IT Workforce Curriculum Version 4.0

Unit 11: Supporting Patient-Driven Care Coordination, Summary – Lecture d, Health IT-Supported Communication between Primary Care Provider and Specialist The vision for patient-driven care coordination can only be realized if there is seamless communication between the primary care provider and specialists Technology to support communication includes health information exchange, referral system software, and telemedicine Further development of these technologies will improve the ability of the patient to partner with their primary care physician to coordinate care and improve health This concludes lecture d of Supporting Patient-Driven Care Coordination. To summarize, the vision for patient-driven care coordination can only be realized if there is seamless communication between the primary care provider and specialists. Technology to support communication includes health information exchange, referral system software, and telemedicine. Further development of these technologies will improve the ability of the patient to partner with their primary physician to coordinate care and improve health.

Unit 11 Summary: Supporting Patient-Driven Care Coordination The goal of patient-initiated information exchange is to place the patient at the center of all of their data and to create a seamless flow of information Although there is technology to support patient-initiated information exchange, work still needs to be done to achieve fully seamless sharing of data Although tools are emerging for patients that support easier access to information sharing, there are technical and cultural barriers yet to be addressed Age and demographics must be taken into consideration when developing tools and processes for information sharing A knowledgeable and educated patient is better prepared to participate in shared decision-making This concludes unit 11, Supporting Patient-Driven Care Coordination. The summary of this unit is that the goal of patient-initiated information exchange is to place the patient at the center of all of their data and to create a seamless flow of information. Although there is technology to support patient-initiated information exchange, work still needs to be done to achieve fully seamless sharing of data. Although tools are emerging for patients that support easier access to information sharing, there are technical and cultural barriers yet to be addressed. Age and demographics must be taken into consideration when developing tools and processes for information sharing. Additionally, a knowledgeable and educated patient is better prepared to participate in shared decision-making.

Unit 11 Summary: Supporting Patient-Driven Care Coordination (Cont’d) Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology that have been designed to empower the patient to gain the knowledge needed to successfully manage their own health The vision for patient-driven care coordination can only be realized if there is seamless communication between the primary care provider and specialists Further development of health information exchange, referral system software, and telemedicine will improve the ability of the patient to partner with their primary care physician to coordinate care and improve health Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology that have been designed to empower the patient to gain the knowledge needed to successfully manage their own health. The vision for patient-driven care coordination can only be realized if there is seamless communication between the primary care provider and specialists. Further development of health information exchange, referral system software, and telemedicine will improve the ability of the patient to partner with their primary care physician to coordinate care and improve health.

Supporting Patient-Driven Care Coordination References – Lecture d Agency for Healthcare Research and Quality. (2011). Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms. Available from: https://pcmh.ahrq.gov/sites/default/files/attachments/Coordinating%20Care%20in%20the%20Medical%20Neighborhood.pdf Bates D. (2015). Health information technology and care coordination: the next big opportunity for informatics?. IMIA Yearbook. 10(1):11-14. Mehotra, A, Forrest, C, & Lin, C. (2011). Dropping the baton: specialty referrals in the United States. Milbank Quarterly. 89(1):39-68. No audio.

Unit 11: Supporting Patient-Driven Care Coordination, Lecture d – Health IT-Supported Communication between Primary Care Provider and Specialist This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. No audio.