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The next step towards making use meaningful: electronic information exchange and care coordination across clinicians
Ilana Graetz1, Mary Reed, Stephen M Shortell
1*Division of Research, Kaiser Permanente Northern California, Oakland, CA †Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN ‡School of Public Health, University of California at Berkeley, Berkeley §Care Management Institute Kaiser Permanente, Oakland, CA ∥Mongan Institute for Health Policy, Massachusetts General Hospital ¶Department of Health Care Policy, Harvard Medical School, Boston, MA.
Background:
Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination.
Objective:
We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites.
Research Design:
Repeated surveys of primary care clinicians during the staggered implementation of an outpatient EHR (2005-2008), followed by an integrated inpatient EHR (2006-2010). We measured the association between EHR use stages (no use, outpatient EHR only, and integrated inpatient-outpatient EHR) and care coordination using logistic regression, adjusting for clinician characteristics, study year, and medical center.
Subjects:
Adult primary care clinicians in a large Integrated Delivery System.
Measures:
Three measures of clinician-reported care coordination for patient care transferred across clinicians (eg, from specialist to primary care team) and across delivery sites (eg, from the hospital to outpatient care).
Results:
Outpatient EHR use was associated with higher reports of access to complete and timely clinical information and higher agreement on clinician roles and responsibilities for patients transferred across clinicians, but not for patients transferred across delivery sites. Use of the integrated outpatient-inpatient EHR was associated with higher reports of access to timely and complete clinical information, clinician agreement on the patient's treatment plan for patients transferred across delivery sites, and with all coordination measures for patients transferred across clinicians.
Conclusion:
Use of an integrated EHR with health information exchange across delivery settings improved patient care coordination.
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