technological resources & personnel costs required to implement an automated alert system for...
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Technological Resources & Personnel Costs Required to
Implement an Automated Alert System for Primary Care
Physicians When Patients Transition from Hospitals to
HomeTerry Field, Lawrence Garber, Shawn Gagne,
Jennifer Tjia, Peggy Preusse, Jennifer Donovan, Abir Kanaan, Jerry Gurwitz
Funding: AHRQ R18 HS017203 and R18 HS017817
Problems with continuity of care High risk transitions Poor communication between physicians
caring for patients in and out of the hospital Existing methods to overcome these
problems:◦from the hospital side◦labor intensive◦or based on integrated EMR for out-patient
clinics and hospitals
Background
1. Can out-patient medical group EMRs be used to provide information to PCPs when patients are discharged to home?
2. What are the technological resources and personnel costs needed to develop an automated system providing information about patient transitions to PCPs?
Research Questions
Medical group practice
330 clinicians
Approximately 180,000 patients
Epic ambulatory EMR
In-house medical informatics team
Methods – Study Setting
Automated system to facilitate information flow to PCPs about patients discharged to home from hospital or SNFs
Includes information about:• new drugs added during hospital stay• warnings about drug-drug interactions• recommendations for dose changes and
lab monitoring• reminders to support staff to schedule an
office visit
The Transitional Care Intervention
Required Information Elements
Discharge notification
SchedulingInfo
NewMeds
LabMonitoring
Admission, discharge, transfer registration
(ADT) interface
EMR integrated scheduling system
EMR pre-dischargeClaims post-discharge
Lab results interface
Information is linked to data in the EMR
database. Program applies rules
to construct messages and direct their flow.
Message Flow
Locally produced interface engine
distributes messages
Primary Care Provider
SupportStaff
Message Example: Dose Warning
Message Example: Request to Schedule an Appointment
Category Hours Cost ($) % of Total Cost
Physicians 614 55,340 47
Operations research analyst 370 12,561 28
Research assistant 202 3,885 16
Nurse 58 1,873 4
Computer software engineer 40 1,692 3
Database administrator 17 597 1
Pharmacist 7 367 1
Total 1,308 76,314
Personnel Time & Costs
Linkages to hospitals, SNFs, outside labs Scheduling system integrated within the
EMR Real time access to claims for dispensed
drugs Locally written interface engine application EMR with a flexible database Internal informatics expertise HIT-experienced physician leader
Technological Resources Required
Linkages to hospitals and labs through ADT and ORU interfaces
Information about dispensed drugs through Surescripts
Internal message delivery through commercially available interface engine
Options for Other Provider Groups
Feasible Requires strong internal informatics
expertise Cooperation from hospitals and SNFs Electronic linkages to external facilities Extensive physician time
Conclusions
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