Event Notification EHR Integrations May Promote Primary Care Coordination

Primary care teams at two Veterans Health Administration (VHA) medical centers found an event notification EHR integration for admissions and discharges improves care coordination, according to a new study published online in JAMIA.

Care coordination is key to ensuring high quality treatment. Currently, when patients are discharged from an ED or hospital in one system, their records are often not updated with the patient's primary care physician. This means that in some cases months can go by before providers learn of the health event from a patient themselves.

This can be a particular challenge in the VHA, where patients get their care from a VHA provider but sometimes visit non-VHA hospitals.

Researchers integrated an event notification for non-VHA hospital admissions and emergency department visits into the EHR, then assessed the EHR integration’s impact on clinical workflows through 23 semi-structured interviews with VHA primary care team physicians, nurses, and medical assistants.

The research revealed that primary care team members found the alerts necessary and effective for supporting timely follow-up care and bridging information gaps.

However, some respondents expressed concern over distinguishing event notification alerts from other VHA notices. Participants also suggested several improvements, including additional data on patients’ diagnosis and discharge instructions, as well as timing alerts to patients’ discharge with clear next steps.

“Participants’ most frequent request was for more patient information including discharge summaries, which may be particularly important if a patient’s diagnosis differs from their complaint upon admission,” the study authors explained. “Test results, progress notes, prescribed medications, and recommended follow-up care may also be helpful.”

“While our notifications were not designed to provide these details, in future, alerts could potentially be linked to discharge summaries or other clinical information to save clinicians a step in the follow-up process,” they continued. “Our findings also suggest streamlining alert access and delivery will improve integration into primary care teams’ workflow.”

Respondents also called for event notifications to be sent out to additional team members to ensure providers act upon alerts. Additionally, physicians and RNs requested ways to prioritize alerts by urgency and include multiple notification modalities.

For example, one physician suggested alerts could operate like campus safety notifications, where “you get an e-mail, you get a phone call, and you get a text. It’s hard to miss that.”

Brian Dixon, PhD, MPA, study senior author and the Regenstrief and Indiana University Richard M. Fairbanks School of Public Health at IUPUI director of public health informatics, noted that while the study examined VHA facilities, many healthcare organizations across the country lack interoperability for care coordination.

"While our study focused on patients whose primary care was provided in the VA system, this is an issue faced by patients and their providers in many, if not most, healthcare systems in the United States,", said in a press release.

"The majority of Americans rely on their primary care physician to coordinate care of medical specialists and hospitalizations,” said Dixon. “They expect their doctor to know about their care, but most of the time, that's not happening.”

As VHA expands access to community-based care, interoperability between VHA and non-VHA providers will become even more vital to efficient, high quality care delivery, the authors noted.

“Future intervention studies should explore the optimal amount and types of information and delivery to make notifications most useful for providers and patients, site-specific characteristics and needs, and the potential of integrating alerts into broader care coordination efforts for high-risk patients,” the researchers concluded.