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