title: Care transitions as opportunities for clinicians to use data exchange services: how often do they occur?
abstract: BACKGROUND
  The electronic exchange of health information among healthcare providers has the potential to produce enormous clinical benefits and financial savings, although realizing that potential will be challenging. The American Recovery and Reinvestment Act of 2009 will reward providers for 'meaningful use' of electronic health records, including participation in clinical data exchange, but the best ways to do so remain uncertain.
  
  
  METHODS
  We analyzed patient visits in one community in which a high proportion of providers were using an electronic health record and participating in data exchange. Using claims data from one large private payer for individuals under age 65 years, we computed the number of visits to a provider which involved transitions in care from other providers as a percentage of total visits. We calculated this 'transition percentage' for individual providers and medical groups.
  
  
  RESULTS
  On average, excluding radiology and pathology, approximately 51% of visits involved care transitions between individual providers in the community and 36%-41% involved transitions between medical groups. There was substantial variation in transition percentage across medical specialties, within specialties and across medical groups. Specialists tended to have higher transition percentages and smaller ranges within specialty than primary care physicians, who ranged from 32% to 95% (including transitions involving radiology and pathology). The transition percentages of pediatric practices were similar to those of adult primary care, except that many transitions occurred among pediatric physicians within a single medical group.
  
  
  CONCLUSIONS
  Care transition patterns differed substantially by type of practice and should be considered in designing incentives to foster providers' meaningful use of health data exchange services.
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA. bobrudin@mit.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rudin
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Salzberg
authors.forename: Peter
authors.initials: P
authors.lastname: Szolovits
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008511:Medicine / Q000458:organization & administration; D058007:Physicians, Primary Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration; D014481:United States