Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review.
BACKGROUND
Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States.


METHODS
We performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care.


RESULTS
We enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management.


CONCLUSIONS
Significant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients' self-management goals, and tools to link patients and their caregivers with community resources.
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA. lsamal@partners.org.|Harvard Medical School, Boston, MA, USA. lsamal@partners.org.
Lipika
L
Samal
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.|Harvard Medical School, Boston, MA, USA.
Patricia C
PC
Dykes
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.|Harvard Medical School, Boston, MA, USA.
Jeffrey O
JO
Greenberg
American Medical Association, Chicago, IL, USA.
Omar
O
Hasan
Yale University School of Medicine, New Haven, CT, USA.
Arjun K
AK
Venkatesh
Partners Healthcare System, Boston, MA, USA.
Lynn A
LA
Volk
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.|Harvard Medical School, Boston, MA, USA.|Partners Healthcare System, Boston, MA, USA.
David W
DW
Bates
D022126:Access to Information; D000328:Adult; D017028:Caregivers; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D010359:Patient Readmission; D010360:Patient Transfer / Q000592:standards*; D036301:Qualitative Research; D012648:Self Care; D014481:United States
Care coordination; Care transitions; Electronic health record; Meaningful use; Readmissions