While healthcare is constantly evolving with new technology like artificial intelligence, electronic health records and blockchain, the cost of preventable hospital readmissions and adverse events continues to burden the system.
Continuity of care presents some of the toughest challenges. What happens to a patient when they leave the emergency department or get discharged? What’s become increasingly clear is that as a patient transitions between care settings and providers, a lot can go wrong. It comes down to the fact that there is no replacement for data integrity.
Mishandled care transitions hurt outcomes
Transitions in care are fraught with pitfalls. Often they’re rushed and communication between all parties may not be clear. Coordination of care can fall to the patient, who may be groggy, confused or just not up to the task. Transitions that don’t go as planned can lead to:
• Inconsistent patient monitoring
• Ordering of duplicate tests
• Medication errors
• Lack of follow-through on referrals
• Delays in diagnosis or treatment
Not only do these issues increase costs, they also contribute to poor health outcomes and hospital readmissions.
Data issues cause delays
Although it sounds counterintuitive, breakdowns in care transitions often have nothing to do with how the patient is treated. Rather they stem from a data problem. Before a health system can refer a patient to a particular provider, it has to verify the information about the provider to whom the patient is being referred. That data, unfortunately, is often incomplete or incorrect, especially if the patient came in through the emergency department. The patient may not have been able to provide complete information about his or her primary care physician at admission.
Additionally, provider data quickly goes out of date. Inaccurate information for providers brings the transition process to a hard stop. While there is no replacement for provider data integrity, many hospitals shy away from outside data due to interoperability and the challenges that come with integrating third-party data into existing clinical workflows and electronic health record (EHR) systems.
When a health system refers a patient, an employee must often dedicate substantial time to sorting through and manually validating providers, locations and credentials using Google and other publicly available resources. The verification process is time-consuming and often results in delays.
A lag or lapse in the verification process puts a hold on the patient’s treatment, medication and follow-up, and causes a breakdown in communications between providers, the patient and the health system.
Fix bad provider information
A major contributor to inaccurate provider data is that hospitals and health systems are not in the data management business. They often lack dependable source information, the technology and the human resources to keep constantly changing provider data current. But, there is a solution. A health system can link its electronic health record system with a referential database, instantly improving the accuracy of its provider data.
The master referential database provides up-to-date, deep-data coverage, with drill-down attributes such as practice addresses across all practice locations, phone numbers, fax numbers, email addresses, practice affiliations, state license(s) and other credentials, such as NPIs and DEA numbers that easily plug into an existing EHR.
A trusted source of truth
A provider referential database differs from a health system’s own records in that it is continuously updated with data points built on data sources covering:
• Hospitals, long-term care facilities, medical group practices, clinics and other relevant organizations
• Healthcare practitioners, such as physicians, RNs, LPNs, NPs, PAs, dental practitioners and ancillary providers
• Integrated Delivery Networks and Accountable Care Organization hierarchies
The referential database is a trusted source of truth that improves and evolves daily by constantly ingesting, verifying and integrating incoming data, including proprietary data collection and outreach findings. In addition, it spans all providers who may interact with a patient, whether they are employed or credentialed by the health system or are independent providers or competing providers.
Speed up the transition process
For health systems using a referential database, access is integrated into the normal workflow. Verifications no longer have to go through multiple people and manual research. The updated data is back in the system immediately and the process flows smoothly.
Transitions of care then become increasingly seamless. Follow-up treatment can take place promptly and all concerned parties are kept in the communications loop.
Accurate provider data results in:
• Prompt discharges
• Efficient use of resources
• Good patient and caregiver experiences
• Continuity of care between hospital, health system and providers
Meet PI objectives
In addition to improving efficiency, accurate provider data can help health systems and their referring partners meet CMS Promoting Interoperability (PI), formerly known as Meaningful Use objectives. These PI objectives state that eligible hospitals and eligible providers who transition their patients to another setting or provider, or who refer their patients, should provide a summary care record for their patients.
Timely sharing of vital patient information better informs decision making at the follow-up point of care and helps prevent duplicate testing, medication errors and hospital readmissions.
Make transitions seamless
Improving care transitions is a critical component in ensuring the delivery of quality care. Smooth transitions improve the patient’s experience and strengthen relationships with referring physicians. They also reduce the cost of healthcare for patients and payers in keeping with today’s value-based models.
Transition planning is most effective when hospitals, community providers and referring physicians work together to coordinate care for patients. Accurate provider data is fundamental to that process.
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About the author:
Dara Price-Olsen is Senior Director, Product Management, responsible for the Provider Data Intelligence Suite at LexisNexis, which includes all provider information related products and services offered by LexisNexis. Dara joined LexisNexis via Enclarity, where she was part of the original inception team in 2005. Through Enclarity, Dara helped define, design, implement, and innovate the original Enclarity provider data accuracy focused Products.
Prior to LexisNexis, Dara was a product management director at FICO. She was the manager of the Data Management organization at the former Northwest Airlines. And before that, she spent ten years at Accenture where she managed large-scale custom development projects for multiple health care, utilities, transportation, financial services, and automotive companies.
She holds a Bachelor of Science degree in computer engineering from Iowa State University.
LexisNexis® Health Care offers a continuum of solutions for healthcare provider data and data management. It encompasses the LexisNexis® Provider Data MasterFile™, the industry’s golden record for health practitioners. For more information, please visit www.risk.lexisnexis.com.