Closing communication gaps to enable value-driven care

Luis Castillo, CEO of Ensocare -

As patients progress through various care settings on the road to recovery there are often gaps in communication between healthcare providers.

Despite the best intentions of care providers, the transition process remains predominantly manual with inefficient phone calls, faxes and the exchange of paper-based records. This can lead to poor care coordination, making it a challenge to fully participate in value-based care initiatives that emphasize the need for rapid and responsive cross-continuum interactions.

Moving beyond the traditional approach
Healthcare providers are still becoming accustomed to sharing information and effectively communicating with one another. Let’s face it, with the frenetic pace of the average healthcare provider’s day, if sharing information with other care settings and organizations isn’t simple and straightforward, it may not happen, and critical data may fall through the cracks.

With the emergence of value-based care and the rise in penalties tied to unnecessary readmissions, the concept of operating in siloes is no longer viable. Organizations must work together to ensure seamless care transitions, robust information exchange and interactive communication to achieve the best quality while reducing risk. There needs to be an infrastructure in place to support reliable cross-continuum dialog.

Building an infrastructure
The key to closing communication gaps is to create an adaptable framework that facilitates fast, easy and consistent information exchange. For example, organizations can leverage care coordination technology to unite patients and families with their acute, post-acute, home care and primary care providers—allowing the entire care team to directly communicate and holistically manage a patient’s recovery. More specifically, organizations can use this technology to establish a digital command center to which all care team members can connect. Within this virtual hub, providers can:

• share, revise, update and alter a patient’s care plan;
• monitor patient compliance with medication and treatment therapies;
• receive real-time updates on the patient’s condition;
• provide encouragement to help the patient stay on track; and
• know when to intervene if worrisome changes emerge.

Patients and families can use these tools to track appointments, access directions for medications, ask questions and upload information from Bluetooth-enabled devices, such as scales and blood pressure cuffs. Providers can even use these tools to share educational materials with patients to ensure they fully understand their conditions and how to manage them.

Think about how much tighter communication could be when a patient’s care team leverages this type of solution. All members could stay abreast of the person’s condition and collaborate on next steps toward wellness.

Expediting care transitions
Another area where communication can fall short is during care transitions between hospitals and post-acute providers. Remember the days when patients would arrive at post-acute facilities with their 100-page referral packet on their laps? Using care coordination technology, hospitals can now electronically send only the most relevant portions of the patient’s medical record to the post-acute provider ahead of the individual’s arrival. This easily digestible information helps the receiving organization quickly get up to speed on the patient’s care and line up any necessary medications and treatment therapies, preventing communication lapses, averting care disruptions and allowing for a smoother transition to the post-acute setting.

Making it part of every day
When employing care coordination technology, it is essential that it seamlessly integrates with other solutions, including electronic health records. For instance, staff should be able to access the aforementioned virtual command center and medical record sharing tool without having to leave one solution and log-in to another. The more this technology weaves directly into existing software, the more likely staff are to use it. This technology can even offer a mobile component, allowing providers access to information from their smart phones and tablets - enabling true care coordination while on the go. Because providers don’t have to be tied to their desks when receiving information, they can respond more quickly, which in some cases can mean the difference between a slight course correction that keeps the patient on track or a return trip to the hospital.

Embracing the change
Although healthcare organizations are still getting used to sharing information, there is no question that enhanced coordination and communication are necessary to survive in the emerging value-driven world. By developing a technological infrastructure to support smoother and faster collaboration, organizations can ensure they are working together to respond to patient needs and achieve the best possible outcomes.

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