1. Assessing theValue of Electronic
Communications in Improving Care Transitions
Shan Xie YuehwernYih
PhD student
School of Industrial Engineering
Professor, School of Industrial Engineering
Associate Director, RCHE

2. Introduction
“care transitions" refers to the movement patients make
between health care practitioners and settings as their
condition and care needs change during the course of a
chronic or acute illness.
– Eric A. Coleman
Example:

3. Introduction
 Unfortunately, these transitions do not always go
smoothly.
 Ineffective transitions can pose potential risks to
patient safety and lead to undesired health outcomes.
Communication breakdown

4. Introduction
 Heath Information Technology (HIT) has been
recognized by National Quality Form (NQF), the Office
of the National Coordinator for Health Information
Technology (ONC), and Agency for Healthcare
Research and Quality (AHRQ) to provide unique value
in improving care transitions.
 Evaluate the HIT systems, fully realize its capacity,
barriers to its implementation and how well it is
adapted and integrated to fulfill its intended purpose.

5. Pilot Study
 Michiana Health Information Network (MHIN), South
Bend, IN
 MHIN has contracted with Indiana Health Information
Technology (IHIT) to pilot a care transitions program.
 Implemented three electronic communications.
 Two hospitals and nine skilled nursing facilities (SNFs)
in Indiana state have participated the pilot since early
2014.

6. Electronic Communications
Direct Messaging Electronic Referral
Template
PowerChart View
(Available at SNFs)
 Secure exchange of patient
health information.
 Adopted as key information
exchange technology by the
Office of the National
Coordinator for Health
Information Technology.
 Its use is being financially
incentivized by CMS in
Medicare reimbursement to
healthcare providers.
Information pulled from EHR, save
as PDF file and attach to Direct
Messaging
 Most Recent Chest X-Ray
 Consults
 History and Physical
Examination (H&P)
 Medication List
 Therapy Notes
 Wound Care
 Cardiac Caths
 Echocardiograms
 Consultations
 Discharge Summary
 Emergency Room Report
 EKGs
 History and Physical
 Labs
 Operative Reports
 Radiology Reports
 Provider Progress Notes
 X-Ray Reports

7. Objectives
 Assess the effectiveness of electronic
communications in improving transitions of care.
 Identify opportunities to use the tools most
effectively within the current care provider
communication process.

8. Project Scope
I. Document the referral process pre and post-implementation based on the
following dimensions.
1. Clinical content
2. Format of information
3. Roles and responsibilities
4. Workflow
II. Evaluate the effectiveness with the following measures.
1. Time takes to perform the tasks
2. Completeness of transferred information
3. Security
4. User satisfaction

9. Method
 Semi-structured interviews were conducted with one
hospital, and six SNFs.
 10 people were interviewed: one social worker
manager, one social worker assistant, four clinical
liaisons, and four staffs in the admission office of
SNFs.
 The interviews were between 35-45 minutes and
were audiotaped.

10. Results – Workflow (Pre with CL)

11. Results – Workflow (Post with CL)

12. Results – Task Time (Assistant)

13. Results – Task Time (Clinical liaison)

14. Results – Workflow (Pre without CL)

15. Results – Workflow (Post without CL)

16. Results – Task Time (Assistant – no CL)

17. Results – Task Time (SNF)

18. Results
 Long medication list generated by the electronic referral template.
 Face sheet and 72-hour report are not integrated in the electronic
referral template.
 Dietitian notes, chest x-ray and history and physical examination are
not always included.
 Social worker call back information is not always included.
 No section break for the referral report.
 The roles of responsibility did not change as it suppose to be.

19. Conclusion – Benefits
Time saving
 For the social worker assistant (printing time, faxing time and search
for fax machine).
 For Clinical liaison – readily available, no need to find the patient chart.
Less dependent on others
 Clinical liaisons are less dependent on social workers and their
assistant ( get information from Powerchart).
 Social workers can spend more time with patients without being
interrupted by others seeking information.
 Information is available to multiple people at the facility.
Eco Friendly - less paper printing.
More secure - with fax: wrong person pick up the fax, loss of information
and potential breach of patient information privacy.

20. Conclusion – Lessons Learned
 Variance in technology adoption.
 Staff turnover.
 Receiving information from multiple modalities (Direct, fax, e-
fax, Powerchart).
 Improved time efficiency, but maybe higher cognitive workload
for clinical staff.
 Value adding activities. E.g., still communicate with social
worker to keep good relationship.
 Not everyone fully understands the functionality of the tools.
 Not everyone who were trained are actively using the tools.
 System reliability (time lag in receiving email alerts).

21. Thank you!
Questions?