In my last post, I outlined the need for Health Record Portability as well as the obstacles to its widespread implementation.  However, there are a few inroads being made.  Here are some of those initiatives.

From the healthcare provider viewpoint, some communities have launched their own Health Information Network (HIN) that enables community physicians, hospitals, labs & other healthcare providers to share their information. You can think of it as a healthcare information utility that supports health information exchange.  This sharing is always dependent upon the consent of the individual patient.  One example with which I am familiar is the East Tennessee Health Information Network (etHIN) in Knoxville, Tennessee.  The hospital systems & physician practices pay a fee to etHIN to be able to share their patients’ health information.  One feature that would have helped me to keep track of my pneumonia vaccine is a Vaccination Gateway that etHIN provides.

But what can you do as a patient, especially if you live in a community without a health information network?  From a non-technological perspective, you can keep paper copies of your medical record.  Usually you’ll want to organize them by practice or medical issue, but if you have some condition that gets monitored by some lab test, you’ll want to group them together.

There is a more modern approach that you may want to consider if your physician’s EMR system supports it.  Microsoft has a free cloud storage application called HealthVault that can help you manage all your electronic medical information in one place.  Once you set up your account, you can ask your physicians (past and present) who use an electronic medical record to send your files to your HealthVault account.  Not all EMRs can provide your records in a format compatible with HealthVault.  It is far from perfect, but it is a beginning.  Hopefully we will see more EMRs that are compatible with HealthVault in the years to come.  You can also upload any records that you have scanned into your computer. A great feature is the ability to create an Emergency Medical Information card that includes your allergies, medications you take, health conditions you have and emergency contact information.  It also has access information so an Emergency Room physician can view your HealthVault record.  It can be folded to fit in your wallet or purse.

Next time I’ll share some examples of situations I’ve encountered where health information sharing just hasn’t worked and, in a later post, some possible ways to prevent these problems.  As always, please share your thoughts and comments.

For Your Health – Dr. Bob

So how can a hospital readmission prevention program actually work?  Over the next few posts I’ll look at each of the three components.  In this one I’ll cover Patient Identification & Prioritization.

It’s important to identify patients as close to the time of their discharge from the hospital as possible.  When a physician cares for his patients in the hospital, he clearly knows the discharge date so he can communicate it to the Readmission Prevention Program.  But it has become more and more common that the primary care physician does not see his patient in the hospital when they have been admitted.  In his place, a hospitalist does the inpatient management.  In this situation, how do the physician and Readmission Prevention Program learn about the patient’s hospitalization and discharge?

• The hospitalist could call or e-mail them, but that’s not very efficient.
• Sometimes health insurance companies have Readmission Prevention programs for non-Medicare patients.  They may have a staff person at the leading hospitals to identify patients that are being discharged.
• Alternatively, the health plan may call discharge planners at the hospitals to learn about their health plan members who have been discharged.
• In more and more locations, Health Information Networks (HIN) are being set up to enable one health care provider to share information with another. The patient needs to authorize the HIN to share their information with the health care providers that care for the patient.   But once that’s done, the hospital’s information can be passed to the PCP’s office and the Readmission Prevention Program.
• In our ACO, one of our hospitalists has developed a hand held application that automatically sends e-mails to the PCP and the Care Coordinator with the Readmission Prevention Program when the hospitalist sends a patient home.

As far as Patient Prioritization or Stratification, some of these Readmission Prevention Programs use clinical criteria, such as the reasons for the hospitalization to determine which patients should be contacted after hospital discharge.  Sometimes a scoring system is used, but that depends on someone at the hospital scoring the patient and that score getting transmitted to the Readmission Prevention Program.  A very popular readmission risk scoring tool is the LACE Tool which calculates a score based upon,

• Length of stay – how long the patient was in the hospital.
• Acuity – whether the patient was a hospital inpatient or not.
• Co-morbidities – how many other diseases the patient has.
• Emergency room visits – the number of these visits in the past 6 months.

A score over 10 indicates that the patient has a high likelihood of readmission and should be contacted promptly after he is sent home.

In the next post I’ll talk about what is covered in the Outreach component of these Readmission Prevention Programs.

For Your Health – Dr. Bob