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Using IT in Transitions of Care: Don’t Let Perfect be the Enemy of Good

June 5, 2014
by Gabriel Perna
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The epicenter of the work to improve care transitions and reducing readmission rates might just be located in the shadow of the Rocky Mountains.

Specifically that epicenter is Denver, Colo., home to the University of Colorado's Health Sciences Center. This is where the Care Transitions Intervention program was developed in the mid 2000s by Eric Coleman, M.D., professor of Medicine and head of the Division of Health Care Policy and Research at the University.

In its initial pilot run, the program, recognized by Health Affairs as influential and “widely disseminated”, helped reduce 30-day readmissions by 30 percent and 180-day readmissions by 17 percent at the locations within the health system. It cut costs by nearly 20 percent per patient and according to Health Affairs was adopted by more than 700 organizations worldwide.

Naturally, replication was followed upon in Coleman’s home state. In 2008, the work from that initial pilot was further developed into a program through the Colorado Foundation for Medical Care (CFMC), the Medicare Quality Improvement Organization (QIO) for the state. Like the initial pilot, that work was successful, reducing readmission rates by 10.78 percent in northwest Denver. By the time the Centers for Medicare and Medicaid Services (CMS) required every QIO to work on integrating care across providers, Colorado was ahead of the game.

Thus, it was no surprise that CMS funded CFMC to lead the Integrating Care for Populations and Communities (ICPC) National Coordinating Center (NCC). Jane Brock, M.D., MSPH, medical director at Telligen [the company that recently acquired a substantial portion of CFMC’s business], is helping lead the center, which supports QIOs in achieving their goals in improving care transitions and reducing avoidable readmissions for Medicare beneficiaries.  Having worked in this environment, Dr. Brock can certainly share wisdom on how to improve care transitions and reduce readmissions.

“We now a lot know about how to better support people during a transition of care. We need to ensure there is a verbal care plan being enacted across a variety of settings,” Brock says.

On July 23, 2014, at the Hyatt Regency Denver Tech Center, Brock will talk about what she has learned in transitions of care and reducing readmissions as one of the keynote speakers at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2). (Since December 2013, iHT2 has been in partnership with Healthcare Informatics, through its parent company, the Vendome Group, LLC.)

Jane Brock, M.D., MSPH

During Brock’s keynote, she will broach where IT fits into transitions of care and what conceptually needs to be done to get the most out of health IT in this setting. The way she sees it, many end-users and developers are too focused on the big picture when it comes to health IT products.

“Historically, we’ve been trying to enact the perfect, finished solution and sometimes that has stood in the way of simpler steps,” Brock says. “There are incremental things that could be put into place while we work on perfection, and yet the work on perfection is so overwhelming that sometimes we let perfect be the enemy of the good.”

Brock cited two examples. When her team began to work on coordinating care and reducing readmission rates, she wanted an electronic bulletin board for basic communications between providers. She says that never happened because of work being done on full interoperability and health information exchange.

There were similar frustrations when she tried to lead an initiative that would better incorporate social notes into the electronic medical record (EMR). In most EMRs, she says medical and social notes were documented in different parts of the record and the latter is not visible to the receiving providers.

“Many of those things have been solved now but it has taken a while,” Brock says, adding that the promise of IT is rooted in standardizing many things that have never been standardized.

In many cases, Brock notes that QIOs are putting in direct communication structures between providers because the IT is too complicated or not available.  This kind of work reflects her own view on how health IT should fit into transitions of care, comparing it to a car: “You want your car get from here to there and it’s not relevant to understanding how it works.”

When IT succeeds in this regard, it can provide a great deal of seamless help for providers. Brock used the example of an electronic tool created by CMS to ensure consistent, standardized assessments of beneficiaries across settings, which can cut down on duplicative work being done.

Down the line, Brock expects health IT tools to evolve so they work in the background and assist transitions of care seamlessly. While the contract for the center from the original funding runs out in July of this year, she says CMS intends to continue the program.

To learn more about Data-Driven Medicine please check out the Health IT Summit in Denver, July 22-24, sponsored by the Institute for Health Technology Transformation