Electronic medical records will enhance DP efforts
Electronically monitor asthma patients
Hospitals are beginning to see the trend of increasing use of electronic medical records (EMRs) as the national stimulus package funds and the health care reform act influence changes in health care practice.
Federal grants are helping to fund EMRs for physician offices, hospitals, and other providers. And the goal is to one day have an electronic health care data system that can be accessed by all of a patient's providers. As some larger health systems inch closer to this goal, the hospital discharge process is a beneficiary of the improved and more rapid ability to communicate during care transition periods.
"The cost of installing an electronic health record for the physician's office is starting to come down, and the federal government has huge stimulus money for doctor's offices," says Trude Haecker, MD, medical director of quality improvement at The Children's Hospital of Philadelphia (CHOP) and a clinical associate professor of pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.
"The government is pushing for us all to be electronic in a certain period of time," she says. "Many small and rural areas will have access to electronic health records, as well but we're not quite there yet."
As electronic technology use increases across the health care sector, care coordination during transitions will become easier, Haecker predicts.
"Having an electronic health record allows you to do some things you need an electronic registry for, like managing and being proactive in coordinating care," she says.
The electronic record can create medicine alerts and reminders, and it can use discharge templates that guide discharge planners through a protocol with evidence-based guidelines, she adds. There are particular advantages to using electronic records when hospitals discharge patients with chronic diseases. For example, CHOP is part of a state chronic care initiative regarding diabetes, Haecker says.
"The initiative we're participating in has given us an opportunity to have insurers participate, because they're really very interested in this, and they're thinking about how to rethink what they'll pay us as providers if we take part in a chronic care model," she explains.
The chronic care model can be applied to diabetes, heart disease, asthma, and other illnesses. These types of collaborations improve reimbursement and emphasize transition and discharge planning, which could result in some type of discharge planning reimbursement down the road. Chronic disease management results in fewer hospitalizations and emergency department (ED) visits, Haecker notes.
Pennsylvania health officials have a particular interest in reducing asthma-related hospitalizations because it's the most common medical reason for hospital admission in Philadelphia, she says.
"We know from the data that 26% of children in the city of Philadelphia have asthma," Haecker says.
With the assistance electronic records and medication alerts, a more aggressive approach to discharge planning has helped to decrease asthma-related hospitalizations and emergency department (ED) visits.
"In Pennsylvania, we've seen hospitalizations drop by about 15%, and ED visits drop by 10% for children with asthma," Haecker says. "It's made a big difference in our practices."
Children with asthma are monitored with the aid of an electronic tool that assesses whether the patient's condition is controlled, she explains.
"We know every child who is admitted to the hospital, and every child is given an asthma care plan that tells them how to manage their diseases," Haecker says. "They attend a class prior to discharge."
"We can assess lung function, and the tool helps you think about whether to increase the dose and steroid dosages," she says. "A lot of great physician support tools are built into our system, and they're worth their weight in gold."
The hospital's nurses and others answer calls from parents around the clock. They are able to do this because of the electronic health system. For instance, they can work at a home office, take the 10 p.m. call from a concerned parent, and immediately pull up the child's health record on a secure computer, Haecker says.
"The nurse can say, 'I see you were in the hospital two days ago and have a prescription for XYZ. Were you able to fill that prescription?'" she says.
Also, every child admitted to the ED receives a follow-up call. After discharge, the child's family is called and asked how things are going and whether the child is taking his or her medications, she adds.
"We say, 'We'd like to see you next week, so come in and bring your medicines,'" she says.
Electronic systems also can contain a wide assortment of patient educational materials, including instructions written in different languages or written at lower literacy levels. These are stored electronically and can be printed when a patient is being discharged.
For example, if a parent is concerned about environmental allergy triggers and how to prevent these, the discharge planner can print out a handout on cockroaches or dust or mold.
"We have thousands of handouts, and we try hard to make sure everything is at the right reading level," Haecker says. "Our goal is to give patients the right information, at the right reading level, and with the right services."
Source
Trude Haecker, MD, Medical Director Quality Improvement, The Children's Hospital of Philadelphia, and Clinical Associate Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA. Telephone: (267) 426-6063.
Hospitals are beginning to see the trend of increasing use of electronic medical records (EMRs) as the national stimulus package funds and the health care reform act influence changes in health care practice.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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