When a hospital sends a patient to a nursing home or rehab hospital, or vice versa, staff on the receiving end often find themselves calling the sender for patient records that never made the trip.
It can be frustrating, time-consuming and even unsafe. And those sending the patients may not even realize it.
“Sometimes it can take hours,” said Pauline Fleury, a veteran nurse and staff development coordinator at Holy Trinity Nursing and Rehabilitation Center in Worcester. “That's hours that the patient isn't getting his antibiotics.”
Jason Cote, a licensed social worker at Beaumont Rehabilitation and Skilled Nursing Center in Westborough, knows the reality all too well.
“There's always a possibility that something isn't forwarded to you,” Cote said. “It's a universal challenge we're all trying to improve upon.”
And it's not that staff members at area institutions aren't familiar and even friendly with each other on the phone, but a little inefficiency for thousands of patients eventually adds up.
So what if all the providers got in a room and talked to each other about it?
That's what's happening with a medical records pilot program launched last year.
“I was shocked by how much I learned as a physician that I didn't realize,” said Dr. Lawrence Garber, director of medical informatics at Reliant Medical Group, who is leading the collaborative effort of 16 Worcester County nursing homes, health care centers, hospitals, nursing associations and physicians groups.
For example, Garber said he had no idea that when he sends a patient with an intravenous line to a nursing facility, staff there need an X-ray of the line to verify proper placement, allowing them to use it to administer medication. That X-ray could have been easily sent along with the patient, but because they don't receive it, nursing homes often order a second X-ray, wasting time for the provider and money for the insurer.
Cote, of Beaumont, was also struck by the in-depth discussion.
“It was a real core discussion about what each of us needed to provide the best care we can,” he said.
Garber said other information as simple as infectious disease risks posed by a patient, or special supplies a patient might need, is often not communicated between providers in general.
“Information is not being transmitted when it's needed, the wrong information is sometimes being transmitted, and as a result of that, patients are being harmed,” Garber said.
But the state hopes that will change as a result of the IMPACT pilot, which stands for Improving Massachusetts Post-Acute Transfers.
The 16 providers have started to use a new form that contains three times as many data points as the standard form hospitals in the state and across the country have been using for decades.
It sounds simple enough. But poor sharing of information has been going on for years.
“Why didn't we do this sooner in health care?” Fleury, of Holy Trinity, asked. “We're all here for the same reason — for the patient.”
Better data collection and record-sharing would be an effective exercise on its own, but state officials have a higher mission in mind.
As the state pushes toward a fully electronic medical record, from which patient records can be shared between providers with the click of a button, providers are realizing that the records that will be shared must be useful.
“It's the value of getting the right information at the right time,” Garber said. “If you don't find the value in electronic medical records, you're not going to implement it.”
Ultimately, the standards being developed here in Central Massachusetts could be adopted at a national level, said Garber, who is also a member of a national workgroup developing standards and interoperability framework for the federal Department of Health and Human Services.
Laurance Stuntz, director of The Massachusetts eHealth Institute, said officials there will use what they learn from the pilot to talk to software vendors that will build the state's electronic network. Having a predefined set of data to program into the system that are proven to be effective will give vendors confidence.
Stuntz said he expects the electronic network to be an important piece of whatever version of health care payment reform the state eventually passes.
Each of the 16 Worcester County groups has a varying level of in-house electronic medical records systems.
At Reliant, with its early adoption of electronic records, getting the additional information on each patient was not that difficult.
“We were able to locate where most of the 300 data elements were within our (system)] so that literally, with the press of a button, we were able to print out a report that had all of the data elements,” Garber said.
At Trinity, paper records are still the norm, though Fleury said they hope to install an electronic system soon.
And Fleury said her nurses are excited to transition from a paper-based to an electronic system in the next six to eight months. It will save them time and frustration and help them better provide for their patients.
“The nurses are ecstatic,” she said.
For VNA Care Network and Hospice in Worcester, which also has an electronic medical records system, the work was a bit more time consuming, said George Richardson, the provider's chief information officer.
“In our case it was a mix,” Richardson said. “We do have an electronic record. But we do not capture all of the elements all of the time in every situation.”
Richardson said the pilot has developed him a good idea of the changes that need to be made in VNA's record system.
“The paper process was tedious at time, but it was definitely necessary,” he said. “It's where we need to go.” n
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