321450
Follow-Up Care Using Health Information Technology After a Hospital Discharge
To describe literature on health information technology (HIT) supporting well-coordinated follow-up care
study design
2-stage systematic-scoping literature review. Stage 1 was an ad hoc review by a clinical expert, included 29 articles and produced conceptual model and search terms. For Stage 2, searches conducted on MEDLINE, EMBASE, Cochrane Library and PsycINFO on publications 1960 – 2014. Of the 400 articles related to HIT, 81 were included. The work was part of a national measure development project.
principal findings
The literature was not robust enough to support a review limited to follow-up in either pediatric or mental health, therefore the general review was not restricted to children or mental health. Perceived opportunities for HIT to support follow-up care include: Enhancing communication between clinicians within and across disciplines and health systems; promoting follow-up; supporting bidirectional communication and patient engagement, while protecting confidentiality and privacy.
Limited data evaluate potential improvement in communication or follow-up. Data confirm the value of patient reminders and suggest human interactions (phone calls) perform better than electronic transactions (text reminders). The capacity to email the clinician enhanced patient satisfaction, however, reduced outpatient visits. Clinicians preferred limited emails due to non-reimbursement. One study found that patients able to access their records electronically did: 80% read notes; 70% of those reported they understood what they read; while 67% reported increased adherence to medications.
Various surveys of system capacities found that there are multiple providers of HIT systems and that platforms do not communicate well with one another. Clinicians who work across multiple platforms report challenges due to lack of standardized user interfaces.
Key technical challenges remain, including interoperability of systems, standardization, and data protection. Non-technical challenges include enhancing design, producing systems that work across patient populations with varying degrees of health literacy, and developing common, pragmatic, and thoughtful policies regarding sharing information.
conclusion
Little evidence exists that HIT currently improves the quality of follow-up care. Challenges remain regarding interoperability across healthcare organizations and platforms. Privacy and confidentiality protections are not consistently resolved. Challenges regarding sharing clinical information between clinicians across organizations include overly restrictive policies that work against coordination of care.
policy implications
For HIT to enhance follow-up care it will need to solve interoperability issues across platforms. While cloud computing offers opportunities’ it also raises privacy concerns. The greatest short term opportunity may relate to enhancing patient-clinician engagement. More research is needed specific to the pediatric and mental health populations.
Learning Areas:
Clinical medicine applied in public healthLearning Objectives:
Describe literature on health information technology related to supporting well-coordinated follow-up care
Keyword(s): Quality of Care, Information Technology
Qualified on the content I am responsible for because: I am a primary care research fellow who has conducted prior and continuing work on emergency department use and quality of care received. My interest in follow-up care has a quality component in terms of integrated coordination and continuity of care regarding the disposition of a discharged patient
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.