Academic journal article Generations

Health Information Technology: A Path to Improved Care Transitions and Proactive Patient Care

Academic journal article Generations

Health Information Technology: A Path to Improved Care Transitions and Proactive Patient Care

Article excerpt

Care transitions can be problematic and costly-even perilous-to older patients. Can a concerted investment in health information technology smooth the path toward better care?

While receiving healthcare services, people are often required to move from setting to setting: from a hospital to home, from a primary care doctor to a specialist, from a nursing home to a hospital. In much of the U.S. healthcare system, and particularly for older adults, such transitions between care settings can be unpleasant-even dangerous-and can lead to poor health outcomes and increased costs (Jencks, Williams, and Coleman, 2009; Coleman and Berenson, 2004).

Health information technology (IT) offers potential solutions to many of the key problems that occur during transitions of care, such as lack of coordination between care providers or challenges accessing the right information at the right time. Health information technology and care transitions have received increasing national attention and have benefitted from significant federal and private investments. This article presents a discussion of the status of health IT in the United States, and technology's role in improving care transitions. We describe a multi-sector effort to promote high-quality, IT-enabled care transitions that led to a 2011 national meeting, "Putting the 'IT' in Care TransITions," and subsequent ongoing efforts.

The Advent of Health Information Technology

Over the past twenty years, IT has transformed the way people interact with the world. However, the healthcare sector is in the early stages of realizing IT's benefits and its potential positive impact on healthcare quality (Bates and Gawande, 2003; Buntin et al., 2011). Electronic health records (EHR) adoption has dramatically increased over the past four years; more than one-half of office-based physicians (55 percent) have EHRs today, up from 17 percent in 2009 (Jamoom et al., 2012). However, the one-third who have EHRs may find their EHRs lack basic but important features such as access to laboratory and imaging results or computerized physician order-entry technology (Decker, Jamoom, and Sisk, 2012).

The federal government has made substantial investments over the past decade to promote health IT adoption among providers and build a supportive national infrastructure. To coordinate national efforts and direct investments, the Office of the National Coordinator (ONC) for Health IT (situated in the Department of Health and Human Services) was created in 2004 through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. With support of the HITECH Act over the past two years, the healthcare delivery system, providers, consumers, technology developers, and innovators have made tremendous progress in improving healthcare through computerization and digital networks (see www.healthit.gov).

At the same time this investment was being made in health IT infrastructure, the federal government, the healthcare sector, private philanthropy, and other stakeholders were increasingly focused on transitions between care settings because of their link to costly, dangerous, and avoidable hospital re-admissions. National advocacy groups have formed, such as the National Transitions of Care Coalition and the Long Term & Post Acute Care (LTPAC) HIT Collaborative. The federal government has dedicated large investments in this area, including the $500 million community-based care transitions program (Section 3026 of the Patient Protection and Affordable Care Act) and the $500 million federal safety effort known as Partnership for Patients, which also addresses transitions of care. In 2010, the Administration on Aging, now part of the U.S. Administration for Community Living, funded the spread of evidence-based transitions models that link medical care to the aging network's social supports and services.

In the private sector, a core group of foundations has had a long history of funding local, regional, and national efforts to improve care transitions. …

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