Problem
Columbus Regional Health, like all eligible hospitals in the U.S., sought an efficient solution to meet certain federal requirements for Stage 2 Meaningful Use, which requires eligible providers, eligible hospitals and critical access hospitals who transition or refer a patient to another setting of care or provider of care to provide an electronic summary of care (Transitions of Care, or Continuity of Care) document. This exchange of summary document must be sent regardless of which EHR the "next in line" provider uses.

Previously, Columbus Regional Health would have had to review within their EHR system every qualifying discharged patient and pull up their summary of care. They would then have to manually send it to that patient’s primary care physician for follow-up care. It was an inefficient and time consuming process.
Solution
IHIE came up with an elegant solution to send these CCDs by utilizing the organization’s DOCS4DOCS Service, which is used by nearly every single clinician in the state in some way. This solution, which is part of IHIE’s larger care coordination and population health services, serves multiple purposes for CRH: it supports their existing workflow, and enables them to far exceed the requirements laid out to send CCDs within Meaningful Use Stage 2.

Additionally, IHIE sends a monthly report to CRH that captures the CCD delivery rate, which serves to validate that they are meeting the requirements of this particular Meaningful Use Stage 2 requirements and is done because it’s just good for patient care.
Keywords
population health, population health reporting, Meaningful Use, Stage 2 Meaningful Use, Stage II Meaningful Use, interoperability, DOCS4DOCS Service, electronic medical record, EMR, electronic health record, EHR, care coordination, efficiency, patient-centered care, Continuity of Care Document, Continuity of Care Service, transitions of care, DIRECT, eligible providers, eligible hospitals, critical access hospitals, Transitions of Care, CCD
Identifier
Carol Burrows
Columbus Regional Health
Clinical setting: Population Health
Benefits
  • Meets Meaningful Use Stage 2 requirements
  • Works within existing workflow
  • IHIE has worked with customers to streamline information in the CCD, making it more useful
Quotes

The Continuity of Care service is a very smooth operation.

The Continuity of Care Service saves us a bunch of time and resources. They’ve really done their clients a favor.

Case Study

Situation:
Jill, a woman in her 50’s is prescribed a blood thinner by her primary care physician. She becomes ill with pneumonia and is hospitalized. At the end of her hospital stay, she receives her discharge medication orders, but at a different dose than what was prescribed by her physician.

Benefits:
When her physician receives a continuity of care document from the hospital, he notices that she was given instructions to take double the amount of blood thinner medication her primary care doctor prescribed. The CCD enabled Jill’s physician to make sure the error was corrected and avoid potentially serious consequences to the patient.

What it Means:
Proper transitions of care, when patients move from one setting to another, is one of the most difficult hurdles in healthcare to overcome. Researchers have estimated that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.