Patient handoffs to post-acute care providers still largely a manual process, hindering effective care coordination

There is a big push both from the private market and federal policymakers to improve interoperability and open up access to health data through smartphone apps and other digital tools.

But on the front lines of healthcare, the way patient information is shared remains largely a manual process done through a combination of faxes, emails, phone calls and paper records, according to a recent study on transitions of care.

The chief medical officer of one hospital admitted that "the routine is patients leave with an envelope full of their chart, and we don't have shared EHRs," according to the report from PointClickCare, a cloud-based electronic health record (EHR) vendor.

The report is based on a study of C-suite executives from long-term and post-acute care (LTPAC) facilities who provided their perspectives on data sharing and concerns about interoperability and other pain points in care delivery and coordination. 

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In all, 36% of acute care providers use manual-only strategies to coordinate patient transitions with the LTPAC providers, compared with only 7% of LTPACs with acute care providers, according to the report.

Approximately 62% of post-acute care facilities rely on phone calls between case workers to transfer patient information and other clinical details. Nearly half (49%) of acute care providers rely on email and fax to share data compared to 31% of post-acute care providers.

Manual methods are inefficient and are prone to mistakes, mismatched details and omissions, the report said. Acute and post-acute facility executives acknowledge that reliance on manual processes hinders effective care coordination and quality of patient care.

“Sending a patient to a facility that doesn't have a good intake process is a reflection on us,” said one hospital chief information officer, according to the report. 

When patients have to be readmitted, the paperwork problem happens in reverse, with emergency department personnel relying on paper instead of complete information about care provided at the post-acute care facility and the reasons for the transfer.

Only 11% of acute care providers use an integrated EHR, the study found, and only 2% of acute care and LTPAC providers are primarily using IT-driven strategies to coordinate patient care and transfer data.

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"There is a lot of talk around how do we optimize care coordination and transitions between venues of care but there is still a lot of manual, paper-based, non-effective processes happening that shows there are opportunities to break down silos," B.J. Boyle, vice president and general manager of post-acute insights at PointClickCare, told FierceHealthcare.

Boyle said there is a misconception that skilled nursing facilities have not adopted health IT. A 2017 data brief (PDF) from the Office of the National Coordinator for Health IT reports that 64% of skilled nursing facilities use EHRs.

Most post-acute care providers (84%) use a combination of manual and IT processes to share data compared to 56% of acute care providers. More than one-third (36%) of acute care providers do not track patients after they are transferred to a post-acute care provider.

In the report, a post-acute center CEO complains about the reliance on faxes as the main method for care coordination: "When you get a 70-page fax and only four or five pages of it are relevant to anything, it's a waste of time on both sides of the equation."

The study comes as skilled-nursing facilities are staring down the impending patient-driven payment model mandated by the Centers for Medicare & Medicaid Services set to go into effect in October, which will shift reimbursement to a value-based model.

“Our healthcare system is approaching a critical time in which the ‘silver tsunami’ will drive baby boomers into hospitals and post-acute care facilities in record numbers. That combined with the nursing shortage, razor-thin margins, the need to reduce hospital readmissions and increased government regulations are all creating the need for technology that can deliver best practices for improving patient care," Boyle said.