Bridging the Chasm: A Systematic Review of a Shared Digital Platform to Automate ED Discharge to Primary Care Intake
Abstract
Background: Handover of care between the emergency department (ED) and primary care is a critical milestone that has been proven to be error- and communication-critical. Even in settings where electronic health record (EHR) usage is prevalent, there continues to be a deep digital divide between such settings. This continuity break creates discontinuous care, medication mistakes, lost follow-up on test results, and patient dissatisfaction, and is a resurgent gap in modern healthcare delivery.
Aim: The review paper presents and critically examines the concept of a shared digital platform to safely automate transfer from ED to primary care. The core function is the automatic conversion of a patient's ED discharge summary to an actionable, structured "to-do list" in their primary care electronic chart.
Methods: Grounded in an aggregation of existing literature, the review surveys evidence and theories regarding health information exchange (HIE), interoperability standards, workflow integration, and implementation science. It further offers a complete architectural framework for the intended platform and accounts for the chief human factors to its uptake.
Results: The analysis describes the platform's potential benefits, including increased follow-up adherence, improved care coordination, and reduced provider burdens. But it also suggests formidable challenges to be addressed, including technical interoperability, data privacy, redesign of workflows, and fiscal viability. The review concludes by discussing the policy and fiscal models required for widespread use.
Conclusion: By synthesizing current evidence, the review offers a seminal guide for healthcare systems, technology providers, and policymakers to close one of the longest-standing and riskiest gaps in patient care, transforming an interval of risk into one of coordinated care.
Full text article
References
Adler‐milstein, J., & Pfeifer, E. (2017). Information blocking: is it occurring and what policy strategies can address it?. The Milbank Quarterly, 95(1), 117-135. https://doi.org/10.1111/1468-0009.12247
Arbaje, A. I., Kansagara, D. L., Salanitro, A. H., Englander, H. L., Kripalani, S., Jencks, S. F., & Lindquist, L. A. (2014). Regardless of age: Incorporating principles from geriatric medicine to improve care transitions for patients with complex needs. Journal of general internal medicine, 29(6), 932-939. https://doi.org/10.1007/s11606-013-2729-1
Ballard, D. W., Kuppermann, N., Vinson, D. R., Tham, E., Hoffman, J. M., Swietlik, M., ... & Dayan, P. S. (2019). Implementation of a clinical decision support system for children with minor blunt head trauma who are at nonnegligible risk for traumatic brain injuries. Annals of emergency medicine, 73(5), 440-451. https://doi.org/10.1016/j.annemergmed.2018.11.011
Benson, T., & Grieve, G. (2016). Principles of health interoperability: SNOMED CT, HL7 and FHIR (Vol. 3). London: Springer.
Boussadi, A., & Zapletal, E. (2017). A fast healthcare interoperability resources (FHIR) layer implemented over i2b2. BMC medical informatics and decision making, 17(1), 120. https://doi.org/10.1186/s12911-017-0513-6
Brooke, J. (1996). SUS-A quick and dirty usability scale. Usability evaluation in industry, 189(194), 4-7.
Chishtie, J., Sapiro, N., Wiebe, N., Rabatach, L., Lorenzetti, D., Leung, A. A., ... & Eastwood, C. A. (2023). Use of epic electronic health record system for health care research: scoping review. Journal of medical Internet research, 25, e51003. https://doi.org/10.2196/51003
Everson, J., Patel, V., & Adler-Milstein, J. (2021). Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations. Journal of the American Medical Informatics Association, 28(4), 727-732. https://doi.org/10.1093/jamia/ocaa323
Grannis, S. J., Xu, H., Vest, J. R., Kasthurirathne, S., Bo, N., Moscovitch, B., ... & Rising, J. (2019). Evaluating the effect of data standardization and validation on patient matching accuracy. Journal of the American Medical Informatics Association, 26(5), 447-456. https://doi.org/10.1093/jamia/ocy191
Greenberg, J. K., Otun, A., Nasraddin, A., Brownson, R. C., Kuppermann, N., Limbrick, D. D., ... & Foraker, R. E. (2021). Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis. BMC medical informatics and decision making, 21(1), 161. https://doi.org/10.1186/s12911-021-01522-w
Griffey, R. T., Shin, N., Jones, S., Aginam, N., Gross, M., Kinsella, Y., ... & Kaphingst, K. A. (2015). The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study. Journal of communication in healthcare, 8(1), 10-21. https://doi.org/10.1179/1753807615Y.0000000001
Harrison, M. I., Koppel, R., & Bar-Lev, S. (2007). Unintended consequences of information technologies in health care—an interactive sociotechnical analysis. Journal of the American medical informatics Association, 14(5), 542-549. https://doi.org/10.1197/jamia.M2384
Hesselink, G., Schoonhoven, L., Barach, P., Spijker, A., Gademan, P., Kalkman, C., ... & Wollersheim, H. (2012). Improving patient handovers from hospital to primary care: a systematic review. Annals of internal medicine, 157(6), 417-428. https://doi.org/10.7326/0003-4819-157-6-201209180-00006
HL7 International. (2023). FHIR Release 4. https://hl7.org/fhir/R4/
Holmgren, A. J., Esdar, M., Hüsers, J., & Coutinho-Almeida, J. (2023). Health information exchange: understanding the policy landscape and future of data interoperability. Yearbook of Medical Informatics, 32(01), 184-194. DOI: 10.1055/s-0043-1768719
Horwitz, L. I., Meredith, T., Schuur, J. D., Shah, N. R., Kulkarni, R. G., & Jenq, G. Y. (2009). Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care. Annals of emergency medicine, 53(6), 701-710. https://doi.org/10.1016/j.annemergmed.2008.05.007
Hripcsak, G., Bloomrosen, M., FlatelyBrennan, P., Chute, C. G., Cimino, J., Detmer, D. E., ... & Wilcox, A. B. (2014). Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting. Journal of the American Medical Informatics Association, 21(2), 204-211. https://doi.org/10.1136/amiajnl-2013-002117
Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: a state of the science review. Journal of medical Internet research, 17(6), e148. https://doi.org/10.2196/jmir.4255
Klein, S., Eaton, K. P., Bodnar, B. E., Keller, S. C., Helgerson, P., & Parsons, A. S. (2023). Transforming health care from volume to value: Leveraging care coordination across the continuum. The American Journal of Medicine, 136(10), 985-990. https://doi.org/10.1016/j.amjmed.2023.06.023
Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. Jama, 297(8), 831-841. doi:10.1001/jama.297.8.831
Kromka, W., & Simpson, S. (2019). A narrative review of predictors of adult mental health emergency department return visits and interventions to reduce repeated use. The Journal of Emergency Medicine, 57(5), 671-682. https://doi.org/10.1016/j.jemermed.2019.08.005
Liu, H. C., Zhang, L. J., Ping, Y. J., & Wang, L. (2020). Failure mode and effects analysis for proactive healthcare risk evaluation: a systematic literature review. Journal of evaluation in clinical practice, 26(4), 1320-1337. https://doi.org/10.1111/jep.13317
Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189
Marin, J. R., Rodean, J., Mannix, R. C., Hall, M., Alpern, E. R., Aronson, P. L., ... & Neuman, M. I. (2021). Association of clinical guidelines and decision support with computed tomography use in pediatric mild traumatic brain injury. The Journal of Pediatrics, 235, 178-183. https://doi.org/10.1016/j.jpeds.2021.04.026
Miller, H. D. (2009). From volume to value: better ways to pay for health care. Health Affairs, 28(5), 1418-1428. https://doi.org/10.1377/hlthaff.28.5.1418
O’Malley, A. S., Grossman, J. M., Cohen, G. R., Kemper, N. M., & Pham, H. H. (2010). Are electronic medical records helpful for care coordination? Experiences of physician practices. Journal of general internal medicine, 25(3), 177-185. https://doi.org/10.1007/s11606-009-1195-2
Parry, C., Mahoney, E., Chalmers, S. A., & Coleman, E. A. (2008). Assessing the quality of transitional care: further applications of the care transitions measure. Medical care, 46(3), 317-322. DOI: 10.1097/MLR.0b013e3181589bdc
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., ... & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health and mental health services research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7
Sarasa Cabezuelo, A. (2020). Application of machine learning techniques to analyze patient returns to the emergency department. Journal of personalized medicine, 10(3), 81. https://doi.org/10.3390/jpm10030081
Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., & Applebaum, S. (2011). New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health affairs, 30(12), 2437-2448. https://doi.org/10.1377/hlthaff.2011.0923
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., ... & Blike, G. (2016). Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Annals of internal medicine, 165(11), 753-760. https://doi.org/10.7326/M16-0961
Stiell, A., Forster, A. J., Stiell, I. G., & van Walraven, C. (2003). Prevalence of information gaps in the emergency department and the effect on patient outcomes. Cmaj, 169(10), 1023-1028.
The Office of the National Coordinator for Health Information Technology (ONC). (2020). Information blocking. HealthIT.gov. https://www.healthit.gov/sites/default/files/page2/2020-11/ONC_IFC_Webinar_Slides_v2_508.pdf
Weber, L., Schulze, I., & Jaehde, U. (2022). Using failure mode and Effects Analysis to increase patient safety in cancer chemotherapy. Research in Social and Administrative Pharmacy, 18(8), 3386-3393. https://doi.org/10.1016/j.sapharm.2021.11.009
Authors
Copyright (c) 2024 Mishal Seror Falah Alotaibi, Zainab Mohsen Al Hikri, Amnah Yahya Asser Aqeel, Sawsan Hussain Mohammed Alawad, Ibrahim Omar Mohammed Khamisy, Sadiah Jameel Abuaseedah, Dina Hamza M Farsi, Mahfoudh Mohammad Ahmad Alabdali, Ebtisam Demshiq Alyami, Fatmah Abdulla Alamri, Nawal Suliman Saleh Alkhmes, Norah Mohammed Ibrahim Aqeel, Ahmed Essa Zalah
This work is licensed under a Creative Commons Attribution 4.0 International License.