October 19, 2020 – Clinicians with access to a shared inpatient-outpatient EHR were more likely to schedule a telehealth follow-up appointment or conduct laboratory monitoring, rather than an in-person visit, according to a study published in the American Journal of Managed Care.
Additionally, enhanced interoperability and patient data exchange can boost follow-up care efficiency.
“For the growing number of patients with chronic conditions, care transitions, such as those after hospital discharge, require coordination among multiple clinicians practicing in different settings,” the researchers explained.
Seamless data exchange and interoperability are important for making that level of care coordination and follow-up care happen, but for many outpatient clinicians that’s not always the case. Outpatient clinicians do not always have real-time access to patient data from recent hospitalizations.
Researchers studied over 240,000 hospital discharges in patients with diabetes to examine the rates of outpatient follow-up visits, telemedicine, laboratory tests, and readmissions – which provide real-time access to all patient data across both types of care settings – impacted the type of follow-up care following hospital discharge.
Clinicians with a shared inpatient-outpatient EHR were significantly more likely to schedule both telehealth and outpatient laboratory tests, rather than in-person visits. Clinicians using an outpatient-only EHR scheduled follow-up care at a rate of 22.9 percent. That rate increased to 27 percent after clinicians received access to the shared inpatient-outpatient EHR. But there was little correlation between readmissions or 30-day return emergency department visits.
With researchers finding lower rates of follow-up visits and little association between hospital readmissions, researchers said these findings could shift follow-up care delivery without impacting patient care.
“Although EHR interoperability and HIE functionality have been consistently promoted as policy priorities for improving the quality and efficiency of the American health care system, there is still limited research evidence to inform policy makers about the effects of continuity in provider access to patient information,” wrote the study authors.
The researchers also said the study shows the importance of patient data access across a number of providers between facilities.
“Our findings from patients with diabetes also complement findings of previous studies in the same integrated delivery system, in patients with diabetes and in general patient populations, in which both providers and patients reported that EHR use facilitated care coordination both by providing informational continuity among providers and by supporting direct communication between clinicians and medical staff through electronic messaging tools,” explained the study authors.
While some studies showed in-person visits resulted in better patient outcomes, researchers said there was little evidence of worse outcomes in this study. Furthermore, researchers said patient data access may have decreased unnecessary or duplicate testing.
Although health information exchange is not perfected across health systems, this study shows the importance of patient data exchange.
“Our study finds that movement toward more seamless health information access, even within an already integrated system, can affect the efficiency of follow-up care after hospital discharge without adversely affecting quality,” researchers wrote.
“These shifts may also potentially improve patient convenience through telemedicine follow-up without requiring the transportation and cost of making an in-person visit to health care providers.”
While telehealth is more convenient for patients, it is also beneficial for the current need for social distancing to mitigate the spread of COVID-19.
“Overall, in a setting that implemented a shared EHR with seamless HIE between inpatient and outpatient providers, patient follow-up care after hospital discharge was less likely to include an in-person office visit and instead was managed through exchange of asynchronous secure messages, telephone telemedicine, and outpatient laboratory tests,” concluded the researchers.