Transitioning from an acute care to a long-term/post-acute care (LTPAC) facility can be dangerous.
According to one study, nearly 23% of patients discharged from a hospital to a LTPAC facility had at least 1 readmission. Research indicates that the leading cause of readmission is harm caused by medication (called an adverse drug event). Studies have shown that as much as 56% of all medication errors happen at a transitional point of care.
By the year 2050 more than 27 million Americans will be using LTPAC services. The majority of these LTPAC patients will transition from an acute care facility at least once each year. With this many transitions, the number of medication errors each year would balloon into the millions. The impact on patients and on the healthcare system itself would be astronomical.
Thankfully there is a solution: medication reconciliation
The Agency for Healthcare Research and Quality (AHRQ) states: “Patients frequently receive new medications or have medications changed during hospitalizations. Lack of medication reconciliation results in the potential for inadvertent medication discrepancies and adverse drug events—particularly for patients with low health literacy, or those prescribed high-risk medications or complex medication regimens.”
Medication reconciliation is a process where an accurate list of medications a patient is taking is maintained at all times. That list is compared to admission, transfer and/or discharge orders at all transitional points both within a facility and between facilities. By seeing orders vs existing medications, clinicians and caregivers are able to prevent drug-interactions and complications due to omissions or dosage discrepancies.
What is surprising is the lack of progress in this area.
We have been talking about interoperability for years in HealthIT. Hundreds of vendors make announcements at the annual HIMSS conference about their ability to share data. Significant investments have been made in Health Information Exchanges (HIEs). Yet despite all of this, there has been relatively little progress made or coverage given to this problem of data exchange between hospitals and LTPAC facilities.
One company in the LTPAC space is working to change that. PointClickCare, one of the largest EHR providers to skilled nursing facilities, home care providers and senior living centers in North America, is dedicating resources and energy to overcoming the challenge of data sharing – specifically for medication reconciliation.
“We are tackling the interoperability problem head-on,” says Dave Wessinger, co-founder and Chief Operating Officer at PointClickCare. “The way we see it, there is absolutely no reason why it can take up to three days for an updated list of medications to arrive at our customer’s facility from a hospital. In that time patients are unnecessarily exposed to potential harm. That’s unacceptable and we are working with our customers and partners to address it.”
Over the past 12 months, the PointClickCare team has made significant progress integrating their platform with other players in the healthcare ecosystem – hospitals, pharmacies, HIEs, ACOs, physician practices and labs. According to Wessinger, PointClickCare is now at a point where they have “FHIR-ready” APIs and web-services.
“We believe that medication reconciliation is the key to getting everyone in the ecosystem to unlock their data,” continues Wessinger. “There is such a tremendous opportunity for all of us in the healthcare vendor community to work together to solve one of the biggest causes of hospital readmissions.”
Amie Downs, Senior Director ISTS Info & App Services at Good Samaritan Society, an organization that operates 165 skilled nursing facilities in 24 states and a PointClickCare customer, agrees strongly with Wessinger: “We have the opportunity to make medication reconciliation our first big interoperability win as an industry. We need a use-case that shows benefit. I can’t think of a better one than reducing harm to patients while simultaneously preventing costly readmissions. I think this can be the first domino so to speak.”
Having the technology infrastructure in place is just part of the challenge. Getting organizations to agree to share data is a significant hurdle and once you get organizations to sit down with each other, the challenge is resisting the temptation just to dump data to each other. Downs summed it up this way:
“What is really needed is for local acute care facilities to partner with local long-term and post-acute care facilities. We need to sit down together and pick the data that we each want/need to provide the best care for patients. We need to stop just sending everything to each other through a direct connection, on some sort of encrypted media that travels with the patient, via fax or physically printed on a piece of paper and then expecting the other party to sort it out.”
Downs goes on to explain how narrowing the scope of data exchange is beneficial: “I definitely see a strong future for CCDA data exchange to help in medication reconciliation. Right now medication information is just appended to the file we receive from acute care facilities. We need to agree on what medication information we really need. Right now, we get the entire medication history of the patient. What we really need is just the active medications that the patient is on.”
In addition to working on FHIR and APIs, BJ Boyle, Director of Product Management at PointClickCare, is also leading a data sharing initiative for those instances when there is no fellow EHR platform to connect to. “We are working towards something that is best described as a ‘Post-Acute Care Cloud’ or ‘PAC Cloud’,” explains Boyle. “We’re designing it so that hospital case managers can go to a single place and get all the information they need from the various SNFs they refer patients to. Today, when HL7 integration isn’t possible, case managers have to be given authorized access to the SNF’s system. That’s not ideal.”
PointClickCare has already taken an initial step towards this vision with an offering called eINTERACT. According to the company’s website eINTERACT allows for the “early identification of changes in condition…and the sooner a change in condition is identified, the quicker interventions can be implemented to prevent decline and avoid potential transfers” which is key to managing patient/resident health.
It’s worth noting that John Lynn blogged about LTPAC readmissions in 2014. Unfortunately at the macro/industry level, not much has changed. Dealing with readmissions from LTPAC facilities is not particularly exciting. Much of the attention remains with consumer-monitoring devices, apps and gadgets around the home.
Having said that, I do find it encouraging to see real progress being made by companies like PointClickCare and Good Samaritan Society. I hope to find more examples of practical interoperability that impacts patient care while touring the HIMSS18 exhibit floor in early March. In the meantime, I will be keeping my eye on PointClickCare and the LTPAC space to see how these interoperability initiatives progress.