Advancing Health Information (HIE) During Inter-hospital Transfer (IHT) to Improve Patient Outcomes

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ABSTRACT The transfer of patients between acute care hospitals (inter-hospital transfer, IHT) is often undertaken to provide patients with specialized care that is unavailable at the transferring hospital. Over 100,000 Medicare patients with high rates of multiple chronic conditions undergo IHT annually. However, IHT exposes patients to the risks of discontinuity of care and lacks potential safeguards that might protect against gaps in communication. Our extensive prior work examining IHT demonstrates sub-optimal transfer processes, including frequent gaps in communication and inadequate information exchange, with up to 35% of patient transfers missing essential clinical information on transfer. Sub-optimal HIE during IHT has been associated with patient harm such as therapeutic errors and delays in care and may contribute to greater mortality observed among select IHT patients. Given the complexities of this care transition, effective HIE has proven difficult to achieve due to the need for solutions to address workflow, data visualization and interoperability to be effective. The overall goals of this study are to leverage our extensive research experience in IHT and health information technology innovation to design, implement, and rigorously evaluate an intervention to improve HIE during IHT in three use cases with different levels of integration between transferring and accepting hospitals: hospitals within the same health system, hospitals in different systems that share a common EHR, and hospitals in different systems that use different EHRs. To achieve this, we propose to refine and implement an interoperable HIE platform that improves reliability of and access to necessary clinical information during IHT. We will build on our prior work that identifies essential clinical information and data visualization for effective HIE during IHT, and utilize user-centered design to rapidly identify, design, develop, refine, and implement requirements from interprofessional users, including clinicians and personnel at transferring and accepting hospitals. The HIE platform will use interoperable, data exchange standards and APIs to seamlessly integrate with existing vendor EHRs within each use case. Our team will rigorously evaluate the impact of this intervention on patient safety outcomes, including medical errors and adverse events, using interrupted time series methodology, and our team will conduct robust mixed-methods evaluation on utilization, perceived usability, and facilitators and barriers to implementation from interprofessional users who interact with the platform. Finally, these data will be presented to steering committee members with expertise in care transitions and dissemination strategy, and executive and health IT leadership from participating hospitals, to generate input on best practices for further refinement and implementation to create a dissemination toolkit to share with other similar institutions.