Care coordination requires the right providers know about patient events, such as admissions to the emergency department, when a patient is discharged and tests resulted after patient has left the hospital. Organizations must have a flexible, accountable way to notify providers of events in real time, which is no small task for a large health system.
Like many integrated delivery networks, New-York-based Northwell Health has grown through multiple acquisitions and uses several different electronic health records (EHRs) throughout 21 hospitals and 450+ physician practices. The variability of the EHR capabilities makes it more complex to design a cohesive notification system.
Using open Application Programming Interfaces (APIs), Northwell Health designed a solution that enables clinicians to see patient event notifications within their electronic health record (EHR) workflow, which enables better care coordination. We took a closer look at this initiative in a presentation at HIMSS 2017, Multimodal Delivery of Patient Events to Providers.
Notifications enable more coordinated care
Northwell clinicians rely on timely identification of patients with risk to provide further care management. The organization launched its patient event notification project to deliver information to primary care providers who needed to know when their patients were admitted to the hospital.
Because primary care providers use an EHR that is different from the hospital EHR, the information gap made it difficult for them to be involved with immediate and follow-up care. Patient event notification is one of the key requirements of Patient-Centered Medical Home, so the IT team at Northwell was tasked with finding a solution.
Northwell soon expanded this program to other types of notifications. For example, as the organization started to participate in full risk, through the insurance company that it started and other payers, Northwell needed to also stratify notifications to address high-risk patients first.
Another type of notification is for patients who have a lab test that has resulted after the patient has been discharged from the hospital, which is a common occurrence. It’s critical for patient safety that the right provider – which may not be the treating provider in the hospital is notified of results
Combining technologies for successful “closed loop” notification process
Northwell combines health information exchange (HIE) technology, interface engine, rules engine and fully supported APIs to generate and deliver notifications. Business process management software tracks these notifications so that the appropriate actions can be taken and results in a “closed loop” process.
For example when a notification requires an action, such as a phone call to a patient, the system follows the protocol of calling up to three times if there was no answer the first two times. Then the system records this information in the EHR, which is critical as it is the providers’ primary method of receiving patient information.
“We were able to deliver about 190,000 email notifications in 2016,” Northwell Chief Information Architect Vish Anantraman, MD, MS said. “We’ve had a high degree of satisfaction from providers being able to follow up with their patients in a timely and effective manner.”
The APIs enable deep integration with the EHR and control of the type of notification and recipient of the notification, for example some practices prefer the notifications of admissions/discharges to be handled by one specific provider each day, while other practices require the notification to only the provider directly. The API integration gives a high level of flexibility and has been a key in the adoption.
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Editor’s Note: Read more about this client’s efforts in a recent HealthIT Analytics article: APIs Boost Care Coordination, Data Exchange at Northwell Health