A contingent of clinicians and information professionals has mobilized around the simple but crucial task of computerizing the basic medical information a provider should hand off to the next facility or clinician caring for a patient.
By agreeing on the content and format of a "continuity-of-care record," the leaders of the standardization effort hope to resolve a distressing lack of communication between providers when patients are discharged from the hospital or otherwise placed in the care of someone unfamiliar with the medications, treatment plans and other critical details involved in a patient's care, said Thomas Sullivan, president of the Massachusetts Medical Society.
That need was underscored by research published in February that found a high incidence of medical errors in the transition of care following discharge from a hospital, much of it blamed on poor communication between inpatient caregivers and primary-care doctors. "The problems associated with the difficulty in easily exchanging patient information have contributed to these errors," he said.
Sullivan is a prime mover behind the standards initiative launched last month by the medical society, the Healthcare Information and Management Systems Society and ASTM International, a not-for-profit forum for creating voluntary consensus standards in many industries, including electronic medical records in healthcare.
The initiative is the latest in a recent string of attempts to gain agreement in the healthcare industry on standard ways to conduct data-exchange activities electronically, which can reduce duplication of effort and costs while expediting information that physicians need to make quicker and better-informed decisions.
For example, HHS and the departments of Veterans Affairs and Defense launched an ambitious effort earlier this year to standardize the fundamental methods of exchanging data to build electronic health records and communicate a variety of data from laboratory, pharmacy and diagnostic information systems (March 31, p. 10).
Such agreements are important to the decades-long drive to create a lifetime health record and manage the full extent of clinical information that can be made available to a physician. But when it comes to using that information in their daily work, doctors consulting with others on a case mainly need to see a simple, stripped-down set of facts instead of wading through the entire record, Sullivan said.
The Massachusetts Medical Society began working with ASTM a year ago to arrive at a standard set of facts in a Web-based format that doctors could easily use and rely on to communicate with each other during a patient transfer.
Meanwhile, HIMSS had independently identified the need for a minimum set of information to be communicated electronically in a patient emergency and agreed to combine its efforts with the ASTM project to standardize the data for continuity of care, said Patricia Wise, director of a HIMSS initiative for an electronic health record. "It made no sense to be working on this in a vacuum," she said.
The most essential facts for coordinating care are an accurate medication list, the most relevant list of recent diagnoses and a brief statement of the goals for a patient's ongoing plan of care, Sullivan said. Combined with demographic and allergy information, that basic summary informs a specialist about a referral and brings primary-care doctors up to date on what to look for in the first days and weeks of taking over care responsibilities, he said.
The Massachusetts Department of Public Health has long required physicians to fill out a paper form asking for most of that information when referring a patient following hospitalization. Hospitals in recent years have put the referral document in electronic form, but differences in computer technology and content have made it impossible to swap the information electronically, Sullivan said.
A study of medical errors at an unnamed teaching hospital, conducted by researchers at Boston's Brigham and Women's Hospital, demonstrated the spotty success in using referral information to manage post-hospital care. Of 400 patients followed after discharge, 76 suffered injuries related to medical care within two weeks of leaving the hospital. More than 60% of the adverse events could have been prevented or quickly counteracted by medical intervention.
The study in the Feb. 4, 2003, issue of the Annals of Internal Medicine found fault with procedures for monitoring drug therapies and the overall condition of patients after discharge. Researchers also determined that unresolved medical problems at the time of discharge often were not communicated to the next responsible physician or other caregiver.
The ASTM committee on healthcare informatics has gained significant agreement on a standard electronic document for communicating critical patient specifics, but several meetings are scheduled during the summer to incorporate the views of medical and professional societies on what should be included.
Representatives of HIMSS also want to make sure that the computer format meshes with other standards initiatives and information technology development efforts, Wise said.
The electronic format being considered is an emerging Internet protocol called extensible markup language, or XML, which can be incorporated into healthcare information systems or used by itself in a Web site, Sullivan said.
Ultimately, the continuity-of-care record should work as a way to transfer essential data from facility to facility, one doctor to another or even from patient to doctor, said Peter Waegemann, chairman of the committee considering the standard. The standardized and familiar content is the most important feature, whether sent as an XML message, an e-mail, a faxed document or printed out by a patient, he said.