Merrimack Valley Providers Use Health IT to Improve Patient Care Coordination after Emergency Room Visits

Four unaffiliated healthcare providers in the Merrimack Valley region of Massachusetts came together in a collaborative effort to solve a care coordination challenge through the use of Health Information Exchange (HIE) technology for their Community of Care.  Their health IT strategic vision was to enhance care coordination by securely sharing of electronic patient data. This particular Community of Care consists of four providers, including the Home Health VNA, Lawrence General Hospital, Pentucket Medical Associates, and the Greater Lawrence Family Health Center, who started working together to address a clear long-standing logistical challenge: the ambulatory care providers did not receive notification when one of their patients visited Lawrence General’s Emergency Center.

This issue was of particular concern to the leaders at Home Health VNA, which often did not learn of emergency room visits until one of its nurses visited a patient at their home, long after the hospital visit.

“Emergency room notification has been an ongoing, insurmountable problem,” said Peg Doherty, RN, the Vice President of Operations at Home Health VNA.  “Our patients would go to the ER [Emergency Room], and we wouldn’t know they went. Furthermore, we wouldn’t know what happened or if anything changed when they came back into our care.”

Home Health VNA and its partners also wanted to eliminate data “siloing”, an issue which hinders the sharing of patient health information between unaffiliated organizations.

“Even though we live in the same community, and we have the same strategic goals, visions, and objectives around patient care, we’re still all managing to our separate service lines and business models,” said Jeffrey Brown, Chief Information Officer at Lawrence General.

To achieve their goal, the organizations decided to connect their Electronic Health Record (EHR) systems to the Mass HIway, the statewide Health Information Exchange created by the Commonwealth of Massachusetts, which provided the electronic pathway that allowed them to easily and securely share patient data. But the digital connection was only the initial step. In addition to needed technology upgrades, each of the organizations also underwent workflow changes on both the clinical and operational sides.

The group applied for and received financial support for their project from the Massachusetts eHealth Institute (MeHI) via a Mass HIway Implementation Grant. MeHI’s program supported collaborative projects between two or more healthcare organizations located in regions across Massachusetts, with the goal of improving patient care coordination and reducing costs through connections made via the Mass HIway.

In the spring of 2014, the electronic sharing of patient data among the group of Merrimack Valley providers went live, when Sanin Rahman, Director of Integration & Strategy at Lawrence General Hospital, successfully sent the first electronic notification of a patient’s emergency department visit to Home Health VNA via the Mass HIway.   Over time, the group of providers envisions implementing further automated processes to update its partners, processes which will improve efficiency across all the organizations involved, saving staff time and providing critical updates to a patient’s electronic health record.

As collaborating partners implement health IT strategies, communication improves among clinicians which benefits patients in regards to their care.  These partners have a shared interest in effectively using technology and electronic patient data.  With electronic exchange of patient information through the Mass HIway, the Merrimack Valley clinicians will gain added knowledge and insight into a patient’s path through the continuum of care. Expected improvements from this increased information include:

  • Avoiding redundant testing, x-rays, and imaging, saving time, money, and impacts to potentially fragile patients;
  • Better adherence to prescription and treatment plans, helping avoid over-prescribing of medication or potential adverse drug interactions;  
  • Improving patient health outcomes by streamlining care delivery and coordination across all settings, including the emergency department, the primary care physician’s office, and at home. 

Ruth Pothier, Chief Information Officer at Pentucket Medical Associates, notes that HIE provides an opportunity to align multiple organizations and eliminate the factors that hinder effective and well-coordinated care.

“We’re trying to affect the beginning of a ‘non-silo’ treatment of patients so that everybody isn’t doing their own thing,” she said. “HIE gets important information into the clinician’s hands before or at the point of care. “

Pothier added that timely notifications of visits to the emergency room will create more opportunities to educate patients about the appropriate use of the emergency room and alternative avenues to receive help, all with the goal of preventing unnecessary visits.

As in Merrimack Valley, providers across the Commonwealth are teaming up to improve patient care within their respective Communities of Care while reducing healthcare costs by connecting with each other via Health Information Exchange technologies, such as the Mass HIway. Peg Doherty of Home Health VNA said this type of collaboration demonstrates that healthcare organizations working together and connecting electronically is the best approach to achieve effective coordination. 

“I think what’s extraordinary about what happened here is we brought together four large organizations. There is something terrific about watching everyone say ‘we need to do this,’ and keep that vision in sight while we work out the differences,” Doherty said. “It’s exciting to show people you can solve problems when using technology to share information.”