Project Details -

Ongoing

The transfer of patients between hospitals, known as inter-hospital transfer (IHT), occurs when the transferring hospital is unable to provide needed specialty care. Over 100,000 Medicare patients with high rates of multiple chronic conditions undergo IHT annually. Transfers of care between hospitals often result in information gaps when the receiving hospital does not have timely information on the patient. This gap in information can lead to patient harm, such as therapeutic errors and delays in care, and may contribute to greater morbidity and mortality. These risks may be mitigated via an improved health information exchange (HIE) that accounts for facility and clinician workflow, improves timely access to data, and uses data visualization to improve presentation of clinical information to lesson cognitive load.

Building on their prior research in this area, the research team will refine, implement, and evaluate an integrated, interoperable HIE platform that will improve reliability, access to data, and data visualization of needed clinical information. The platform will be designed to three use cases of data exchange during IHT: hospitals within the same health system, hospitals in different systems with a common electronic health record (EHR), and hospitals in different systems with different EHRs.

The specific aims of the research are as follows:

Utilize user-centered design principles and prior knowledge and experience to refine a currently functional interoperable HIE platform.
Evaluate the impact of this intervention on clinician-reported medical errors, medical errors attributable to sub-optimal information exchange, adverse events, and other measures of patient safety and workflow.
Evaluate the utilization and perceived usability of the HIE platform.
Combine data on use, usability, and barriers to implementation to develop a plan for further refinement of the platform and for a dissemination toolkit.

Requirements identified from interprofessional users, including clinicians and personnel at transferring and accepting hospitals, will inform the design of the improved HIE platform. The platform will use interoperable data exchange standards and application programming interfaces (APIs) to integrate with existing vendor EHRs within each use case. Researchers will evaluate the impact of this intervention on patient safety outcomes, including medical errors and adverse events, using interrupted time series methodology, and conduct a robust mixed-methods evaluation on utilization, perceived usability, and facilitators and barriers to implementation from interprofessional users who interact with the platform.

Researchers will present data to steering committee members with expertise in care transitions and dissemination strategy, and executive and leadership from participating hospitals, to generate input on best practices for further refinement and implementation. They will also create a dissemination toolkit to share with similar institutions. The lessons learned will be used to inform successful and sustained adoption by other healthcare systems, thus broadly improving care provided to transferred patients.

Safer Inter-Hospital Transfers by Improving Access to Health Information

Theme:

Supporting Health Systems in Advancing Care Delivery

Subtheme:

Using Digital Healthcare Tools to Improve Patient Safety

An enhanced health information exchange platform that improves workflow, interoperability, and visualization of data for inter-hospital transfers may reduce the morbidity and mortality seen today during inter-hospital transfers.

A better transition improves patient safety

Inter-hospital transfer is a common occurrence among patients with multiple chronic conditions who need specialized care not available in the transferring hospital. Such patients are routinely transferred between different clinical providers, hospitals, or healthcare systems. While critical to meeting the needs of patients, inter-hospital transfers can result in errors that reduce patient safety due to the lack of continuity of care. Communication and information exchange gaps are frequent during inter-hospital transfer, which can lead to poor patient outcomes. Dr. Stephanie Mueller and her team at Brigham and Women's Hospital recognize the vulnerabilities that can happen with the transfer of care for patients with chronic conditions and want to address health information exchange gaps during these transfers.

Communication is key for successful transfers

Building on their prior extensive research in inter-hospital transfer and health information technology innovation, Dr. Mueller and her research team are developing an interoperable platform to improve communication and access to clinical information for patients undergoing inter-hospital transfers. Using a user-centered design approach, this platform will identify essential clinical information in the originating hospital’s electronic health record (EHR) and optimize data visualization for clinicians involved in receiving patient transfers. The team will design the platform for three use cases during inter-hospital transfer, including patients transferred from hospitals within the same health system, hospitals in different systems with a common EHR, and hospitals in different systems with different EHRs. An evaluation of the platform will examine its impact on patient safety outcomes, such as medical errors and adverse events; its clinical use and perceived usability; and any facilitators and barriers to use from those who interact with the platform.

“Our hope is to develop and successfully implement a platform that improves information exchange of necessary clinical information that clinicians need to access to be able to safely care for patients at time of transfer. This platform is going to be user-friendly and accepted by frontline users because it's being developed and implemented with their input from the forefront.”-Dr. Stephanie Mueller

Patient safety must come first

The inter-hospital transfer platform has the potential to increase access to data for clinicians during transfers and ultimately improve safety for patients. Additionally, by leveraging existing data exchange standards and implementing the platform in various use cases, the platform should be easily adopted and able to scale across an organization and to other similar organizations. In the last year of the study, the team will develop a toolkit to support widespread dissemination and adoption. Overall, Dr. Mueller and her team hope that the lessons learned will inform successful and sustained adoption by other health care systems, thus broadly improving care provided to transferred patients.