Advancing Health Information Exchange During Inter-Hospital Transfer to Improve Patient Outcomes

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.