In a recent project initially funded by a grant from the Office of the National Coordinator for Health Information Technology (ONC), Rhode Island Quality Institute (RIQI) has taken a new step toward improving transitions of care, patient engagement, and care coordination. The new service, Designee Alerts, delivers clinical event notifications via email or text message to a critical but under-served pillar of care — the family and friends supporting the patient.
CUSTOMER: Rhode Island Quality Institute (RIQI)
CHALLENGE: Extend clinical alerts to the third leg of the patient care triad — family and friends — to improveoutcomes, patient and family satisfaction, and save lives.
OUTCOME: Using InterSystems HealthShare, as soon as relevant admission, discharge, or transfer information is entered into any electronic medical record in any hospital throughout Rhode Island, the system alerts the patient’s designees. Designees experience less confusion around transitions of care, and can intervene in cases such as opioid overdose to prevent patients from being “treated and streeted” and repeating the cycle.
A family member could be alerted, for example, at the moment an elderly parent is transferred from a nursing home to the hospital, or the moment a patient goes to the hospital due to an overdose of opioids — a scenario RIQI says is a primary use case for Designee Alerts.
“With this kind of an alert, someone responsible for an adult opioid user can intervene to avoid another case of the patient being ‘treated and streeted,’” said Scott Young, senior director product strategy and growth at RIQI. “Otherwise the cycle of abuse and overdosing might continue, at great cost to all.”
Connected Healthcare System Accelerates Development
For several years, RIQI has been sending clinical event notifications to providers through CurrentCare, its statewide health information exchange based on the InterSystems HealthShare® unified health record. CurrentCare connects every hospital in Rhode Island, and its clinical event notifications have helped Rhode Island’s acute care organizations reduce readmissions and costs, improve care coordination, and elevate quality measures.
RIQI leveraged the provider clinical event notification functionality it already had in CurrentCare to speed the creation of Designee Alerts. Now, as soon as relevant admission, discharge, or transfer information is entered into any electronic medical record (EMR) in any hospital throughout the state, the system alerts the patient’s designees.
“We’ve seen Designee Alerts positively impact patients and their personal communities by decreasing confusion around transitions of care,” said Young. “Particularly for patients with comorbidities or those dealing with end of life care, these alerts can be a game changer for their loved ones.” But despite the benefits noted by early users of the service, RIQI faces two challenges to adoption by a wider audience.
Addressing Privacy and Identity Concerns
Designee Alerts currently relies on the patient to give designees access to their account in CurrentCare’s patient portal, CurrentCare for Me. When a designee receives an alert, it includes only the name of the patient and a link to the patient’s CurrentCare for Me account. Once the designee follows the link and logs in, he can view the alert details. With access to the patient’s CurrentCare for Me account, the designee can also view other health information in the record. “Remember that CurrentCare for Me and Designee Alerts are built on top of our HIE’s unified health record,” said Young. “Some patients aren’t comfortable giving their designee access to all of their health information.”
The designee enrollment process presents another challenge to adoption. “Due to privacy concerns, we want to be absolutely certain that only the intended designee gains access to the patient’s account,” explained Young. “Some designees drop out of the enrollment process before completion due to the burden of proving their identity.”
Coming Next: Streamlined Enrollment, Health Record Access Not Required
To make it easier and faster for designees to enroll, RIQI is developing a standalone application for mobile devices. The application will enable designees to receive alerts without burdensome identity proofs or having to access the patient’s account and health information in CurrentCare for Me.
RIQI also will expand the marketing of Designee Alerts from patients to specialists who have the biggest stake in keeping family and others informed about their loved one’s status. These include those working in palliative care, substance abuse, mental health, and geriatrics, as well as organizations that support them, such as the Alzheimer’s Association.
Future Innovations
Optimal healthcare outcomes and satisfaction depend, in part, on good communication. RIQI plans to enhance communication for patients and providers, beyond Designee Alerts, with new services such as:
- Including end-of-life planning and directives information in CurrentCare so that it is easily accessible for patients, providers, and families
- Connecting social services into CurrentCare so providers can see, for example, that a patient has no transportation to a care location and can arrange for it with a support organization
- Analyzing the unified health record in CurrentCare to proactively identify gaps in care and notify patients
“HealthShare software is stable and reliable, and using HealthShare for our patient portal gave us a huge head start developing Designee Alerts,” said Young. “That and our bi-directional data feeds with the EMR systems of every hospital in the state drive much of what we can do.”
