LEAN Healthcare: Discharge Planning – Looking for Help Beyond the EHR

Optimium Health has had numerous discussions over the past 6 months with hospital administrators who all seem to highlight the same issue: a need to lower readmission rates. Much of this focus is due to new guidelines from CMS citing readmission penalties of up to 2% of hospital revenues for poor readmission performance. However, it also has to do with hospitals desire to improve transitions of care both internal and external to the hospital.

A recent press release from the New York State University at Buffalo School of Nursing caught our eye as it illustrates how technology is being developed to create a model for proactive post hospitalization health care delivery. An excerpt from and link to the full press release is below:

It’s an all too familiar story: a patient—specifically a patient with chronic disease—goes into the hospital to get well and is discharged only to be readmitted within 30 days. Medicare spends $15 billion a year on readmissions alone. It turns out that better communication to patients and their physicians about follow-up care might be one way to prevent a return to the hospital or emergency room.

The Agency for Healthcare Research and Quality (AHRQ) has awarded the University at Buffalo School of Nursing a grant to create a pilot project whose goal is to work with primary care physician’s offices, their patients and families to see that patients get follow-up care very soon after leaving the hospital.

Sharon Hewner, PhD, RN, assistant professor of nursing and author of the grant is a specialist in population health analysis, health services research, and informatics. Hewner says that there has been a lack of timely communication between the hospital and community setting. – See more at: https://www.buffalo.edu/news/releases/2014/07/020.html#sthash.pTdB5sut.dpuf

While the University at Buffalo technology will be set up to specifically interface with a regional health information organization, Optimum Health has begun early stage development of a discharge planning module as part of its OPTIMI$ERTM Clinical Workflow Technology Suite. Importantly, OPTIMI$ER can help your health organization achieve its CMS goals of lowering the cost per patient served, improving the patient experience, as well as reducing the 30-day readmission rate. As with all OPTIMI$ER products, the discharge planning module will interface with Cerner, Epic, McKesson, MediTech and most other EHR systems built on an HL7 platform. If you would like further information for OPTIMI$ER products, please contact: heather@www.optimiumhealth.com 

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