The National Quality Forum (NQF) has issued a report that provides five recommendations for using electronic health records to effectively facilitate, measure, and improve care communication and care coordination across multiple healthcare facilities.
Patients often interact with multiple providers across multiple healthcare systems and settings, resulting in medical information being dispersed across different, often disconnected, sources. Efficiently communicating this information between patients, nurses, clinicians, case managers and other stakeholders would allow nursing teams to better coordinate different aspects of care and ensure they are aligned with patient goals, the NQF said.
With funding from the Centers for Medicare & Medicaid Services (CMS), the NQF convened a multi-stakeholder committee to identify opportunities to measure and improve care communication and care coordination using EHRs. The NQF’s new report, Leveraging Electronic Health Record (EHR)-Sourced Measures to Improve Care Communication and Coordination, outlines the following five recommendations to make EHRs more useful to measure and identify areas for improvement:
• Collect and share standardized data
• Optimize the usability of EHR for patients and caregivers
• Optimize EHR usability for physicians
• Development of novel EHR data elements to improve measurement
• Use EHR data to close measurement gaps
To take advantage of EHR-related data for measurement, the U.S. healthcare system must continue to push the availability of standardized data items, the report said. Initiatives like USCDI are laying the groundwork for this standardization, and the committee identified additional standardized data elements that could be added to EHRs to facilitate measurement of care communication and care coordination. The Committee identified gaps in standardized data elements related to:
• Measures for care communication and care coordination (e.g. shared decision-making, tools to facilitate care planning).
• Care goals that can be entered by physicians and other team members, as well as the ability to identify tailored patient goals (eg, the ability to attend a daughter’s wedding) and fields for physicians to assess whether those goals are being met .
• Reasons for moving care between different settings (eg, due to problems in care coordination, a diagnostic error, or a clinician or team member signing off on a case).
• Communication between physicians and patients and their carers (e.g. during a transition in care when sharing critical test results).
In addition, according to the report, EHRs can improve action feasibility by replacing chart checks and claims-based data with automated extraction; Provide data elements (both existing and new) to develop new action plans related to care communication and care coordination; Improving the specificity of existing accountability measures by re-specifying them with an EHR data source; and export data to measure specific processes and outcomes important to care communication and care coordination.
The recommendations are also intended to encourage greater accountability, the NQF said. Better use of EHR data is critical to measuring and improving the quality of care in general, and also critical to promoting equitable health outcomes. Gaps in care communication and care coordination are more likely to negatively impact patients disproportionately affected by social determinants of health (SDOH) factors, such as food or housing insecurity, and increase their risk of poorer outcomes.
“Fragmentation in healthcare is one of the most commonly cited frustrations among patients, and yet measuring and improving coordination and communication between care organizations has remained largely unsolvable,” said Dana Gelb Safran, ScD, NQF president and CEO, in a statement. “EHRs hold enormous promise for solving both the technical challenges of communication and coordination between settings and the measurement challenges associated with these critical dimensions of quality.”
As different healthcare systems may be at different stages of achieving full interoperability and have different technical functionalities, the report outlines recommended actions that can be taken by organizations at different levels of EHR maturity.