Ensocare - Topics on readmissions, discharge process and improving patient care

Fostering Transparency

Written by Jill Reeves, MHA | 2/6/17 2:00 PM

In recent years, the need for better communication and access to information across care settings has been a “hot button” topic in healthcare. In particular, being able to “follow” a patient after hospital discharge has become paramount due to health systems’ growing care coordination responsibilities and accountability for readmissions.

Although electronic health records (EHRs) and patient portals have helped to some degree, many hospitals are finding they need more visibility and reach into the post-acute and home environments to keep patients in sight once they leave the hospital. This is where care coordination solutions can make a significant difference:  

During a post-acute transition. Hospitals can electronically share meaningful information to ensure a receiving facility has pertinent data, orders and prescriptions prior to the patient’s arrival. This helps bridge any possible care gaps while promoting quality and continuity during the transition.

While the patient is in a post-acute facility. Hospitals and health systems can also use these solutions to closely monitor a patient’s progress and facilitate communication with the post-acute provider. Doing so enables hospitals to assess a patient’s readmission risk and intervene if the individual is not receiving or responding well to the care provided.

When the patient goes home. In addition to keeping tabs on patients in the post-acute setting, care coordination technology enables hospitals to follow an individual after he or she is discharged home. Leveraging Bluetooth-enabled equipment, hospitals can virtually monitor key health indicators, such as pulse oximetry and blood pressure for patients with heart failure. They can also track whether a patient attends follow-up appointments, participates in therapy sessions and/or fills prescriptions. Ultimately, care coordination technology can help hospitals quickly determine which patients are or aren’t adhering to their care plans, thus enabling case managers to focus their time on deploying interventions for those who patients who require more assistance.

The goal behind greater transparency is to ensure all stakeholders have complete and accurate information about a patient’s condition and progress. By leveraging care coordination technology, hospitals and health systems can achieve this level of clarity—ultimately reducing readmission risks while supporting more favorable outcomes.

How might your organization and patients benefit from greater transparency? For more information about care coordination solutions and their ability to provide enhanced insight into a patient’s discharge plan, download our e-book.