Using an Electronic Medical Record for Continuity of Care

• 8/13/2009
• Author: Steven Berman
• Category: The Journal Blog
• 25362 Views
• 0 Comments
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This week, Allen Hsiao, the lead author of  “Dropping the Baton During the Handoff from ED to Primary Care: Pediatric Asthma Continuity Errors,” which appears in the September 2009 issue, guests on the Journal blog. As part of the AHRQ-sponsored “Electronic Records to Improve Care for Children” (ERICCA) project, the authors examined the handoff of care for asthmatic children between the ED and the primary care providers in a traditional paper-based documentation system. Despite the great efforts to achieve continuity using phone calls and paper faxes, the authors found that all too often, “batons” are dropped in this important transition of care, with errors in continuity of information and continuity of care. The Journal invites your own comments on any progress on continuity of information or care that you’ve been able to make at your own organizations.
 
Continuity has been seen as a necessary attribute of high-quality care and is especially important for and valued by vulnerable populations such as inner-city children with asthma. Patients who have continuous relationships with their primary care physicians have substantially decreased risk of emergency department visits and hospitalization. The ERICCA project successfully deployed an electronic medical record into the pediatric emergency department of Yale-New Haven Children’s Hospital to be used for discharge instructions and prescriptions. Primary care providers at the two community health centers cited in the article, as well as others, now receive information through electronic faxing and can also view the instructions and medication lists online through an online portal. This has greatly improved continuity of information. Because the project also implemented the electronic medical record in the pediatric respiratory medicine clinic, an added bonus is the emergency department can now share an electronic medication list with them; providers at both ends know exactly when an inhaler was refilled or when the last course of steroids was prescribed.

With the U.S. government’s recent big push for electronic medical records in ambulatory and hospital settings, we should soon be able to greatly diminish continuity errors. It will take work to pass critical information between different systems, but getting off of paper and transmitting the information electronically is half the battle. We sincerely hope that physicians soon won’t have to “practice in the dark”—not knowing a patient’s history or medications or that he or she was recently treated in an emergency department.