The community of care continues to expand well beyond the traditional experience in the clinic. While plenty of attention has been given to electronic health information in the process of patient engagement, there is much more to the patient experience in this expanding context.
A recent study from the Canadian Patient Safety Institute highlights some important recommendations regarding continuity of care in a patient experience that is extends beyond the clinic. Although the purpose of the study was to understand the nature of the patient experience for those requiring home care services, there are some important takeaways regarding the structure of and methods for communicating with stakeholders across the continuum of care for the benefit of patients:
Case managers ensure quality care: Assign each home care client a cross-sector case manager with the authority and responsibility required to ensure the planning and delivery of a consistent quality of safe care.
Non-professionals need training, too: Offer unpaid caregivers training, ongoing support, counseling and health assessments.
Integrated teams lead to better results: Build integrated, interdisciplinary healthcare teams, involving clients and their caregivers, to ensure continuity of care delivery across all healthcare sectors, with particular attention to clients discharged from hospital to home care.
Collaboration is an ongoing effort: Explore opportunities for increased collaboration between home care and institutional care.
Medication requires consistency: Standardize medication packaging, equipment selection;
Sharing electronic charts streamlines care, communication: Implement a common electronic chart accessible by all caregivers from all sectors to standardize communication among disciplines and across sectors and expand the use of electronic reporting and communication tools;
Risk assessments must recur: Develop and standardize policies regarding the process and timing for risk assessment to ensure that changes in risk are flagged and followed-up. (Tools that already exist in Canada such as the Resident Assessment Instrument and its Clinical Assessment Protocols could be useful for assessing risk and guiding care.)
Certain medical conditions benefit from less limits: Lift restrictions on the supply of portable oxygen tanks for clients with chronic obstructive pulmonary disease (COPD).
Policies establish order, maintain safety: Implement policies and procedures to safely manage medication in the home care setting;
Members of the support benefit from clearly defined responsibilities: Develop standard competencies for home support workers.
The recognition that both professional and other caregivers participate in the patient experience is an underlying aspect of the real “meaningful use” of EHR. What’s more, electronic health information must be seen as important data and as a platform for “teachable moments” in the continuity of care.
The designations of physician, nurse, physician assistant and the like have been earned through a commitment to education and training. This high level of insight does set these professionals caregivers apart as a result of their abilities such as interpreting health data and providing appropriate guidance.
Patient access to information (and EHR patient access especially) is valuable, but guidance and coordination among those knowledgeable professionals in the context of engaging individual patients is even more valuable. Source
