The Issue of Persisting Clinical Communication Gaps

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For the past several years, healthcare practices have progressively implemented more electronic paperwork and phased out physical paper forms. Patient records are easily stored and accessed through online portals, and test results are instantly accessible once uploaded to these patient portals.

What is the reason for this progressive push to shift everything online? It is the result of a combination of: 1) the 2009 American Recovery and Reinvestment Act, which served to strengthen health IT infrastructure, 2) President Obama’s encouragement for healthcare providers to shift paper records to electronic health records (EHRs), and 3) The Office of the National Coordinator for Health Information Technology’s 10-year vision for health IT platform interoperability to reduce costs and improve patient control of healthcare.

So, what does EHR use look like in a healthcare setting? Physicians often have a computer while they see a patient, asking questions and performing relevant examinations. During the appointment, they type or document subjective reports from the patient and objective measurements and observations in the patient’s individual healthcare record at the time of service. Sometimes, the healthcare provider may need to complete some or all visit documentation after the time of service if they are unable to complete everything during the appointment. Additionally, not all healthcare practices utilize the same EHR system as there are a variety of systems in use across different practice settings and specialties.

How Does EHR Use Impact Physician-Physician Communication?

Despite the goal of making comprehensive patient health records more widely accessible, clinical communication gaps still exist, especially amongst primary care physicians (PCPs) and physician specialists. This can result in miscommunication about patients, wasted time and money, and frustration on both the patient and physician ends.

A recent study in The Annals of Family Medicine reported that communication among physicians also suffers despite EHR use. 17% of PCPs reported they sometimes send clinical information to a specialist upon referral, while 33.3% sometimes obtain clinical information from the specialist after the patient has been seen. 4.9% of PCPs reported they seldom or never send information and 1.5% seldom or never hear back.

How Does Inadequate Communication Impact Patients?

Inadequate communication between physicians is not just harmful to the practice, but it is also detrimental to patients. Adverse patient impacts can include receiving the incorrect procedure or medicine or causing a delay in testing.Inadequate communication between physicians is both harmful to the practice and detrimental to patients.Inadequate communication between physicians is not just harmful to the practice, but it is also detrimental to patients. Adverse patient impacts can include receiving the incorrect procedure or medicine or causing a delay in testing.

These impacts are not just an inconvenience to patients — they are costly. For example, medication error morbidity and mortality annual costs are $77 billion per year, with three and a half billion dollars accounting for the cost of hospital-based, drug-related injuries.

How Can the Healthcare System Bridge the Communication Gap?

Keeping these serious issues for patient well-being and safety in mind, what are some ways to bridge this healthcare gap moving forward? The following are just a few ideas:

• Allocate time within physician schedules to allow for follow-up and communication with fellow practitioners. It’s reported that one-third of the amount of time spent with patients is needed for completing administrative tasks.
• Consider embedding an asynchronous electronic communication tool within the EHR systems.
• Use a standardized communication format to help get providers on the same page, such as the SBAR, which stands for situation, background, assessment, and recommendation.
• Establish a workflow process and regularly audit to ensure all relevant medical history is being transferred to and from referral sources.

Clearly, while EHR systems may allow patients to more universally access their healthcare information and make more informed decisions, a gap between communication with PCPs and physician specialists still exists.

Identifying the sources of the gap within individual practices and working to address them can enable improved communication and allow for optimized patient outcomes and reduced healthcare costs. At ChartLogic, we can help you improve patient care, office efficiency, and profitability for the physician practice. Contact us today to get started!