Revolutionizing emergency care: Interoperability vital

The value of emergency care delivery can be increased through the development of regionalized integrated networks of emergency care that capitalize on emerging changes in the health care system and meet time-sensitive patient needs, according to an article published in the December 2013 issue of Health Affairs.

Patient demand for timely acute care resulted in the existence of the emergency care system as we know it today. However, according to the Ricardo Martinez, MD, of the Grady Memorial Hospital in Atlanta and Brendan Carr, PhD, of the University of Pennsylvania in Philadelphia, U.S. emergency care remains outdated and fragmented. “The continuum of emergency care (including prehospital care, the ED, and the hospital-based subspecialists who support the emergency care capabilities of hospitals) must be transformed to provide greater public value—that is, high-quality care at lower costs than those of current approaches to emergency care delivery,” they wrote.

Martinez and Carr reviewed new models of care coordination as well as current challenges to successfully redesigning the system, suggesting a commonsense approach to developing effective, regionalized, and integrated emergency care networks that are value-based and better respond to patients’ needs.

Firstly, the authors offered redesigning the idea of regionalization so that patients are no longer transferred and referred to specialty care centers. Rather, hospitals and providers should be interconnected, sharing quality and performance goals and incentives to better emergency care outcomes across time and conditions.

“Developing the ability to connect emergency care resources across hospitals and health systems would move the decisions about diagnostics and therapeutics to the patient instead of moving the patient to other care facilities for further evaluation and care,” wrote Martinez and Carr. “This multidirectional collaboration would be safer and more efficient, cost-effective, and patient-centered than historic unidirectional transfer models.”

However, several challenges to these changes have been identified by the authors. These include people, quality and processes, technology, finances, and jurisdictional politics. With the system’s current shortage of a wide variety of medical professionals, the emergency care system is limited in its ability to respond to time-sensitive conditions. The unidirectional flow of many emergency care facilities creates problems such as inefficiency, ineffectiveness, delays in care, poor handoffs, and unnecessary travel.

When it comes to technology, modalities like MRI enable rapid accurate diagnoses but may require patient transfer to larger referral centers for specialized diagnostics and therapeutics. Lack of interoperable clinical systems adds to collaboration restriction and catalyzes patient movement for evaluation and definitive care.

Financial incentives, as well as physician and prehospital reimbursement structures, are misaligned. Lastly, futile variation in administrative processes and approved levels of practice hinders resource sharing and collaboration.

Solutions for said issues include allowing midlevel providers to practice at the top of their license, sharing resources in short supply across regions, establishing virtual collaborative relationships, instilling a patient-centered system-based approach, sharing medical data using “tele-stroke” models and making cognitive resources virtual, creating financial models that incentivize system based-outcomes,  and standardizing certification and credentialing procedures across regions to address workforce shortages.

“Emerging technologies, infrastructures, and care models offer opportunities to develop more efficient, more effective, and safer systems of care that provide higher value for participants across a region,” concluded the article’s authors. “Policy makers, health care industry executives, and providers should take advantage of these opportunities to accelerate the development of patient-centered, value-drive integrated networks or emergency care.”