No one doubts the importance of Continuity of Care in Medicine.
ONC’s 45 CFR Part 160 Subpart C Final Rule includes a number of criteria (22 out of 44) that have a specific focus on Continuity of Care.
302a Drug-drug Interaction checks, 302c Problem list, 302d Active Medication List, 302e Active Medication Allergy List, 302h Incorporate Lab Test Results, 302j Medication Reconciliation; 302p Emergency Access ; 304c, d, e, f, g, h, i; 306a, b, c, d,e, f, g, h.
What is missing at these ONC guidelines, if you look under the hood?
Missing is the ability to reach out to a superior, colleague or domain expert as and when there is a need for a “second opinion” (e.g. advice and assistance) that improves patient quality of care.
Consider a busy 24 x 7 healthcare facility where one provider has a question at 1545 hours that impacts patient care and where the provider will be going off shift at 1600 hours.
Suppose he/she poses a question using ordinary e-mail services/systems – the result will be either a quick response and a timely intervention or a 16-hour delay (worst case) and an untimely intervention.
Another variation to this scenario is, the provider, not having received a response by 15:50, will perform an intervention in the absence of possibly important information, resulting in a medical error.
What is missing is “dynamic Continuity of Care” where a record of the provider’s outgoing request for information posts to the patient EMR and the response to the request for information comes back, not to the provider, but to the point of service, where it will be seen by anyone attending to the patient on night shift.
So, we have here yet another reason why ordinary e-mail is not effective for medical collaborative initiatives.
Why not just leave a note for the person who takes over on night shift? The answer for busy clinics is that provider in our scenario will not necessarily know who his/her replacement will be and even if he/she were to know, there could be a last minute change in provider.
Bottom line, don’t engage in collaborative consultations using anything other than in-line messaging/notification services where requests go out from points of service and responses come back to those same points of service.