Countless reasons have been proposed why electronic clinical records are slow in finding use in rehabilitation hospitals. From physician concerns about workflow to extreme costs, the issues mount and inhibit adoption of EHR systems. One can speculate the most important reason why clinicians are reluctant to adopt clinical IT systems is a perceived lack of added value. Clinicians are quick to point out that it takes too long to document electronically; and when done, it is usually health system administrators, payors, CMS and hopefully, the patients who benefit from the clinician’s keyboard efforts. To really add value for the clinician it is still often necessary to develop best-of-breed systems that enable the information specifics to be shared openly whenever and where ever required.
Frequently, these systems circumvent existing systems with a strong administrative focus in one form or another. Usually, best-of-breed systems are cumbersome to integrate, poorly maintained with minimum resources and are not interoperable with other systems. Further, rehabilitation hospitals and individual rehabilitation professionals are highly specialized. For optimal patient care, the various rehabilitation provider organizations and health professionals have to co-operate closely in the delivery of patient care, often calledInterdisciplinary Team Coordinated Care.
Rehabilitation care can be described as the continuous patient-oriented co-operation of hospitals, physicians, specialists and other health care professionals during patient care episode and often extending across the post-acute care continuum. The quality of patient care in these patient shared care environments is currently the subject of study in healthcare transformation initiatives. The literature suggests that coordinated and integrated care provides patient care as effective as a specialist-only environment, but is less expensive.
Information technology has the potential to enable efficient communication, reduce costs, improve quality of care and is a means to patient empowerment.
In this new world of health care transparency and patient centric accountability, success is dependent upon provider/clinician collaboration and compromise. Acknowledgement of each professional contribution to patient outcome and the adaptability to apply a new expectation set of disciplined communication will be required to practice in a shared care environment. Integrated care presents a series of challenges to the availability and processing of information including trusting the shared information and the accurate and clinically safe interpretation of that information. If not managed, IT can lead to more complex and variable processes imposing additional workload and sources of error on clinicians. Shared care requires excellent (i.e. fast and high-quality) communication between the various health care providers. Data must be of high quality (i.e. correct and complete), high reliability and high flexibility. A common framework for content and context is necessary.
Industry wide agreement, oversight and enforcement will be required to standardize and accommodate new learning and expression of clinical concept and content. Clinical content and context will require standardization and translation to achieve cross provider utility. Different information systems used by the various health care providers of shared care must be able to interoperate, so that one system can understand the context and meaning of information provided by another system (semantic interoperability). The systems in which domain concepts are hard-coded directly into its software and database models will result in systems that are expensive to modify and extend, and consequently have a limited utility and lifespan.
Rehabilitation providers are slow in adapting electronic means to capture report and coordinate patient-centric care requirements within and across the siloed landscape of post-acute care. They must now consider that the next generation of meaningful use of those systems must demonstrate interoperability.