Do primary care physicians receive information on patients referred to the Ed?
Emergency physicians reported, however, that they frequently did not receive information on patients referred from a primary care office, suggesting that a significant number of PCPs do not send information with their referrals or that information is lost in transit once it reaches the ED and never reaches the patient’s chart.
When should the ed medical record be available to patients?
The ED medical record should be promptly available after the patient encounter. For EMR systems, technological assistance should be available immediately 24/7 and plans should be in place to manage records in the event of an EMR system failure. Hospitals should provide a plan for appropriate and timely review of technology and software updates.
Should primary care providers be notified when a patient visits the ER?
Primary care providers were most concerned about being notified if their patients were experiencing an illness that might require admission or follow up, and many said that they did not need to be notified if their patient visited the emergency department for an acute complaint that could have been addressed in a primary care setting.
How are emergency medicine records transferred to primary care?
Many emergency physicians also reported using systems where their records are automatically faxed to the offices of primary care providers affiliated with their hospital after the patient’s discharge. Depending on when the ED notes are signed and entered into the patient’s medical record, this may involve a delay.
Why do primary care physicians lose opportunities to educate their patients about when it is appropriate to use emergency departments?
In addition, primary care physicians lose opportunities to educate their patients about when it is appropriate to use emergency departments and to learn about gaps in their own availability that may be driving unnecessary utilization by patients.
What, if anything, can policy changes do to improve the communication and coordination between emergency and primary care physicians?
What, if anything, can policy changes do to improve the communication and coordination between emergency and primary care physicians? Given many physicians’ concerns that they are not compensated for time spent in communication, it might seem logical to establish a clinically meaningful definition of appropriate communication that can be linked to reimbursement. This approach is unlikely to be effective for several reasons.
How do emergency physicians communicate?
When they do communicate, emergency and primary care physicians most commonly communicate by telephone. Many emergency physicians also reported using systems where their records are automatically faxed to the offices of primary care providers affiliated with their hospital after the patient’s discharge.
How does the growth of primary care groups help PCPs?
While rising hospitalist use and the growth of larger primary care groups help PCPs decrease their call responsibilities and maintain a more balanced lifestyle, they inevitably decrease interactions between office-based and hospital-based physicians.
Why are PCPs important?
PCPs’ frequent physical presence in the hospital created opportunities for interaction and the development of relationships between emergency and primary care physicians, which in turn made providers more likely to contact each other regarding shared patients.
Why are ambulatory specialty tools suited for coordination with ambulatory specialty care?
Because avoiding emergency department utilization is a goal of the patient-centered medical home , these tools appear most suited for coordination with ambulatory specialty care, rather than with emergency care providers.
How many people will be covered by the ED in 2019?
Under health reform, an estimated 32 million people will gain health coverage by 2019. Since insured people are much more likely to seek care in emergency departments, ED use will likely increase significantly. In addition, many newly insured people will be covered by Medicaid, whose enrollees have the highest rates of ED utilization of any group, possibly because of less access to primary care. 1-3
What is the role of emergency physicians in the medical record?
Emergency physicians should play a lead role in the selection of all medical record documentation aspects for the health care system. An effective ED medical record assists with: documentation of clinically relevant aspects of the patient encounter including laboratory, radiologic, and other testing results. efficiency in the patient encounter ...
What should hospitals provide?
Hospitals should provide a plan for appropriate and timely review of technology and software updates. Hospitals should provide emergency physicians the same access to dictation and transcription services as is provided to other hospital medical staff .
Why is complete information important in emergency care?
When it comes to emergency medical care, complete information is vital to making the best clinical decision. Timely access to existing records often affects clinical actions, such as decisions to admit, order expensive imaging tests, or use narcotic pain relievers. For example, incorrectly using HIPAA as the reason for not sharing important ...
What does HIPAA say about directory information?
What HIPAA says: Providers may disclose “directory information” (i.e., patient’s location and general health status) if the caller identifies the patient by name. This exception permits callers to locate friends or family who may have been involved in an accident.
What does incident to mean in HIPAA?
While HIPAA does not define exactly what “incident to” means, it requires that providers “reasonably protect” PHI with appropriate safeguards to limit incidental disclosures. This may include speaking quietly when discussing PHI or moving patients to private areas.
What is additional information disclosure?
Additional information may be disclosed if it is to be used for a “health care operations” purpose, which includes six broad categories of activities such as quality improvement and customer service. If information beyond directory-level information is sought for personal interest, such disclosures are impermissible.
Does HIPAA require PHI disclosure?
It is important to note that HIPAA does not require that the PHI be disclosed to the requesting provider in this example. In fact, HIPAA only requires disclosures in two circumstances: to the patient and to the U.S. Department of Health and Human Services (HHS) for compliance purposes.
Can a provider disclose PHI?
A provider may disclose PHI to the media where necessary to identify, locate, or notify individuals responsible for the patient’s care, but media-initiated inquiries about a specific patient do not fall within this exception . ADVERTISEMENT.
Is disclosure permissible under HIPAA?
If failure to disclose would materially and adversely impact care, it is probable that the disclosure would be permissible under HIPAA. Law v. Ethics. A provider may use his/her professional judgment as to whether to disclose when a permissive exception applies.
Emergency Care: The Path of Least Resistance
Clinical Communication and Care Coordination
- When and how communication happens. Care coordination in the emergency department draws on many sources of information, including the patient, family members, the patient’s usual primary care physician (PCP) or practice partners, and/or the patient’s medical record. Most obvious are patients themselves, along with family members or caretakers. Howe...
The Clinical Encounter
- Physicians described several points in the ED encounter when communication could occur, from the patient’s entry to the ED through final disposition (see Figure 1). But interaction at some points could be more challenging—or more useful. Initial assessment. When referring patients to the emergency department, many PCPs said they send patient information by fax or speak directly …
Communication Barriers
- Physicians described several barriers to improved communication and coordination of care. Some of these were specific to particular communication modes, while others were overarching issues affecting all types of communication. Real-time communication: telephone. While alternative communication methods could be useful in many cases, real-time, physician-to-physician comm…
Other Barriers
- Providers also cited a number of barriers that were not specific to any one communication modality. These included issues that are deeply embedded in the practice of medicine, such as reimbursement and payment systems and medical liability. Lack of time and reimbursement. Emergency and primary care physicians most commonly cited insufficient time and lack of reim…
Policy Implications
- What, if anything, can policy changes do to improve the communication and coordination between emergency and primary care physicians? Given many physicians’ concerns that they are not compensated for time spent in communication, it might seem logical to establish a clinically meaningful definition of appropriate communication that can be linked to reimbursement. This a…
Notes
- 1. Weber, Ellen J., et al., “Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?” Annals of Emergency Medicine, Vol. 52, No. 2 (August 2008). 2. Newton, Manya F., et al. “Uninsured Adults Presenting to U.S. Emergency Departments: Assumptions vs. Data,” Journal of the American Medical Association, Vol. 300, No. 16 (October …
Data Source
- In addition to performing literature reviews, HSC researchers conducted a total of 42 telephone interviews between April and October 2010 with 21 pairs of emergency department and primary care physicians across 12 communities that are part of the Community Tacking Study. The communities are Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark…