Alaska hospitals take advantage of tech to coordinate care
Editor's note: This article has been updated to correct the spelling of Rachel Lieber's last name and the estimated number of hospitals in Collective Medical's network.
It’s pretty easy for patients to disappear in the labyrinth of the medical system. Alaska’s hospitals are trying to make sure that it’s much harder.
By late August, more than a dozen Alaska hospitals were live on a technology platform run by Collective Medical that allows them to see a patient’s medical history upon arriving at their emergency departments.
That’s somewhat novel; without it, hospitals would have to gather all the information they could from the patient and request any prior information from other emergency rooms and other hospitals to put together a medical history.
“For years, I have worked in emergency departments where there is a book somewhere where there are care plans for our patients,” said Dr. Keri Gardner, the chief medical officer at Alaska Regional Hospital. “That care plan, instead of just being at Alaska Regional, will now be visible to (any hospital in the network).”
Alaska Regional Hospital’s Emergency Department went live on Collective Medical’s platform in early August. It’s easy to use and embedded in the hospital’s electronic medical record system, Gardner said. The providers there recognize the value in being able to see a patient’s recent emergency room visits, prescription history and other records.
Collective Medical, a 10-year-old company with about 1,000 hospitals in its network around the country, collects information from hospitals’ emergency departments and runs it through its platform, sending notifications to emergency departments where a patient is also seen to provide more information. It runs through an HL-7 interface and is Health Insurance Portability and Accountability Act-compliant, said Rachel Lieber, the northwest region manager for Collective Medical.
Beyond the medical side, the system also provides another notification of interest: safety threats. Assaults and threats against emergency department staff happen all over the country, including in Alaska. Lieber said the safety notifications came up fairly early in Collective Medical’s development.
“Knowing how often your staff are facing assault, aggression or violence helps you know what your staff are dealing with in the workplace,” Lieber said.
How a hospital deals with safety issues for staff varies from patient to patient, Gardner said. The safety flags can also help protect other patients. For example, if an incoming patient may be a threat to other people in the emergency room, he or she could be placed in a separate room, she said.
“This is a big issue in Anchorage,” she said. “The health care workers who staff emergency departments are at risk. I have personally experienced and personally witnessed injuries to emergency department workers ranging from cuts and bruises to broken bones.”
Gardner pointed to the leadership of the Alaska State Hospital and Nursing Home Association in getting all the hospitals in Alaska to invest in the same platform. Lieber said Collective Medical began working with providers in the state about four years ago, around the same time that ASHNHA began its care coordination initiative.
Care coordination is a key reason for choosing the program, along with improving emergency department utilization, said Becky Hultberg, CEO of ASHNHA. Other hospitals in the network have documented 15 percent decreases in emergency department utilization and 10 percent utilization decreases among frequent emergency department users.
“Along with improving patient care, reducing avoidable hospital admission and readmissions and (streamlining) transition to post-acute care providers are often cited by hospitals as the biggest benefits of using the Collective platform,” Hultberg wrote in an email.
Gardner said another important driver of the program is cost reduction and improved value. Being able to see which procedures and prescriptions a patient has undergone recently may inform care and reduce overutilization, especially on controlled prescription drugs.
Over-utilization of emergency departments at hospitals is a major issue nationally. Emergency services are one of the most expensive ways to receive health care, but studies have shown that some individuals are visiting emergency departments more than a dozen times per year.
Alaska has a handful of these individuals as well, known as “superutilizers,” who are responsible for a major chunk of the emergency room costs annually. In 2016, the top 6 percent of emergency department users accounted for 23.8 percent of the charges, or about $148 million, according to the Alaska Department of Health and Social Services.
Some have suggested one of the reasons individuals may be over-using the emergency departments is that they do not have adequate access to behavioral or primary care services.
The Collective Medical platform works with providers of various specialties and populations, including jail clinics and behavioral health providers, which helps connect different points in the care continuum, Lieber said.
“The emergency room may be the best place to interact with some individuals that are facing housing insecurity or homelessness, or are challenged by mental health disorders or substance abuse,” she said.
“Sometimes the emergency room, while we want to make sure we’re using it appropriately, might also help us start conversations with individuals who may not otherwise have access to a primary care.”
Whether because of health care record privacy laws or because of insular operations, hospitals and health care organizations do not always communicate. An effort like this is helpful, Gardner said.
“It’s unusual to see hospitals working together at this level, and it’s refreshing to see,” she said.
Elizabeth Earl can be reached at [email protected].