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(The RAND Blog)

August 13, 2013

How Electronic Health Records Can Lead to Care Coordination

by Robert S. Rudin

Inadequate care coordination is a major problem in health care delivery, but information technology (IT) is emerging as an important tool for enhancing coordination and, ultimately, improving the delivery of care.

Most chronic conditions require multiple clinicians to coordinate care, and most patients who have these conditions visit providers from many different medical groups. This creates obvious logistical challenges, such as making sure all providers are up to date on the current care plan, as well as their respective roles and responsibilities for keeping track of the patient. Additionally, patients with more than one chronic condition — who incurred roughly 93 percent of Medicare spending in 2011 — require coordination among an even greater number of providers.

Experts have proposed IT as a key tool for improving coordination among patients and their providers — an especially important goal for provider organizations as they move toward accountable care. However, evidence shows that today's electronic health records (EHRs) and health information exchanges do not include adequate functionality to improve care coordination or facilitate caregiver collaboration.

A colleague and I recently proposed a vision of information technology capabilities that has the potential to substantially improve care coordination activities among the individual clinicians, caregivers, or provider organizations involved in care for a given patient.

There are numerous opportunities for care coordination technology to improve the U.S. health care system. For instance, it could integrate into electronic health records nationwide provider look-up capabilities based on National Provider Identification numbers, which would help providers identify other members of a patient's care team. A provider could also use care coordination technology to set her “interruptability” status, so that other providers can know when she is available for discussing a particular patient's needs, perhaps via phone or videoconference. Care coordination technology can also generate “drop-the-baton” alerts for patients who have fallen off a provider's radar.

These examples suggest that IT has great potential to improve care coordination by supporting providers as they identify collaborators, establish contact with collaborators, engage in collaborations, and monitor patients to ensure appropriate coordination.

So far, however, EHRs do not include the tools providers need, and policy action — including support for both standards development and additional informatics research — is necessary if these tools are to be developed and used.


Robert Rudin is a policy researcher in engineering and applied sciences at the nonprofit, nonpartisan RAND Corporation.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.