The Patient-Family Journey from Outpatient to Inpatient: Improving Quality and Safety With the Outpatient EMR and PCP Collaboration

By David J. Badolato, MD

Most Americans agree that the healthcare system is in need of a major transformation to deliver value to all stakeholders; however, there are varying perspectives on what exactly is broken and how it needs to be fixed depending on each stakeholder’s definition of value. According to the Joint Commission Center for Transforming Healthcare, “an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients” (Joint Commission on Accreditation of Healthcare Organizations, 2012).

In my view, this miscommunication is a result of two key issues in today’s healthcare system. The underuse of the medical summary derived from the outpatient electronic medical record (EMR) and the minimal communication between referring primary care physicians (PCP) and hospital providers have led to serious quality and safety implications for patients. Every touchpoint throughout a patient’s (and family’s) care journey can be positively impacted by optimal use of medical summaries and enhanced collaboration among healthcare professionals.

The majority of people seek to have their medical needs met at a primary care practice level; therefore, strategies and actions that improve safety, quality, and affordability for all stakeholders require highly focused attention and research to create new initiatives that can be readily implemented at that level.

Strong foundation: PCMH model 

The good news is that an infrastructure has already been built to manage these key systematic problems, which often result in serious medical errors. The bad news is that the healthcare community has yet to implement it.

A patient-centered medical home (PCMH) is indispensible, both for the paradigm shift that will ensure a patient focus and for the proficiency of healthcare innovation. The PCMH is a soundly supported foundation that will determine the success of healthcare’s transformation to a value-based versus volume-based system. Value should be defined as the healthy outcomes achieved per dollar spent over the full cycle of care for each patient, as articulated in Redefining Health Care by Michael Porter and Elizabeth Teisberg (2006). Optimum care costs less, especially when applied at the level of primary care that provides an ongoing relationship, whole-person orientation, coordinated and integrated care, and advocacy to guide the patient-family journey. PCMH primary care is designed to be safe, effective, patient-centered, timely, efficient, and equitable—the six aims of the 2001 report, Crossing the Quality Chasm (Institute of Medicine, 2001).

Value transformation of healthcare in the U.S. requires primary care to make this paradigm shift to the PCMH, and for the PCMH to be vertically integrated throughout the cycle of care. Essential to its implementation is a quality primary care foundation that emphasizes population health management, uses value-driven best practices in preventive health and chronic disease management, and takes care coordination and transitions into account.

Optimal primary care costs less over the full cycle of care and provides the best opportunity to sustain proficient and efficient value-driven care that delivers healthy outcomes per dollar spent. It supports the Institute of Healthcare Improvement’s Triple Aim of: 1) improving the health of the population, 2) improving patient experience, quality, and satisfaction, and 3) reducing the per capita costs of healthcare. Recently, the Triple Aim has been changed to the Quadruple Aim of 1) better outcomes, 2) lower costs, 3) improved patient experience, and 4) improved clinician experience. Focusing our innovation on value for all stakeholders will drive our success.