According to some estimates, transition of care [from emergency room to the primary care] is the costliest part of the healthcare delivery system in the US. Out of estimated 150 million emergency room visits reported in 2010-11 across all 50 states, 80% of such visits resulted in follow-ups with primary care physician [PCP]. But for only 5% of all such reported PCP visits – relevant clinical information such as procedures performed, medication administered and tests conducted were available to the attending primary care physician. [In other words, for 114 million visits no ER information was available to the PCP] Estimated cost involved in chart chasing, mailing, faxing, phone calls, etc. is estimated to be in the range of 1.5 billion dollars in 2011 and projected to grow to 2.9 billion dollars by 2014 – whooping 24% growth.
Interesting observation is that HIE will not reduce this cost in near future as HIE implementation and adoption is moving really slow. There are many vendors operating in the middle offering multitude of delivery alternatives such as smart scans, electronic fax on demand and automated chart routing systems based on the primary care provider information [if such information is available]. None of these solutions are either improving or enhancing the quality of care.
With so much focus on Accountable Care Organizations [ACO], let’s hope that ER-PCP weak link will also be addressed seriously