Continuity of Care: What's the Big Deal?

Continuity of care is an ideal that health systems and health care providers are striving to achieve. Continuity of care refers to a situation where all health care providers taking care of a patient know that patient well--through repeated visits or through their access to the patient's complete medical records. In an ideal world, the health information of all patients will be digitized and uploaded into computers so that, no matter which health care facility a patient might walk into, their health history will be instantly available to whoever is caring for them. All providers will be on the same page.

Every day here at Johns Hopkins, a wide assortment of people walk into our emergency department (ED) to get care. But whenever we discover that a patient who is new to our ED already has a doctor who's affiliated with some other hospital, we wonder what led that patient to our doors. We usually start by asking the patient why they didn't go to their own doctor's hospital, and the response usually comes down to, "I really didn't think it was important."

But this matter is so important, in terms of the patient's continuity of care! Let's talk about why…

Records

When you see a health care provider, he or she is often affiliated with a particular hospital or health system. With the advent of electronic patient records, all the records of a provider who's affiliated with a particular hospital or health system can now be easily accessed and shared by every other provider at that same hospital.

The eventual goal is for all these electronic records to be somehow stored centrally so they can be shared easily and instantaneously between all health systems and hospitals.

But for now, the reality is often quite different and, a lot of times, the records of patients from other hospitals or health systems can be difficult to obtain--particularly if a patient's providers are not affiliated with your hospital, or a patient walks into your facility during off hours.

It's like starting over

Today, if you go to an ED that's not affiliated with your own provider and so doesn't have access to your provider's records, it's often as though you were starting all over in care. Many of your laboratory and radiology studies will have to be repeated, simply because the results of your previous studies cannot be obtained.

Starting over--when a hospital has to repeat studies like this--can be expensive, time consuming, and not without difficulty for you (like getting your blood redrawn!). How expensive? Researchers in Memphis, Tenn., were able to temporarily link together all the electronic medical records of 12 EDs--and the savings gained shot up into the millions of dollars when just those 12 EDs were able to avoid repeating patient studies and treatments.

And it puts you in danger

Suddenly going to an unfamiliar hospital can also be dangerous for you, since important facts about your health history can be missed or overlooked. Items that might seem unimportant to you could turn out to be critical in your care. One example: You might end up with new prescription medications that interact poorly with other ones you already take--a situation that could put you at risk.

The federal government has now mandated that by 2014 all health care facilities and providers must make their records electronic and sharable. (And the government plans to penalize any providers who aren't compliant by 2015.)

What can patients do?

All patients can do their part today to keep themselves safe. Here are some steps to take:

  • Know your health provider's name and contact information and have these readily available.
  • Find out the hospital your provider is affiliated with.
  • If you do have a health emergency, go to that hospital.
  • If you end up in an unfamiliar ED

But what if you have to be transported by ambulance, and the ambulance drivers have to take you to the closest hospital, which isn’t your provider’s hospital? Or, say that you're traveling and in a strange city--you will of course have to settle for a random ED. In this case,

  • be prepared to give the staff of the ED permission to contact your own health care providers and to obtain your records.
  • know your medical history intimately and tell all the details, even if some don't seem important to you.
  • make sure you mention any medications that you have or take.

In other words, do whatever you can to make sure your care is continuous and unbroken--because continuity of care is important!

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