In Alameda County, A Big Data Effort To Prevent Frequent ER Visits

CAL/AAEM News Service at
Sat Jul 2 09:43:29 PDT 2016



June 22, 2016


In Alameda County, A Big Data Effort To Prevent Frequent ER Visits 



neKuPvi4tU7syyfQcwtSI&_hsmi=30933831> California Healthline



By Jenny Gold


Almost every day, a patient comes into Dr. Arthur Sorrell's San Francisco
emergency room still wearing a wristband from another hospital nearby.


"There are folks who have a life of going from emergency department to
emergency department, and that's how their day is spent," said Sorrell, an
emergency physician and administrator at Sutter Health. "It's sad and
tragic, but that's what happens."


The wristband is at least a hint.


Without it, emergency room staff often have no idea they are sharing
patients with other hospitals just a mile away. So they treat those patients
completely independently, often repeating tests unnecessarily, assigning
them multiple case managers when only one is needed and offering
contradictory advice.


Some patients have chronic health problems that send them repeatedly to the
ER, while others are seeking food, a warm bed or someone to talk to.


Even if ER staff do know about visits to other hospitals, sharing
information about the patient is a struggle. "I have to tell my unit
coordinator to call over to the other hospital and have them fax over the
records," said Sorrell. Sometimes, a 50-page fax will arrive, which Sorrell
must sift through while juggling dozens of other patients.


But that vexing reality may soon change for hospitals in Alameda County, as
they team up to share patient health records and other data in real time
among their emergency departments.


So far, their partnership includes four Sutter Health hospitals and two
Alameda Health System hospitals. Since the program began on March 31, Alta
Bates and Highland Hospitals have learned that they shared more than 2,000
patients, and over a third of them made six or more ER visits in the past


The hospitals share a system called PreManage ED, which tracks all of their
ER patients. When an emergency department enters a patient's name into the
system, it gets an alert if that patient has visited other hospitals. If so,
the emergency department staff can view information about the patient's
recent treatment and find out whether he or she already has a case manager
somewhere else.


The system can also benefit the many patients who end up visiting multiple
hospitals. If a patient already had an x-ray, CAT scan or other test at one
hospital, for example, the shared database can help ensure he or she doesn't
get the same test again.


Some experts, however, say competition among hospitals can be a deterrent to
data sharing.

Whether a hospital is willing to share information with competitors depends
on how it gets paid, said Dylan Roby, an assistant professor at the
University of Maryland School of Public Health.


Hospitals that want to avoid having their payments reduced by federal
penalties for readmissions, for example, have a strong incentive to
collaborate in order to avoid unnecessary ER visits by Medicare patients.
Hospitals participating in collaborative care networks that are paid monthly
amounts for patient care also have an incentive to share information.


"But it's not always in [hospitals'] financial interest to share data about
patients," said Roby. Facilities that still depend on fee-for-service
payments they receive for each individual patient visit, for example, may
prefer to fill their beds rather than collaborate with competing hospitals.


PreManage ED already is being used by hundreds of hospitals nationwide,
primarily in the Pacific Northwest. Twenty California hospitals use the
system, and dozens more are in talks to do so.


But what sets Alameda County's effort apart is that it also plans to include
community health clinics and other social service organizations, so they too
will receive alerts from the hospitals when their patients seek emergency


The idea for the collaboration arose in 2015 from the experience of a single
patient - a 57-year-old Oakland woman with a history of mental illness and
chronic substance abuse. In just three years, the woman visited local
emergency rooms more than 900 times.


"We really thought we were her favorite hospital. She knew the names of
everyone, from the doctors to the security guards," said Tracy Schrider, who
coordinates the care management program at Alta Bates Summit Medical Center
in Oakland and had assigned the woman a social worker. "We had no idea she
was already in a case management program and was going to Highland even more
than she was going to us!"


The teams at the two hospitals sent the woman to different agencies and gave
her conflicting advice, Schrider said. "Everybody meant well. But she was
being referred to three different substance abuse clinics and two different
mental health clinics, and she had two case management workers both working
on housing." It was not only bad for the patient, it was also a waste of
precious resources for both hospitals, Schrider said.


Elsie Kusel, an emergency medical services coordinator for Alameda County,
helped discover the connection. The patient had taken hundreds of ambulance
rides in the previous year.


"We brought everyone to the table. There were more than two dozen people in
one room, talking about one person," Kusel recalled. They included
representatives of both hospitals, several community-based organizations,
the paramedics, the Berkeley public health department and the fire
department. All of them had helped care for the woman at some point - they
just didn't know it.


The PreManage ED project will make patients like that 57-year-old woman
known to all the providers who can help coordinate her care, wherever she
seeks treatment.


"We've made visible a group of patients with unmet needs throughout our
community," said Sorrell.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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