Integrated EHR enables shift to virtual post-discharge follow-up


A recent study published in the American Journal of Managed Care found that provider use of a shared inpatient-outpatient electronic health record was associated with a shift toward follow-up delivered through a combination of telemedicine and outpatient laboratory tests, with no differences in 30-day emergency department visits.

“Timely availability of clinical information during health care transitions, in a setting with robust telemedicine access, can shift the method of care delivery without adversely affecting patient health outcomes,” wrote the researchers.

The research team studied nearly 250,000 hospital discharges in patients with diabetes from 2005 to 2011. From 2006 to 2010, they explained, an integrated delivery system staggered implementation of an integrated EHR across 17 hospitals.

“This created a stepped-wedge study design to study the impact of shared inpatient-outpatient EHR use,” the researchers wrote.

The integrated EHR automatically includes patient history and clinical information with the outpatient EHR used by primary care providers and specialists, including order-entry capability for follow-up, medication reconciliation, secure messaging and notifications to outpatient providers that patients had been hospitalized.

After the shared EHR implementation, the researchers found that the proportion of seven-day follow-up delivered via telemedicine and without an in-person office visit increased from 22.9% to 27%.

There were no statistically significant differences in the rates of ED visits or readmission associated with the integrated EHR.

“Because we found that follow-up care was more likely to be delivered through only telemedicine and laboratory tests, without any evidence of adverse changes in downstream health events as measured by ED visits and rehospitalizations, these changes in follow-up care represent potential improvements in the efficiency of health care delivery without adversely affecting quality,” wrote the team.

They noted that this may be yet another advantage of telehealth availability: “Although patient convenience and access are typically considered primary benefits of telemedicine, our finding of EHR-supported efficient post hospitalization follow-up through telemedicine may also be relevant as current crisis-based social distancing to protect patients and providers from infectious disease spread is rapidly shifting many medical office visits to telemedicine.”

The researchers also pointed out that health information exchange availability might affect follow-up patterns in other settings, as could different patient populations.

“Shared EHRs and HIE are only tools to increase information availability; their impact is dependent on the clinical workflow and delivery system context in which they are used,” they wrote.


Although the study tracked patients from 2005 to 2011, before the current telehealth boom, it offers yet another piece of evidence for why virtual care is likely to remain a staple in healthcare even after the pandemic.

Furthermore, questions of post-discharge patient activity are likely to loom large in the coming weeks, as the Centers for Medicare and Medicaid Services require hospitals to send electronic notifications to other healthcare facilities when a patient is admitted, discharged or transferred.

Some vendors, such as AllScripts’ CarePort Health, have stepped up to assist, with customizable patient-event notifications to help manage the referral process.


“Calls for increases in exchange capabilities at hospital discharge are growing, but few settings have measured the large-scale impact of EHR-based information integration across delivery settings,” wrote the researchers.

“Our study finds that movement toward more seamless health information access, even within an already integrated system, can affect the efficiency of follow-up care after hospital discharge without adversely affecting quality. These shifts may also potentially improve patient convenience through telemedicine follow-up without requiring the transportation and cost of making an in-person visit to health care providers,” they continued.