Transfers—sending patients to a different facility and, alternatively, accepting patients from referring providers or hospitals—are regular occurrences. But unfortunately, so are the hampered communication and data management efforts surrounding them.
In fact, most health systems waste significant time and resources trying to track down the provider information they need to quickly make the best decisions about patient transfers. So when a hospital can rapidly identify whether a certain specialist is in their hospital or network, a transfer can be avoided, bolstering patient safety, quality, and revenue.
When a provider isn’t quickly found in one of many solutions the typical hospital uses to manage provider data, they are said to add the provider “on the fly”—to the EHR, credentialing system, etc. This scramble occurs even though end-to-end provider data management technology exists.
Patient transfer decisions
As an essential aspect of healthcare, transfers are undertaken to improve care management. They may involve moving patients within the same system for a procedure or transferring an individual to another facility or system that has more advanced care capabilities or medical technology. In all cases, the goal of the transfer is patient-centered—to maintain the continuity of medical care.
The reasons for transfers vary from voluntary (e.g., a patient/family request) to necessary or mandatory (e.g., hospital capability/capacity issues or insurance issues). If it’s a request, typically the treating physicians and a senior medical staff leader such as the chief medical officer or department chair will thoroughly discuss the benefits and risks involved with the patient and/or family.
How EMTALA factors in
In other cases, a transfer is necessary and not entirely up to the hospital alone to make the decision. For example, the federal Emergency Medical Treatment and Labor Act (EMTALA), referred to as the “anti-dumping” law, requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.
EMTALA contains numerous provisions that guide hospital decision making, but if an emergency medical condition exists, treatment must be provided until the emergency medical condition is resolved or stabilized. If the hospital does not have the capability to treat the emergency medical condition, an "appropriate" transfer of the patient to another hospital must be done in accordance with the EMTALA provisions.
Specifically, EMTALA requires hospitals to:
- Assess to determine whether an emergency condition exists
- Stabilize the patient and determine disposition (only if an emergency condition exists)
- Post call rosters with specific dates
- Ensure on-call physicians respond in a timely manner
Through EMTALA, the federal government created a hospital obligation that only individual physicians can fulfill by consenting to on-call responsibilities. But hospitals, for their part, must ensure that they have on-call physicians who are prepared to participate in the care of patients as needed to:
- Determine whether an emergency condition exists
- Provide adequate care to stabilize an emergency condition
- Determine whether a transfer is “appropriate”
Health systems cannot fulfill EMTALA obligations unless they have a comprehensive provider data management solution that aids in quickly identifying physicians by specialty who are on the schedule or on call. Both the Centers for Medicare & Medicaid Services and the Office of Inspector General have administrative enforcement powers with regard to EMTALA violations. And the penalties are significant.
Adverse effects of missing provider data
Provider data challenges surrounding patient transfers aren’t the only problem. The documentation of the patient transfer itself is an important but often missed as part of the transfer. The documentation should always be clear at all stages of the transfer. As it is often the only legal document reflecting that the patient was transferred, it must include the patient's condition, the reason to transfer, details and status of vital signs before the transfer, clinical events during the transfer, the treatment(s) administered, and the names and designation of referring and receiving clinicians.
Despite current and widespread availability of recommendations and guidelines for safe patient transfer, the guidelines are often are not met. For example, many hospitals and provider offices cannot locate the referring provider's information in their EHR, resulting in the manual creation of a stub record. This process is time-consuming and has a high probability of capturing inaccurate data. The downstream effects cause provider enrollment and billing delays.
Lack of interoperability is another challenge during patient transfers and causes additional work for healthcare staff. Interoperability is important in healthcare because patients receive care from multiple providers—who in turn work in multiple healthcare settings or systems. In short, interoperability enables disparate software systems and/or technologies such as mobile apps, third-party systems, and EHRs to communicate.
Without it, provider data, patient data, revenue cycle data, and more remain in silos. Sometimes, data can be exchanged between them rapidly using an application programming interface (API), a spreadsheet, or other means, but often it ends up being manual. "No nurse or clinician wants to manually enter data," according to Ziad F. Gellad, MD, MPH, AGAF, Associate Professor of Medicine and Associate Vice Chair for Ambulatory Services in the Department of Medicine at Duke University Medical Center and co-founder of digital health startup Higgs Boson Health.
Solve the missing provider data problem once and for all
symplr Directory has tools designed to streamline the maintenance of accurate provider data across your healthcare enterprise. For example, working with your EHR, it creates the most efficient enrollment process for all teams involved. Users can search symplr Directory's National Provider Network and enroll a provider directly into symplr Directory and Epic (for example) in real-time without leaving Epic Hyperspace.
In addition, symplr’s tools reshape the patient transfer experience by providing a seamless workflow that allows your staff to easily search for providers. They can locate any provider with an NPI number in symplr Directory. The flexible and customizable functionality allows staff to enroll a provider in symplr Directory and your EHR within minutes. This enables faster claims processing, more rapid patient updates, and expedited timelines for sending results to the referring provider.
Learn more about symplr Directory today.