From the 1960 film The Time Machine based on the H.G. Wells novella

Science fiction is one of my favorite genres, both current and classic. I just finished reading a collection of H.G. Wells stories, marveling at the world of the future he imagined from his late 19th century perspective.

With his “phonographic machines” operating like smart phones, it reminded me of both the expansiveness of and limits to our vision of the possible.

Many people can imagine how current technology might evolve and be put to use differently; some visionaries may accurately foretell totally new technology; and, of course, some advances to come aren’t even conceivable yet. I saw this play out at an October meeting, “Putting the IT in Care TransITions,” previewed here by my colleague Amy Berman. You can read about it in this just-released briefing document, which gives a snapshot of the day, summarizes the convergence that developed on priority action areas, and highlights some of the movement already taking place.

A meeting participant explores an interactive touch-screen wall. -Burwell Photography

The remarkably diverse group of nearly 200 technology innovators, clinical practitioners, health system leaders, and policy makers that gathered in Washington, DC, at the Kaiser Center for Total Health (and hundreds more who joined via webcast and in the Twitter-sphere), engaged in envisioning a new future that is healthier and safer for people who transition between hospital and home (as well as other health care settings and providers) through better use of health information technology.

For us at the John A. Hartford Foundation, this issue remains critical because of the disproportionate impact that poor transitions in our fragmented health care system have on older adults. One in five Medicare beneficiaries returns to the hospital within 30 days of discharge, often unnecessarily, at a cost of more than $17 billion per year. We have long supported work by innovators such as Eric Coleman, Mary Naylor, Mark Williams, and June Simmons on improving care transitions for older patients and we see health IT as a way of making even more and faster change.

The group that came together in October worked to identify where current technology can be better employed and where new technology and innovations are needed. The meeting was hosted by the John A. Hartford Foundation, the Gordon and Betty Moore Foundation, and Kaiser Permanente, in partnership with the Office of the National Coordinator for Health IT within the U.S. Department of Health and Human Services. Other key participants included federal agencies like the Center for Medicare and Medicaid Innovation, responsible for the Partnership for Patients, Health 2.0, and Health Affairs. (Below, you can watch Susan Dentzer, editor of Health Affairs, give a great explanation of why transitions of care are so important and how even low- or no-tech improvements are still needed).

Attendees split into breakout groups based on the most important IT-related problems and the opportunities for improvement and innovation. Across all the groups, four main areas emerged as priorities in which health IT can play an essential role:

1. Developing a shared care plan

2. Strengthening feedback loops

3. Ensuring medication reconciliation

4. Reducing variability in care settings and care providers

These four areas provide a way of organizing future action for the meeting participants and others who want to join this movement to make transitions safer with health IT. For example, participants expressed great enthusiasm and will likely form a working group to create a model care plan that people leaving the hospital (and other settings) could develop in partnership with their health care teams, which could be electronically shared and added to by all of a patient’s providers across settings.

We know work has already begun for many meeting participants. A two-week challenge to take action was issued to participants, and you can see some of the responses here. The Office of the National Coordinator for Health IT and the Partnership for Patients issued a funding challenge for software developers to generate an intuitive and easy-to-use application to empower patients and caregivers that utilizes the Medicare Discharge Checklist. The $40,000 in prizes will be announced in the next few weeks.

Feedback from the meeting revealed that going forward, participants would like more opportunities to connect with each other and new partners in the field around this issue. We look forward to supporting these kinds of opportunities to continue the good work launched at the “Putting the IT in Care TransITions” meeting. Together, we can create a future where care transitions are supported by health information technology so that individuals receive safer, higher quality care that results in better health at lower cost to our system.

More helpful links:

  • The October 14th meeting webcast will be available for viewing until mid January, along with downloadable supporting meeting materials.
  • To view video interviews from 10/14, click here, and here.
  • To view photos from 10/14, click here.
  • “Putting the IT in TransITions” ONC Beacon videos can be found here.