Optimizing Care Transitions at Time of Discharge

Information exchange is critical to high-quality transitions of care. Real-time patient event notifications and timely follow-up actions taken by providers can improve health outcomes, mitigate risk, and improve the overall patient experience. Communication tools supporting health information exchange between healthcare providers have historically been insufficient, especially between inpatient and ambulatory clinicians, as much of the information is being faxed. We focused on automating patient event notifications that include relevant clinical information for a smooth transition of care for patients discharged from the hospital and those discharged home on parenteral antibiotics.