Medicine on a Mission: New Discharge Notification Brings Crucial Information Full Circle

One of the major contributions of academic medical centers such as University of Maryland Medical Center (UMMC) is providing outstanding care to patients hailing from far and wide. But getting each patient’s treatment information back to their primary or referring physicians — crucial to patients’ safety and continuum of care — has often been a challenge, with summaries of patients’ hospital care, lab tests and newly prescribed medications not arriving to professional colleagues in a timely or reliable way.

Here at UMMC, we are applying our brand theme, “Medicine on a Mission,” to how we interact with physician partners. We are on a mission to be a valuable resource, providing timely, accurate information about patients cared for at the Medical Center. We have recently implemented new automated discharge notifications accompanied by a brief “clinical summary,” rapidly bringing primary and referring doctors up to date on their patients’ hospitalizations, faxed within 24 hours of discharge. Spearheaded by UMMC’s medical staff leadership and the Office of Referring Physician Services, this effort builds on a 2011 UMMC initiative to auto-fax doctors “admit notification” letters letting them know their patient had been admitted for care here. “We want to make it easy for doctors and patients to access the Medical Center, we want to provide excellent care and we want to return patients back to their doctors, making sure they have all the relevant information to pick things back up,” says Mark Kelemen, M.D., senior vice president and chief medical informatics officer at the University of Maryland Medical System. Dr. Keleman works with physicians at the medical system’s 12 hospitals and the faculty of the University of Maryland School of Medicine to facilitate the successful adoption of leading-edge clinical information technology.

“The final discharge summary may take a few weeks to complete, but we may ask patients to get to their doctors within a week of discharge. So the challenge of documenting complex care was competing with our desire to get key information promptly to doctors,” Dr. Kelemen adds. “The key to safe, well-coordinated medical care involves strong communication, and this is an area we knew we needed to improve, so we leveraged technology to help.” 

Making technology match the concept

Technology doesn’t always match communication concepts, and that was the case when UMMC physicians, 
administrators and IT professionals first conceived the idea to implement automated discharge notices. Janine Good, M.D., associate professor of neurology at the University of Maryland School of Medicine and medical director of ambulatory services at UMMC, was among the leaders to tackle improvements to the physician communication process. “That’s why this is exciting — it’s a big step for doing our part in the 
continuum of care,” Dr. Good says. “Now we have tools to help patients over the transom and guide them into models to keep them out of the hospital.”

The first stage of the process was taking advantage of the tools available within patients’ electronic 
medical records, Dr. Kelemen explains. “We did some custom IT programming to be able to take 
relevant information out of UMMC’s electronic medical record system and put it in a format useful to referring physicians.” 

Each “clinical summary” includes:

  • Date of discharge
  • Discharge diagnoses
  • Pertinent clinical information
  • Activity, diet and allergy information
  • Symptoms for follow-up
  • Names of all known referring physicians, whether primary care or specialists
  • Prescription medication list
  • Scheduled follow-up appointments
  • Most recent laboratory test results

Innovations ongoing

The new “clinical summary” circumvents many problems that present before they begin, such as 
patients returning to their primary or referring physicians with an entirely new list of medications they 
were taking, but no context to offer regarding their drug changes and additions. “The doctor wouldn’t have that in their record and wouldn’t necessarily know the major reasons for any change. This often required a series of phone calls and a lot of time and effort spent on both sides to collect that information and present it back to the referring physician,” Dr. Kelemen says. “Medications, what happened in the hospital, and early follow-up recommendations and treatment plans are all part of this summary.”

But innovations to this new system haven’t ended with its launch. Drs. Good and Kelemen hope that in the 
near future, discharge summaries will also include a mention of any pending lab tests done during hospitalization that hadn’t reported results upon discharge. That way, primary and referring doctors don’t duplicate tests and will know what results are imminent that may shed more light on their patients’ needs.
“We also have a great care coordination program in the hospital that identifies patients at high risk of readmission,” Dr. Good says. “We’re looking at how we can red-flag these patients on discharge as well.”