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Miscommunication in Patient Hand-offs and Its Impact on Patient Care

Imagine this scenario: you’re a provider that requires a specialist consult for your patient. You put the order into your EMR but you aren’t sure who is going to see the patient or when. You’d like to kick off the process with a phone call but you aren’t sure who to call and you don’t have the time to check so you leave it. Later that day you check the patient’s chart to find that they had received the consult hours ago but you hadn’t been notified. The consultant left their notes but you have some questions and you’re struggling to get a hold of them. Unfortunately, situations like this are commonplace for providers and are a bit of a headache. 

When it comes to referrals and consults, there are many potential points of failure that are only getting more complicated over time. In 2012, the Joint Commission Center for Transforming Healthcare found that an estimated 80 percent of serious medical errors involve miscommunication between caregivers during the transfer of patients. Not surprisingly, a separate study in 2006 found that 20 percent of malpractice claims were related to missed or delayed diagnoses because of issues in the handoff process. These are some pretty serious numbers that warrant attention. With the shift to Electronic Medical Records, it should be a priority for the software to enable providers to effectively communicate. In reality, though, it’s becoming even easier for providers to not communicate.

In theory, all the information providers need should be on the patient’s chart but that’s just not always the case. In a 2011 study, 70 percent of specialists rated the background information they usually received as fair or poor. Another study found that more than half the referring physicians needed more feedback information than was provided by the specialist. The easiest way to solve these problems is to have a direct line of communication between specialists and referring providers to clear up any confusion and to complement the data on the chart. Interestingly, a study in 2018 found that while most hospitalists prefer direct communication, 91% said direct communication happens less than 50% of the time. This makes sense - even if you have the other provider’s phone number, text messages and calls are not a secure way to communicate sensitive patient data. The solution is for providers to have an extremely easy way to directly communicate through secure software. 

Some of the same issues exist in provider-to-patient communication as well. In 2011, a study found that a significant number of providers don’t know whether their patients saw the specialists they referred them to. This could be solved with a quick call, but that’s just one more thing to tack onto a doctor’s already busy schedule.

With pMD, provider-to-provider communication is an easier and more HIPAA-compliant way to communicate Protected Health Information (PHI). Messages can even be tied to a patient in pMD so there’s never any confusion as to which patient is being discussed. With pMD® Charge Capture™, post-discharge follow-ups are automated so providers can be sure their patients schedule their referrals. Providers can even message their patients directly to clear up any confusion and answer any of the patient’s questions. pMD is making communication around patient care more streamlined so medical errors can be avoided in the future.


To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.

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