New App Uses EHR to Alert Doctors of Patient Readmissions
Murmur, a new app developed at the University of California, San Francisco, aims to improve care by notifying physicians when patients are readmitted to their hospitals.
The app connects electronic health record (EHR) information with hospital scheduling software, detects readmission within a set time period and sends doctors a text alert when patients return to the hospital. The default interval is five days, as readmissions within that time frame are most likely to be related to care the patient received while in the hospital.
Dr. Nader Najafi, a member of the UCSF development team, says Murmur improves communications in large hospitals, where patient care often rotates between multiple physicians, Fierce Healthcare reports. During a two-week trial, developers tested Murmur with 18 attending physicians. The physicians received notifications regarding 14 patient readmissions — not enough to be a nuisance for busy doctors, but enough to inform them when they may need to take another look at a readmitted patient.
The UCSF team designed Murmur to work with Epic, a hospital EHR system used at some of the nation’s most prestigious hospitals, as well as by pharmaceutical retailer CVS. According to EHR Intelligence, Epic facilitates the exchange of 1.3 million health records per day, making it one of the most pervasive systems in the U.S.
Hospitals that don’t use Epic can adapt Murmur to a different health record system and create their own programs, says Najafi. He estimates that an experienced developer could put together a text alert program within one business day, using any EHR and scheduling software preferred by the hospital.
Leveraging EHR for Cost Savings
University of Michigan researchers have found that three key Affordable Care Act (ACA) reforms, used together, can significantly cut hospital readmissions. Over a one-year period, organizations using the Meaningful Use of Electronic Health Records program, the Bundled Payment for Care Initiative and the Accountable Care Organization had 2,400 fewer hospital readmissions at a cost savings of $32 million.
All three programs are based on the concept of value-based care. Instead of the fee-per-service approach — the pre-ACA model in which hospitals received reimbursement for every line-item service they performed — value-based reimbursement pays hospitals based on overall quality of care. Readmission rates are a key metric in a value-based system, because a large number of readmissions may suggest inadequate care during patients’ first visits.
High readmission rates may also indicate poor communication within a patient’s provider network. Many readmissions are unnecessary, particularly for patients with chronic conditions, and they can result in unnecessary costs for patients, hospitals and insurers.
With Murmur, readmitted patients come to the attention of the doctors who originally treated them instead of transferring to different providers unfamiliar with the case. Future improvements to the app — such as linking primary care office, rehab center and nursing center scheduling software to the EHR — could improve collaboration before readmissions ever take place.
Murmur is just one innovative way to connect electronic health records and other technologies, providing better patient care at a lower cost and reducing patient volume in clinics and hospitals. For example, wearable technology may make physical examinations obsolete by 2025.