Lost In Translation

By Charlie Miraglia

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Dr. Charlie Miraglia is hc1’s Chief Medical Officer and resident movie buff. You can reach him on Twitter @ccmiraglia.

In this 2003 Bill Murray and Scarlett Johansson film, the characters meet in Tokyo and develop an improbable relationship in the midst of both cultural and language challenges that separate them from each other – and from the Japanese people around them. While much of the following action is humorous, the underlying theme is all about people connecting, which brings us to another major challenge we’re currently facing in healthcare today – connecting the providers and the people they care for.

As we continue to develop value-based care models and place more emphasis on care coordination, providers of healthcare must strive to become even more patient-centered, promoting integrated care across the continuum and working together to determine the most cost effective settings of care. Smooth transitions between these settings, as well as determining how long care should be delivered in each setting, will be crucial to improving outcomes.

If we focus on the care delivered following an acute care hospital stay, commonly referred to as post-acute care (PAC), keeping these still vulnerable patients stable and continuing to improve their overall condition will be critical to enhancing the quality of care delivered and overall patient satisfaction. For this to be possible – getting each patient the right care at the right time in the right setting – every part of the delivery system must be connected, especially with respect to information and data.

Let’s briefly review the PAC journey to make the picture a little clearer. After leaving the hospital, a patient might need further care in progressively less acute settings. This might include one or more of the following:

  • Long term acute care hospitals
  • Inpatient or outpatient rehabilitation facilities
  • Skilled nursing facilities
  • Assisted living facilities
  • Home health care
  • Hospice care

These PAC settings rely on critical information to be successful in treating or caring for the patient, including discharge summaries from recent and past hospitalizations, up-to-date details on medications, laboratory data, and notes on any specific problems that have been experienced throughout the patient’s episodes of care.

Almost 40% of all Medicare beneficiaries receive PAC after being discharged from the hospital. Despite its importance in keeping patients on the road to recovery, however, PAC is by most standards the most disconnected piece of the puzzle. In fact, many PAC facilities still store much of their data on paper and have little or no means to receive data electronically. For these institutions there is a very steep technology climb to establish a more meaningful exchange of information. In addition to the inaccessibility of data, PAC providers face additional challenges as well – lack of funding, lack of the proper information technology skills, lack of interoperability of electronic health records and other systems, and perhaps most frustrating of all, multiple competing initiatives in the face of limited resources.


To make matters worse, if the electronic data needed to guide decision making in these PAC settings is not available to providers when needed, patients often face increased complications leading to more emergency room visits, and readmissions to the hospital. While this can obviously significantly increase overall costs of care, more importantly, it is often life threatening to patients. Studies have also shown that patients and their caregivers are often unprepared for their role in the next care setting and don’t understand essential steps in the management of their conditions. Patients and family members are abruptly expected to assume a self-management role in the recovery of their condition(s), with little or no support or preparation.

If the transformation of healthcare is going to include the improvement of patient outcomes, an increase in the quality of care delivered, and the enhancement of value associated with the dollars spent on care, PAC and the transitions from one type of care to another need to become much more patient-centric. Otherwise, much of the crucial data and information meant to be communicated from provider to provider and between providers and patients will continue to be lost in translation.

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