Electronic Referral Management System for Outpatient Services - Essay Example

? Electronic Referral Management System for Outpatient Services Lisa Nellius Wilmington Integrative Independent Study Project A MGT 7710 Dr. John Hoehn August 23, 2012 Integrative Independent Study Project A NAME: Lisa Nellius SSN: XXX-XX-last four digits DEGREE PROGRAM: Master of Science in Management, (enter concentration) ELECTRONIC REFERRAL MANAGEMENT SYSTEM FOR OUTPATIENT SERVICES MENTOR: Dr. John Hoehn SITE: Wilmington University North Dover, Dover Air Force Base Georgetown, Delaware I have approved the above student’s MGT 7710 Project proposal. MENTOR’S SIGNATURE: _______________________________________________ Electronic Referral Management System for Outpatient Services Many healthcare organizations have poor referral coordination and communication from an inpatient setting to outpatient services. This is due to many factors such as poor timing, lack of significant information and lost paperwork. The Accountable Care Act is focusing on quality care in all health care organizations. The need for coordination of healthcare across the continuum has been identified as a major challenge. The integration of an electronic referral management system within an electronic health record is a potential solution to help break down the barriers of a fragmented referral system that has negatively affected health care delivery. Although there has been identification of the need for improvement in the coordination of referral management, there is a marked lack of knowledge regarding which elements should be targeted for improvement (Hysong et al., 2011). A literature review of business management may assist in the operational aspects of the project and gain new knowledge on a more effective coordination of the referral process. The use of the electronic health record within the e-referral system will provide easier access to all the essential information needed to manage an efficient referral system. Coordinating a team of stakeholders to analyze the significant information that is essential to create a successful referral management system will prove valuable. Transitioning patient care across the continuum effectively should be one of the major goals for healthcare organizations to assure quality care and patient safety. Improving the referral system will enhance access to evidenced-based healthcare, reduce readmissions and improve the patient outcomes after a hospitalization. The development of an electronic referral management system should further increase the referral rates from inpatient to outpatient services. Problem Statement Healthcare organizations have a fragmented and inefficient communication system to transition patients from the primary to secondary care setting. The purpose of this research effort is to illustrate the effectiveness of an electronic referral management system within an electronic health record and demonstrate effective transition of care to optimize patient outcomes. Research Questions How can the implementation of an electronic health care referral management system improve patient outcomes after hospitalization? Why is it important to invest in IT resources to implement an electronic referral management system in healthcare organizations? How are patients' outcomes to be measured. Some objective criteria needs to be used to determine if an electronic health care referral management system is effective or not. There are several ways to measure it but a lower re-referral or re-admission rate is the best indicator with regards to the effectiveness of the new system as proposed in this paper. How to maximize resources and operate under constraint. Healthcare organizations are under increasing financial pressure to cut costs or keep expenses down and additional items for the budget like investing in IT resources have to be justified by the management. Investments in IT help an organization to keep up with the deluge of patient data and manage it in an orderly manner that will allow management and health care staff to keep track of essential information. Rationale The Affordable Care Act will bring millions of new patients in our healthcare system. Our present healthcare delivery model is inefficient and expensive. Improving coordination of care from primary to secondary settings by implementation of an electronic referral management system will greatly improve the delivery of health care services by avoiding the delays in care, has a positive impact on patient outcomes and help sustain our healthcare system in the long run. The management of healthcare organizations must prepare for the expected influx of all new patients who otherwise did not avail of health care services due to financial considerations but are now readily amenable to do so due to the universal provisions of the health insurance act. Adoption of an electronic referral management system will greatly improve the logistical needs of an organization by increasing its efficiency such as that of a throughput or output criteria. Definition of Terms Best Practices. Actual practices that are used by all qualified providers following the latest treatment modalities that produce the best measurable results on a given dimension (Blue Cross Blue Shield, 2012). This process is otherwise known in the industry as benchmarking. Care coordination. A process that links patients’ health care needs and their families to services and resources in a coordinated effort to provide them with optimal health care. Care coordination often is complicated in part due to the various multiple systems of care and services frequently available as there is no standardization in this regard (Bodenheimer, 2008). Continuity of Care. Continuity of care is the process by which the patient and the healthcare team are working together to manage the care of the patient to achieve a goal of high quality, cost effective care (American Academy of Family Physicians, 2010). Core Measures. Standardized performance measures identified by Joint Commission to improve care, external accountability, pay for performance programs and advanced research in health systems (http://www.jointcommission.org, 2012). Discharge Planning. The activities that help facilitate a patient’s movement through the continuum of emergency care to another or eventually to a convalescent or home setting. It is a multidisciplinary process that begins on admission to the emergency room to the acute care setting and has the goal to enhance continuity of care without any gaps (Bodenheimer, 2008). Evidenced-Based Practice. This is defined as any evidenced-based practice that is “a decision-making approach based solely on integrating a clinical expertise that combines with the best available evidence from research.” Gaps. Gaps are the discontinuities in care. They may appear as losses of information or momentum or interruptions in the delivery of health care (Cook, Render, & Woods, 2005). Hand-offs. This is a term used in medical parlance to refer to a form of communication between healthcare services as a shorthand for transferring a patient from one department to another department within the same facility or from one institutional facility to another facility. This communication can be either written or verbal (Harris, Tornabeni, & Walters, 2006). Metrics. Also known as the objective indicators, this is “a set of measurements that quantify results” that is easily understood even at a quick glance or when in a hurry. Outcomes. This is how the patients and their problems are affected by healthcare interventions or otherwise known as the end results. Outcomes also represent the consequences or side effects of interventions and result in changes in patient experiences, safety, and/or costs, whether positively or negatively. Outcomes shape perceptions which affect satisfaction levels. Patient-Centered Care. Care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations and their lifestyles. The patient and family are considered as integral parts of the health care team, who collaborate with the health care professionals in making clinical decisions (IHI, 2010) such as using interpreters in case of a language barrier, sensitivities as to age, gender or marital status, superstitions, taboos or other characteristics unique to a patient based on their racial ethnic backgrounds. Patient Satisfaction. The perception of the patient(s) of one or more aspects of a care system such as prompt response, the hospital environment, attitudes of the health care providers and other measures usually associated with the delivery of services. It is the total outcome that measures the quality of the interaction between the patient and the health care team, from the viewpoint of the patient as a consumer of health services provided (Medical Dictionary, 2010). Performance Measures. Utilized synonymously with performance measurement is the use of statistical evidence to determine progress towards specific or defined organizational objectives (Medical Dictionary, 2010) with regards to patient care. Readmission Rates. The percentage of previously admitted patients who return to the hospital within seven, fifteen, and thirty days from date of discharge ( IHI, 2011). Readmission rates are an important “metric” as it is a means of evaluating the patient’s quality of care and the complete and thorough preparations for a proper medical discharge towards a full recovery. Hypothesis There is poor communication in transitioning patients from the primary to secondary care setting. These inefficiencies lead to suboptimal patient outcomes and breakdown within the delivery of care. Implementation of an electronic referral management system within the electronic health record will improve the continuum of care without gaps or interruptions. Literature Review The health care industry has undergone rapid changes over the years but has been quite rapid within the last few decades. The industry is characterized today as a profit-oriented type of undertaking for most stakeholders such as health institutions, insurance providers and even the medical practitioners themselves. This is understandable considering that the country does not have the same type of socialized care available in other industrialized countries where expenses are shouldered primarily by their respective governments. This means there is an emphasis over cost containment while attempting to deliver quality health services in a very competitive setting. In short, health care is primarily a private enterprise oriented to produce profits for investors but at the same time implement competitive strategies without sacrificing either quality or safety. The industry has become big business in itself and a major contributor to the economy. It has not only become intensely competitive but also more complicated with continuing industry consolidation through mergers and acquisitions. The general idea is the size confers advantages not otherwise available to smaller providers, such as negotiating leverage with suppliers, doctors, and other providers. Innovations are supposed to lower prices while improving quality of care but a weakness in this value chain is perceived during hand-offs when patients are transferred. Innovative practices were soon adopted by healthcare organizations and among these are so-called best practices which are benchmarks to be followed by all accredited providers. The idea is to offer an acceptable minimum standard of care across all sectors of the industry to make sure patients get value for money and assured of the same quality of care wherever they want to be admitted. The industry is considered a vital industry in the sense the health of the citizenry is at stake and in this regard, the government tightly controls the industry through various policies and regulations that are to be strictly followed at all times, enforced by various agencies. The population has undergone a marked shift in terms of demographics, that is from the mainly young nation it once was to now a primarily graying population with large proportion of it composed of seniors and soon-to-retire baby boomers. The expected increase in this change in demographics is estimated to be substantial enough to potentially overwhelm the health system if no drastic changes in delivery systems will be adopted soon enough. Obamacare alone is thought to expand the potential client base of hospitals by some 30 million due to the required insurance policies to be procured as mandated by the new law (Pear, 2012, p. 1) and the numbers could be substantially higher if other factors are taken into account, such as increased life span due to the advances in medical science and medical technology as well as the illegal immigrants who will be allowed to avail of medical services despite being unregistered or undocumented. Despite the best efforts at cost containment, medical costs have escalated fast enough in just the past few decades. Ten million were covered by medical insurance back in 1966 at a cost of only $1.7 billion but today, fifty million people are covered but at a staggering $372 billion or a disproportionate increase in cost of 218 times but only a five-fold increase in people covered. Private competition in the industry has resulted in a trend of ever-increasing costs that is not commensurate with expected increases in the quality of care delivered. This is despite efforts by the government to regulate a vital industry that is propelled by the profit motive but perhaps more importantly, the rise in costs has been due largely to wrong notions and false premises from bad policy choices made by the stakeholders, primarily by health insurance firms, providers, the institutional organizations and the employers themselves (Porter, 2004, p. 7) that results in chaos. In such a situation, the industry itself, politicians and consumer groups have rightly expressed a concern with the level of care coordination required for a satisfactory continuity of care when a patient is transferred from one primary care doctor to a specialist, or from one department to the next department or even from one hospital to another hospital; a complex process indeed. A number of the innovative practices that have been adopted and implemented so far to somehow simplify this process to ensure continuity of care were evidence-based practices and the core measures identified by the Joint Commission together with electronic health records. It is a step in the right direction but seems to fall short based on the high rate of readmissions due to inadequate procedures during transfers or hand-offs wherein vital information can get lost or often delayed during the transmission from one provider to the next provider. A brief delay can potentially have serious or even fatal consequences if lives are at stake and no data is available. The industry is under increased scrutiny because an estimated 98,000 people die every year from medical errors caused by a confluence of factors like harried staff, miscommunication, delay in transmittal of vital medical information because records were either misplaced or lost in a chaotic situation where every minute counts, literally. There needs to be a better system. The various problems encountered by healthcare organizations can be traced to a lack of proper coordination of seemingly disparate and discrete activities when all these should be seen as mere parts of a whole continuum in the health care delivery. The American Association of Colleges of Nursing (AACN) had tentatively but correctly identified the root cause of a problem often encountered as mentioned above to the absence of a person who is in charge or responsible to oversee all the transfers and movements of information as the patient goes through the entire process of receiving health care services. The AACN had proposed the creation of a new type of nurse position known as the clinical nurse leader (CNL) to coordinate everything before crucial information can get lost or misplaced. The CNL is intended to serve as a communication hub to oversee smooth flow of information, performing a vital task as member of the health care team. The designation of a CNL has been recommended by a task force created by the AACN precisely to minimize or eliminate entirely communication gaps that can occur during a patient's transfer or discharge (AACN, 2004) but more importantly, aligns health care practices with other best practices adopted in business management, which is to delegate some authority to a person but at the same time pinpoint responsibility and assign accountability to avoid medical mistakes. The idea is to put someone directly in charge of securing vital patient information at all times. The complexity of health care delivery can be traced to increasing use of sophisticated medical technology and the sheer amount of patient information being generated from results of laboratory tests, dosage of medicines and other information collected in the care of the patient. It is therefore necessary that someone is squarely in charge of all that information to ensure it is readily available whenever and wherever needed in all types of health care settings. A review of business management practices for industries involved in handling large amounts of information can be very helpful in this regard. A few examples are logistics firms that handle a lot of real-time data but still manage to deliver on-time information, companies that are engaged in fast-moving consumer goods and even the air traffic control system at airports are excellent paradigms from which the health care industry can learn a few lessons from. There has already been a precedent in this regard and that is the Mayo Clinic, which is often cited for a very efficient information management system it had developed (Berry & Seltman, 2008, p. 49). It handles team medicine very well but handles information during hand-offs much better, where it achieves a factory-like production line efficiency with no diminution in quality of care levels. The creation of the recommended CNL position is the equivalent of a chief information officer (CIO) of a big corporation but the CNL will be concerned with all the information that had been generated, collected, stored, retrieved or accessed with regards to a particular patient. A CNL must be familiar or knowledgeable with all types of information systems to facilitate tasks related to ensuring that information is available anytime anywhere in all care settings. Existence of electronic health records as required by the Health Insurance Portability and Accountability Act (1996) makes the task of using electronic referral management system easier to do because it will merely integrate one computerized information system with another similar system. New information technology arising from the combination of computer technology and communications technology can be leveraged by health care organizations in their operational requirements with regards to managing the mountain of data and information they have. This is a relatively new field called informatics and is now used together with wireless technology. The use of informatics can greatly improve patient outcomes and raise satisfaction level of patients because this system provides cheaper, faster and more accurate information coupled with the added benefits of portability and flexibility for the users of that information like doctors, nurses, payers, insurance firms, patients and hospital administrators. The most promising of these new informatics technology is the active radio frequency identification (active RFID) as opposed to the older passive RFID. The active RFID holds a wealth of information such as patient name, medical history, dosages, allergies, primary care physician, contact numbers of family members, attending physician, Medicare, etc. which can be easily linked to portable devices such as laptop, netbook, smartphone or PC tablet. In fact, this active RFID-based system is perfect for proposed electronic referral management system because it uses a tag that contains all patient information which can be read by a portable RFID reader during transfer or discharge. It is an ideal solution because it integrates seamlessly with existing computer information systems at minimal costs. A tie-up with a cellular phone service provider is all it takes to adopt this new system. The cost of installing an active RFID system has dropped significantly because of vast improvements in production methods and technologies, including the hardware and software. In most cases, this system can also be upgraded or modified and even scalable as requirements go up in terms of usage to the newer QR (quick response) system of storing information on a chip. It is a two-dimensional bar code that can hold more information which can be updated anytime. Its potential use is almost limitless; an example is preventing human errors by enabling a pharmacist to fill out electronic prescriptions contained in the RFID tag to prevent common medication errors or the wrong dosages simply by using a sensor (Tan, Kato & Chai, 2010, p. 8). The identified communication gaps during transfers and discharge of a patient can be answered adequately by using active RFID. The RFID tag can hold so much information it could be used not only to store vital medical information such as laboratory test results, medications, contact persons, emergency numbers or attending physician but can also serve as both virtual integrated electronic health record and e-referral system all rolled into one convenient device. Its cost is cheap it can be absorbed by the health care provider organization without a significant increase in its operational budget; the only major cost is during its initial installation. Otherwise, the organization can alternatively charge it to the patient's bill but it will not add a big amount. A more imaginative and innovative way to truly enhance patient-centered care is to give away these RFID tags for free upon discharge of the patient and earn considerable goodwill along the way. Patient satisfaction is greatly enhanced which is one of the metrics used in performance measures and hopefully translates into lower readmission rates because of more accurate data. Scarce financial resources can be maximized by the adoption of an active RFID system. It is an excellent way of demonstrating an ability to operate efficiently even under constraint but still deliver quality health care services while accommodating a potentially larger patient base. In the long run, a healthcare organization is measured by patient perceptions with regards to its type of service rendered in terms of the quality of care and this can be positively influenced by use of not necessarily costly ways or devices that enhance their hospital stay experiences as something memorable or pleasant. A favorable feedback by patients who are today more pro-active in terms of participating in their own care is the best compliment that any service organization can have. Referral coordination is greatly improved with no significant accompanying costs. The healthcare industry has evolved due to a number of internal and external factors. A key driver for these changes in the structure of the industry has been the continued shift from the original family physician with an individual medical practice to that of big integrated health care maintenance organizations HMOs) such as those classic vertical arrangements seen in hospital- physician relationships (HPRs) or otherwise known as physician-provider organizations (PPOs). This trend towards group practice is seen to continue for the foreseeable future as the industry is now more profit-oriented more than ever before with the rise of large hospital chains which try to encourage patients to stay withing their own respective institutional systems. However, this new development has exposed or identified the one vulnerable point in which patient care can be also negatively affected and this is during the hand-off procedures when a patient is discharged. This is the critical period when probable discontinuities in patient care can conceivably occur. The use of an active RFID system together with the designation of a CNL to oversee all matters related to a successful discharge planning with the right information can effectively address this issue. Methodology This research will utilize both quantitative and qualitative data to know results of the proposed electronic referral management system. In this connection, the primary metric to be used will be the readmission rate which is generally regarded in the health care industry as the best indicator of the quality of care service rendered. Although the usual window for considering readmission is within the first seven days from date of discharge, this research will extend this window to gathering data for readmission rates within the next fifteen and thirty days. In other words, three sets of data on readmission rates will gathered, which are seven, fifteen and thirty days from date of discharge. This will give a more comprehensive picture of the effectiveness of the new system once implemented. The data to be gathered will encompass a six-month period. For purposes of this data collection effort, a patient who was previously discharged but again re-admitted for a new or entirely different ailment will not be included in the data set. This is to exclude essentially new patients (or previous patients with new ailments) and to narrowly focus the data collection exclusively on those patients who are readmitted only due to the same ailment or sickness and thereby give an indication of the quality of care they had received prior. This manner of exclusion will include all three data sets, that is the seven, fifteen and thirty days data set within a proposed six-month period of data gathering. Whenever possible, other factors that might influence readmission rates will be included such as age, gender, economic status and level of educational attainment. The idea is to further refine the data for any confounding factors. Additional qualitative data will be gathered using subjective criteria such as questionnaires and surveys to give an idea on the level of patient satisfaction, they being the consumers of health care services. One key question to be asked to a patient or if not possible (because of being either a minor or incapacitated to answer) to the parent or guardian is whether they will seek the same services again in the future for any future confinement due to an illness or injury. This will give a direct or indirect indication of their level of satisfaction with regards to the quality of care they had just received at the healthcare institution. This can be supplemented with other means of gathering qualitative data such as exit interviews prior to discharge, opinion polls, and asking some open-ended questions like how they can describe their hospital stay. Both telephone and on-line interviews can also be utilized, depending on time and financial resources constraints but the data gathered must be tested later on for its validity with a right sample size. Reference List American Academy of Family Physicians (2010). Definition of continuity of care. Www.aafp.org Retrieved from http://sitesearch.aafp.org/?q=continuity+of+care&t1-search=true&sp_cs=UTF-8 American Association of Colleges of Nursing (2007). White paper on the education and role of the clinical nurse leader. Retrieved from http://www.aacn.nche.edu Berry, L. L. & Seltman, K. D. (2008). Management lessons from Mayo Clinic: Inside one of the world's most admired service organizations. Columbus, OH: McGraw-Hill Professional. Blue Cross Blue Shield (2012). Glossary. Www.bcbs.com Retrieved from http://www.bcbs.com/glossary/?firstlet=B Bodenheimer, T. (2008, March 6). Coordinating Care - A perilous journey through the health care system. New England Journal of Medicine, 358(10), 1064-1071. Cook, R. I., Render, M. & Woods. D. D. (2000). Gaps in the continuity of care and progress on patient safety. British Medical Journal, 320, 791-794. Harris, J. L., Tornabeni, J. & Walters, S. E. (2006, October). The clinical nurse leader: A valued member of the healthcare team. Journal of Nursing Administration, 36(10), 446-449. Hysong, S. J., Esquivel, A., Sittig, D. F., Paul, L. A., Espadas, D., Singh, S., & Singh, H. (2011). Towards successful coordination of electronic health record based -referrals: a qualitative analysis. Implementation Science, 6(84), 1-12. Retrieved from http://www.implementationscience.com/content/6/1/84 Institute for Healthcare Improvement (2011, April 26). Readmission rate. Www.ihi.org Retrieved from http://www.ihi.org/knowledge/Pages/Measures/ReadmissionRate.aspx Joint Commission (2012, February 15). Core measures sets. Www.jointcommission.org Retrieved from http://www.jointcommission.org/search/default.aspx?Keywords=core+measures&f=sitename&sitename=Joint+Commission Pear, R. (2012, July 11). House votes (again) to repeal Obama health care law. New York Times. Retrieved from http://www.nytimes.com/2012/07/12/health/policy/house-votes-again-to-repeal-health-law.html?hpw Porter, M. E. & Teisberg, E. O. (2004, June). Redefining competition in health care. Harvard Business Review, 1-14. Tan, K. T., Kato, H. & Chai, D. (2010). Bar codes for mobile devices. New York, NY: Cambridge University Press US. Annotated Bibliography Akbari, A., Mayhew, A., Al-Alawi, M., Grimshaw, J., Winkins, R., Glidewell, E., & Pritchard, C. (2008). Interventions to improve outpatient referrals from primary care to secondary care. Retrieved from http:www.ncbi.nlm.nih.gov/pubmed/18843691 This article states that there remains a need to improve the referral process from primary to secondary care. Process improvement will impact patient outcomes, health care organizations, and health care cost. The authors discussed results of seventeen studies comparing selected interventions to improve referral rates. Adequate education for the professional and support staff on new process design had a significant impact on results. Balady, G. J., Aides, P. A., Bittner, V. A., Franklin, B. A., Gordon, N. F., Thomas, R. J.,Yancey, C. W. (2011). Referral, enrollment, and delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and Beyond. Circulation, 124, 2951-2960. doi:10.1161/CIR.0b013e31823b21e2 The authors present many factors associated with limited referral and enrollment to an outpatient cardiac rehabilitation program. There are patient oriented factors as well as health care system issues. The inpatient electronic automated system has been shown to have significant impact on referral rates. This reference is and American Heart Presidential advisory, clearly presenting the need to improve referral rates in an outpatient setting. The authors also discuss the Patient Protection and Affordable Car Act and the need to improve care coordination. Improvement of care coordination, will improve quality of life and decrease mortality as patients are referred to appropriate outpatient services. Bendtsen, P., Ekman, D., Johansson, A., Carlford, S., Anderson, A., Leijon Nilsen, P. (“n.d.”). Referral to an Electronic Screening and Brief Alcohol Intervention in Primary Health Care in Sweden: Impact of Staff Referral to the Computer. International Journal of Telemedicine and Applications, 1-9. The research presented in this journal article is a study utilizing computerized technology to improve existing processes within a primary care setting. There have been promising results utilizing electronic tools, but insufficient research describing the effectiveness of electronic interventions. Statistical analysis in this study indicated no significant effect utilizing and electronic intervention versus usual referral. Bodenheimer, T. (2008). Coordinating Care - A perilous journey through the health care system. New England Journal of Medicine, 358(10), 1064-1071 The author presents a health policy report on the lack of coordination of care that affect on quality care in health care organizations. The report shows several studies the problems associated with inefficient referral and lack of coordination of care. Electronic referrals systems have been found to improve care coordination and also provide the information needed to promote a successful referral from a primary care setting to secondary. E- referral systems can be implemented with success and improve quality of care. Gandhi, T. K., Keating, N. L., Ditmore, M., Kiernan, D., Johnson, R., Burdick, E., & Hamann, C. (2008). Improving Referral Communication Using a Referral Tool Within an Electronic Medical record. Retrieved from http://www.ncbi.nlm.nih.gov/books/books/NBK43671 The article discusses how poor outpatient referral management has an impact on the quality and safety of patient care. The authors study the use of a referral manager application within an electronic medical record. The application was compared to the usual manner referral were processed. The results displayed that effective referrals three times higher in the primary care practice that utilized the application tool. Hysong, S. J., Esquivel, A., Sittig, D. F., Paul, L. A., Espades, D., Singh, S., & Singh, H. (2011). Towards successful coordination of electronic health record based-referrals: a qualitative analysis. Implementation Science, 1-12 The authors conduct a qualitative study to investigate the breakdowns associated with the use of an electronic referral system. There are four evolving themes, lack of standardized policies, adequate training, clear roles and responsibilities, and delayed response to a referral. This information is of value when implementing an electronic referral management system in a health care organization. Being aware of these occurrences will facilitate a successful referral. Morgan, G. (1998). Images of Organization (The Executive Edition ed.). London: Sage. The author of this book provides the use of management theories and metaphors to help deal with organizational problems. Implementation of a new process can create anxiety and resistance to change. The information presented provides tools to assist in the negotiation of change within the organization. Adapting to change is important to sustain a health care system in today’s environment. Mueller, E., Savage, P. D., Schneider, D. J., & Howland, L. L. (2009). Effect of a Computerized Referral at Hospital Discharge on Cardiac Rehabilitation Participation Rates. Journal of Cardiopulmonary Rehabilitation, 29, 365-369. Retrieved from ww.jcpjournal.com The authors assessed the effectiveness of a computerized referral process at hospital discharge. The computerized referral system was designed to improve the already established referral process. The results of this study concluded that the use of a computerized referral system improved participation rates for outpatient cardiac rehabilitation programs. Pearson,. A., Laschinger,. H., Porritt,. K., Jordon,. Z., Tucker,. D., & Long,. L. (2007). Comprehensive systematic review of evidence on developing and sustaining nursing leadership that fosters a health work environment in healthcare. International Journal of Evidenced-Based Healthcare, 5, 208-253. doi:10.111/j.1479-698.2007.00065.x The review presented by the authors addressed the concept of nursing leadership to promote change within the health care organization. Styles of leadership and characteristics have an impact on implementation of new processes. Common themes ability to collaborate, emotional intelligence, positive behaviors and being supportive during the change creates a healthy work environment. Wolper, L. F. (2011). Managing Organized Delivery Systems (5 ed.). Sudbury, MA: Jones and Bartlett. The author of this book presents concepts on managing organized delivery systems. As healthcare reform emerges and transition from a volume based to value based system takes place, information technology will become an essential component in the United States. Health information technology strategies will provide greater value for health care cost. The electronic health record will be an essential component of patient and physician communication. Providing organized delivery models will help sustain health care quality levels in all care settings. Read More