1. Automating Maintenance of Care Team Relationships from Electronic Health Administrative Data to Decrease Variability of Care Coordination using the Health Information Exchange Infrastructure Discussion Variability of timeliness in care coordination is reduced by automating the document transfer process such that it provides just-in-time and consistent solution that does not require manual intervention. Using standardized HIE artifacts help support consistency and completeness of information transfer. Rule-based system allows for ease and flexibility in determining relevant patient- provider relationships based on the patient and visit context. Subscription services allow clinicians to specify care coordination preferences to fit their needs. Contact Pallavi Ranade-Kharkar (pallavi.ranade@imail.org ) Table 1. Care Coordination Goals Figure 1. Architecture to Reduce Variability in Care Coordination using the HIE Infrastructure Future research Care team relationships curated from past and current administrative data provide a reusable resource for additional service development. Method Create a rules repository to determine relevant care team relationships based on the patient and visit context (problem list, visit reason and location) and provider roles. Capture clinician preferences for types of documents of interest, frequency of exchange, and types of triggers. Process HL7 ADT transactions from multiple sources in real-time and extract care team relationships between patients and providers. Refine care teams based on current patient and visit context. Automate transmission of documents to the members of the curated care team using the HIE infrastructure at a pre-determined time and/or interval. Introduction Care coordination across healthcare specialties, locations and roles can be inadequate and unpredictable, leading to low patient and physician satisfaction and poor quality of care. An integral aspect of care coordination is the “exchange of information among participants responsible for different aspects of care” 1. We analyzed electronic health administrative data from multiple sources, programmatically extracted and curated relevant care team relationships. We then used the health information exchange infrastructure to automate transmission of documents for specialty care referrals. Pallavi Ranade-Kharkar, PhDc, MS 1,2, Greg Gurr, BS 3, Darren K. Mann, BS 1, Sidney N. Thornton, PhD 1,2 1 Intermountain Healthcare, Salt Lake City, UT; 2 Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, 3 Aglilex Technologies Inc., Chantilly, VA. Conclusion Rule-based automation of data transmissions to support care coordination eases the operational burden of busy clinicians and offers a predictable workflow. Clinical Domain DescriptionExample Rules CardiologyManagement of medications for chronic health issues through acute encounters. If patient is on Warfarin therapy, send surgery progress notes and discharge note to the cardiologist and PCP. Women and Newborn Sharing perinatal data with newborn’s pediatrician. If baby was pre-term, send the NICU swallow study results to the pediatrician. Behavioral and mental health Avoid duplicate psychiatry workups in acute encounters through coordination with patient’s primary care team. If a disoriented Alzheimer’s patient gets admitted to the Emergency Department (ED), immediately notify the psychiatrist and PCP. Reference 1. Agency for Healthcare Research Quality: http://www.ahrq.gov/professionals/ prevention-chronic-care/improve/coordination/atlas2014/chapter2.html. EHR Data Drive Trigger Provider Directory Services Document Creation Services Notification Services Care Coordination Manager Subscription DB Knowledge Base Services Care Team Manager Terminology Services Subscription Services Terminology DB Care Team DB Rules Repository Messages from multiple sources Patient and Visit Context Clinical Data Repository