CHATTANOOGA, TN – BlueCross BlueShield of Tennessee is partnering with local healthcare provider groups and hospitals to roll out technology designed to improve care after the patient is discharged from the hospital.

The Holston Medical Group in Kingsport, one of the largest multi-specialty groups in the Southeast, is the first to incorporate Smart Transitions from San Francisco-based Performance Clinical Systems in its hospital discharge workflows.

BlueCross executives say many benefits in patient safety have been achieved since the technology was introduced, including alerting primary care physicians in 18 percent of the cases that a new high-risk medication had been prescribed and in 24 percent of the cases that post-hospitalization tests were ordered requiring primary care physician follow-up.

“With recent studies showing readmission rates as high as 20 percent within 30 days of leaving the hospital, and with our associated costs for these readmissions being as much as $60 million a year, we believe creating a link between inpatient and outpatient care teams is critical for improving outcomes and satisfaction for our members as well as for those who pay the bill,” said Robert Mandel, MD, senior vice president of healthcare services for BlueCross.

“We aim to empower all participants in the transition of care workflow with an easily embraced solution that not only supports evidence-based medicine, but makes care-related information accessible in a much more timely manner than traditional processes,” he said.

Performance Clinical executives describe Smart Transitions as a cloud-based interactive clinical checklist system, accessible through a secure Internet connection. The technology provides guidance for clinicians making patient discharge plans, and it makes those plans instantly available via a computer to primary care physicians for follow-up with their patients.

All steps are captured electronically in a database for ongoing analysis to support quality and performance improvement goals.

“Creating a strong chain of care communication is vital for delivering the quality of care expected of our physicians,” said Scott Fowler, MD, president of the Holston Medical Group, which has 800 employees, including 150 physicians and mid-level providers. The group bills itself as a national leader in clinical research as well as electronic health record integration and use.

Physicians typically resist new technology because of the expected disruption to their workflow, Fowler said. In this case, he said, he found they were receptive.

“Our hospitalists appreciate how easy it is to incorporate into their routine and our primary care physicians are already benefiting from the real-time access to comprehensive transition of care plans,” he said.

“We’re delighted that BlueCross BlueShield of Tennessee turned to us to help them drive this important component of their Medical Home Initiative,” said Performance Clinical’s co-founder and chairman, Jeremy Nobel, MD. He said the interactive clinical checklist system provides partnering medical groups, hospitals and primary care teams with the infrastructure for decision support, shared access to patient-specific plans and performance analytics to drive improvement.