Health information exchange–enhanced care coordination: implementation and evaluation of event notification services in the Veterans Health Administration

Health care is delivered globally in fragmented systems of care that require coordination. Care coordination often rests on the shoulders of primary care clinicians. In this case study, we examine the implementation and evaluation of a health information exchange–based event notification service (ENS) designed to alert primary care teams when their patients experienced an acute care event (emergency department visit or hospitalization). ENS can also be referred to as Admission, Discharge, Transfer alerts. Implementation occurred in two Veterans Health Administration (VHA) medical centers, and it was designed to alert dozens of primary care teams when Veterans experienced non-VHA acute care events. The case study examines the impact of ENS in primary care, and it discusses the facilitators and barriers to ENS in the VHA. The case study also considers future work needed to expand adoption and use of ENS, including the US requirement that hospitals implement ENS per Medicare and Medicaid regulations.