There is increasing interest in the use of telehealth initiatives nationally.  Simultaneously, Medicare and other payors are increasingly recognizing that home-based care can be effective, cost-saving, and more person and family centered.  To date, opportunities for trainees to learn about home-based care are limited by current funding mechanisms.  For example, the primary care exception that allows residents to see patients in clinic and bill medicare, does not apply to the home setting. 

Authors: Alvin Rajkomar, MD and Sara Murray, MD

Co Authors: Kara Bischoff & Sirisha Naranaya

Background:

Advanced care planning documentation is recognized as an important tool allowing patients to direct the type and intensity of medical care they receive. Systematic and educational innovations over the past decade have been effective at increasing the conversations around advanced care planning as well as the numbers of completed advanced care planning documents such as advanced directives (AD) and Physician Orders for Life Sustaining Treatments (POLSTs). 

Technology is increasingly proposed as a more efficient conduit to facilitate communication between generalist and specialist providers. However, little is understood about how to use these technologies to improve provider-to-provider collaboration and communication regarding specialist consultations. Electronic portals (e.g., EPIC, CPRS) serve an important role in enhancing connectivity between providers across service lines, but greater connectivity does not necessarily translate into greater collaboration.