From ‘sneaker-net’ to high-tech hand-offs between healthcare facilities

It’s called “sneaker-net” – the low-tech transfer of a patient’s healthcare file by a courier wearing sneakers. “Sneaker-net” usually occurs when a patient is being transferred from a hospital to a nursing home or other facility. And if the ubiquitous manila folder of papers isn’t being carried over, it’s usually faxed, mailed, shared via USB key, or even brought over by the patient himself. “The whole process – often called ‘care transitions’ – is inefficient and fraught with possibilities for errors,” said Eric Chetwynd, director of product strategy at Newton-based Curaspan, which offers a technology solution to “sneaker net,” tracking patients as they are moved from hospitals into post-acute care facilities, streamlining payment, referrals and even rides, while also providing analytics to track patient care along the way. Chetwynd spoke with Globe correspondent Cindy Atoji Keene about smoothing the hand-off procedure between medical providers to allow for safe and effective discharges.


“In many ways, the term health care ‘system’ is a misnomer. When patients are discharged from a hospital, often they need the help of so many different players – home health aides, physical and occupational therapists, visiting nurses, and doctors – but there aren’t any standardized mechanisms to coordinate care and no one to assume responsibility for the patient. Organizations talk about interoperability between services but don’t really support it – they are more interested in EMRs (Electronic Medical Records) that keep information and data inside their walls where often others in the care continuum can’t access it. So the process is like a dinosaur but Curaspan is trying to bring it into the 21st century. I have a personal example of this experience – recently my mother had hip surgery replacement and had a number of glitches as she got ready to go to a rehab facility – the first one was getting a doctor to sign off in a timely matter; then her ride was late because of rush hour; finally, her medication was not in in the dispensary when she finally did arrive. I have to say that it was a very frustrating experience for me and the rest of family involved with this transition. These gaps happen all the time, but Curaspan is alleviating a lot of these challenges by facilitating communication and eliminating the failure points, which include duplicate tests, lack of follow-through on referrals, inconsistent patient monitoring, medication errors, and other problems. Part of my role is working with industry organizations to craft laws and legislation, including aligning financial incentives. Until recently, for example, there wasn’t even a billing code to incentive physicians to follow-up on patients after they go home – doctors wanted to call and check on patients but didn’t get paid for it. Now there is a transitional care code that physicians can bill under. And here at Curaspan, we are currently handling about 20 percent of all hospital discharges in the U.S. with our IT platform, linking EMRs between providers to better transition patients from place to place. An example of one big timesaver: instead of relying on ‘tribal knowledge’ to try to match patients to skilled nursing facilities, case managers can access a database that includes an algorithm to place patients by level of care, clinical needs, geography and even religious affiliation and dietary preferences. My mother had to sit in bed in pain, waiting for meds to arrive but had Curaspan been used, this probably would not have happened. After all, inefficient care transitions are a burden not just on patients but also their families and caregivers. This just doesn’t have to be.”

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