Table 4 Factors influencing information at the transition of care

Fragmented relationships in the United States between providers (outside of the VA, Kaiser and additional exceptions)

An extremely fragmented relationship between providers in much of the United States has meant almost no electronic information flow within and between primary, secondary and tertiary providers. When government agencies provide carrots and sticks to encourage information flow, RHIOs and HIEs emerge. When government funding is removed – as for the RHIOs –the absence of coherent sets of providers/insurers with financial incentives to make the exchanges work led, in most cases, to the closure of the exchanges.

Clalit HMO: a vertically integrated health service provider across primary, secondary and tertiary care

A fully vertically integrated health service provider that covers the full spectrum of needs for hospital and community, Clalit, has excellent information flow between hospital and community.

Maccabi, Meuhedet and Leumit HMOs: integration in primary and secondary care only

Health services providers that provide integrated community care – the Maccabi, Meuhedet and Leumit HMOs in Israel – have excellent information flow between providers in the community, but the information flow breaks down when patients transition in or out of the hospital (with an important exception for Maccabi, Meuhedet and Hadassah).