Care Coordination and the Community Information Exchange
Using data to facilitate care coordination
Improving Coordination Phase I: "Closing the Loop"
Integrating person-level data across the education, health, and social services sectors to better understand the “whole person” makes it possible to support needs effectively. The goal in Phase I of this project is to ensure that an appropriate referral is made and the person/organization who made the referral knows that the needed service is in process.
Ideally, community members - e.g., teachers, nonprofit managers, clinicians - could flag a need, make a referral within the partnership, and ultimately learn that the needed services are now in process.
This process is known as a “closed-loop referral.”
Improving Coordination Phase II: Understanding Outcomes/Improving Service Delivery
Closing the loop is essential but to really improve systems, and ultimately lives, an effective and efficient referral system must be able to answer:
• What was the outcome of the service?
• Are we creating beneficial and equitable impact?
• Are all the needs of the family now met?
• Are services being duplicated?
• Is the service or program delivering the desired results?
• Are innovations working?
In Phase II of this project the loop has been closed and important knowledge has been gained. Summarizing the service information in a helpful manner to understand more about service delivery and outcomes is a goal of this ultimate phase.
