Strategies 3.2.1:
Redesign patients' care transitions by prioritizing timely, consistent and complete communication between care sites (hospital, clinic, long-term care, home health, hospice) and the associated health care professionals.

Strategy from the 2011-2020 Minnesota Heart Disease and Stroke Prevention Plan

2015 Interoperable Electronic Health Record Mandate
By January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting. The commissioner of health, in consultation with the e-Health Advisory Committee, shall develop a statewide plan to meet this goal, including uniform standards to be used for the interoperable system for sharing and synchronizing patient data across systems. The standards must be compatible with federal efforts.

Website: Minnesota Laws and Mandates

Minnesota Stroke Partnership - Hospital and Professional Education Work Group
The Minnesota Stroke Partnership (MSP)is a coalition of stroke experts who collaborate to recommend and implement key strategies to reduce the burden of stroke in Minnesota. Their mission is to raise awareness of stroke, promote stroke prevention, and improve systems of stroke care throughout Minnesota.

Contact: Al Tsai
Website: Minnesota Stroke Partnership
Minnesota Stroke Registry
The Minnesota Stroke Registry program is part of a national effort to reduce the incidence of death and disability caused by stroke. This national effort is led by the Centers for Disease Control and Prevention through the Paul Coverdell National Acute Stroke Registry.

The Minnesota Stroke Registry assesses the use of best practice guidelines for acute stroke treatment by conducting real-time data collection on stroke treatment with Minnesota hospitals. Using these data, hospitals are able to measure and improve the quality of patient care.

Contact: Al Tsai
Minnesota Stroke Registry

Reducing Avoidable Readmissions Effectively (RARE)
The RARE Campaign is engaging hospitals and care providers across the continuum of care to prevent 4,000 avoidable hospital readmissions across Minnesota between July 1, 2011 and December 31, 2012. Doing so will alleviate the burden these readmissions place on patients and their families and will allow them the comfort and well being of staying in their own beds.

Contact: Institute for Clinical Systems Improvement, Minnesota Hospital Association or StratisHealth
Website: Reducing Avoidable Readmissions Effectively

If you would like to report current activity around this strategy, please contact Sueling Schardin at (651) 201-4051 or


Updated Tuesday, May 13, 2014 at 12:55PM