In theory, doctors should be able to pull up all data available on a patient located within any networks to which they have access. In other words, not only should they be able to see any data on Patient A within the EMR where A’s care is documented, but also retrieve data on A from within any HIEs which connect with the EMR. But the reality is, that’s not always the case (in fact, it’s rarely the case).
To help weave together patient data strung across various HIEs, three exchanges have teamed up to pilot test the idea of a patient-centered data home (PCDH). While many health leaders have looked at the idea of putting patients in charge of their own data, largely by adding to or correcting existing records, getting patients involved in curating such data has been difficult at best.
In this model, Arizona Health-e Connection, western Colorado’s Quality Health Network and the Utah Health Information Network are testing a method of data sharing in which the other HIEs would be notified if the patient undergoes an episode of care within their network.
The alert confirms the availability and specific location of the patient’s clinical data, reports Healthcare Informatics. Providers will then be able to access real-time information on that patient across network lines by initiating a simple query. Unlike in other models of HIE data management, all clinical data in a PCDH will become part of a comprehensive longitudinal patient record, which will be located in the HIE where the patient resides.
The PCDH’s data sharing model works as follows:
- A group of HIEs set up a PCDH exchange, sharing all the zip codes within the geographic boundaries that their exchanges serve.
- Once the zip codes are shared, the HIEs set up an automated notification process which detects when there is information on the patient’s home HIE that is available for sharing.
- If a patient is seen outside of their home territory, say in a hospital emergency department, the event triggers an automated alert which is sent to the hospital’s HIE.
- The hospital’s HIE queries the patient’s home HIE, which responds that there is information available on that patient.
- At that point providers from both HIEs and query and pull information back and forth. The patient’s home HIE pulls information on the patient’s out-of-area encounter into their longitudinal record.
The notion of a PCDH is being developed by the Strategic Health Information Exchange Collaborative, a 37-member HIE trade group to which the Utah, Arizona and Colorado exchanges belong.
Developing a PCDH model is part of a 10-year roadmap for interoperability and a “learning health system” which will offer centralized consent management and health records for patients, as well as providing national enterprises with data access. The trade group expects to see several more of its members test out PCDHs, including participants in Arkansas, Oklahoma, Indiana, Kentucky and Tennessee.
According to the Collaborative, other attempts at building patient records across networks have failed because they are built around individual organizations, geographies such as state boundaries, single EHR vendors or single payers. The PCDH model, for its part, can bring information on individual patients together seamlessly without disrupting local data governance or business models, demanding new technical infrastructure or violating the rights of local stakeholders, the group says.
Like other relatively lightweight data sharing models (such as the Direct Project) the PCDH offers an initial take on what is likely to be a far more complex problem. But it seems like a good idea nonetheless.
