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September 28, 2015 Readers Write No Comments

HIEs Deliver the Promise of mHealth
By Stuart Hochron, MD, JD

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The successful transition from fee-for-service to value-based care will require a high degree of coordination and the sharing of real-time health information among physicians and patients. This article describes how quality and cost incentives are encouraging payers and providers to leverage the information contained within health information exchanges (HIEs) to empower providers and patients.

Patient outcomes improve when timely personal health information (PHI) is shared with and among providers and their patients. Reducing preventable hospital readmissions is an example of the power of this information. As a result of recent successes in the acute care and post-discharge environment, payers and physicians responsible for the care of populations across multiple EHRs are seeking ways to (a) avoid treatment delays and improve care quality by sharing PHI among clinicians, and (b) engage and empower patients. Mobile communications that engage physicians and patients and deliver relevant clinical information can help healthcare organizations coordinate quality care, manage cost, and satisfy physicians and patients.

Until recently, providers seeking PHI from multiple EHRs were required to access and navigate secure HIE websites using personal computers or mobile devices. Web access has generally been less than a user-friendly experience. The fact that many HIE websites are not mobile enabled and rarely push data to user-friendly mobile apps has further limited physician-HIE engagement. Today, however, mobile technology has given rise to an increasing number of user-friendly mobile apps that integrate with HIEs and push the type of information that physicians and patients find most useful.

All sectors involved in value-based care can benefit from mobile delivery of HIE data. Government benefits when the transition to value-based care is facilitated. Payers benefit by more efficiently coordinating care, containing cost, and facilitating quality and member satisfaction. HIEs benefit by expanding their services. Physicians benefit from easy access to critical information and from financial incentives that derive from effective value-based care. Patients benefit from greater security that results from knowing when and why their PHI is being accessed and by whom.

The following case studies represent mobile HIE initiatives that add value in different ways.

Case 1 – Patient Status Notifications to ACO Physicians

An ACO managed by a hospital system is implementing an automated status notification system for primary care physicians. It provides ACO physicians with the opportunity to participate at an early stage in the care of patients presenting to emergency departments or who are hospitalized. In the absence of such information, treating physicians are deprived of the opportunity to discuss details of the patient’s medical history with the patient’s primary care physician. This lack of communication can to lead to otherwise preventable hospital admissions, over-prescribing of diagnostic studies, iatrogenic complications, lower patient satisfaction, poorer outcomes, and increased cost.

Automated patient status notification takes advantage of hospital-HIE data connections, whereby PHI is uploaded in real time to the HIE when a patient presents to a regional emergency department or hospital. ACO-participating physicians are identified by the ACO and HIE using unique numeric codes.

When a patient is registered by an emergency department or is admitted to a hospital, the HIE identifies the patient as part of the ACO, reconciles the physician identifiers, and feeds pre-selected PHI to the patient’s ACO physician(s). This information includes the patient’s name, DOB, diagnoses, emergency facility location and contact information, and the time of ED registration and/or admission. The message is delivered from the HIE to physicians via an HL7 or sFTP (secure fie transfer protocol) data feed that reaches the mobile vender’s server through a VPN (virtual private network).

In this case, all physicians credentialed by the ACO’s hospital are required to participate in the hospital’s mobile communication platform. The time interval between ED registration or admission and ACO physician mobile notification is measured in seconds. Armed with this information, ACO physicians are able to the share key patient information with treating physicians at remote facilities.

Case 2 – Fraud-Protecting Payers and Patients Using HIE Status Notifications

An HIE seeking to expand the scope of its services is developing a mobile patient app that will fraud-protect state Medicaid and its beneficiaries and engage patients. Fraud-protecting Medicaid beneficiaries has the potential to reduce state and federal government annual losses related to fraud. Engaging patients has the potential to improve outcomes, control cost, and improve patient satisfaction. The system will use the HIE’s mobile patient app to authenticate patients and notify patients in real time when a healthcare facility or provider adds, accesses, or requests access to PHI. Patient access to this information requires a paper-based application and considerable time and thus is rarely requested.

Medicaid patients will self-authenticate using the HIE’s secure mobile app. After downloading the app from either the Google Play store or Apple App Store, patients will register by answering a few simple questions including their name, date of birth, and state of residence. The mobile app will connect to Equifax, the HIE’s consumer credit reporting agency, which will ask patients up to five personal financial questions. Questions can be related to a patient’s cable television bill and other commonly purchased product products and services, which broadens the potential applicability of the authentication process. Once authenticated, the patient’s app is activated and protected by a PIN. Patients can present their activated mobile HIE app when accessing Medicaid services at pharmacies, hospitals, and other facilities to document their identity.

Each Medicaid beneficiary has a unique Medicaid and HIE identifier. When a request by a provider for access to a patient’s health record is received by the HIE or when PHI is added, the HIE will store this information, identify the patient as a Medicaid beneficiary, reconcile the patient’s Medicaid and HIE identifiers, and feed pre-formatted notifications specific to each type of status change to the patient’s mobile app. Examples of patient notifications include 

  • Radiology results have been delivered to your physician’s office.
  • Laboratory results have been delivered to your physician’s office.
  • An admission-discharge-transfer summary from a hospital has been delivered through your HIE.

The patient app will also provide patients with relevant health and insurance information and connect patients to network providers and services.

HIEs, like electronic health records in hospitals and physicians’ offices, are repositories of large amounts of PHI. The goal of realizing value from collecting and storing such data is directly related to how quickly and easily relevant PHI is shared with providers and patients. Relevant PHI that is delivered in real time to engaged physicians and patients has the greatest potential to improve outcomes, control cost, and increase physician and patient satisfaction.

Using HIEs to deliver PHI-related information instantly in user-friendly ways to physicians’ and patients’ mobile devices is delivering on mHealth’s promise of adding value through innovation.

Stuart Hochron, MD, JD is co-founder and chief medical officer of Practice Unite of Newark, NJ.

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