Electronic Health Records

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What is the role of HIEs in electronic patient engagement?

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Established to enable provider-to-provider communication, health information exchanges (HIEs) integrate with multiple systems, technologies, and provider cultures. While their exchange activities have always been on behalf of the patient, the idea of actually giving the patient a seat at the table is a fairly recent development. HIEs, by their nature, are in an ideal position to share the data they already manage with the people from whom it had been collected, the patients themselves. But sharing HIE data with patients is easier said than done.

As providers have accepted (if not always embraced) the transition to electronic medical records (EMRs), patients are now in a better position to acquire and access health information using their own electronic tools. Again, that process has remained more elusive than easy.

Provider EHRs that offered tethered patient portals were a good first step for patients who see one provider or multiple providers in a single health system.  But patients under the care of multiple providers — including families with specialists such as pediatricians or cardiologists, in addition to internists or GPs — were required to use a separate portal for every provider, making it anything but easy to organize and manage health information in one spot.

With their established roles and relationships as health information aggregators and integrators, HIEs are poised to enter into the equation, providing value to both consumers and clinicians. HIEs are equipped to integrate with whatever systems and technologies their providers already use, and they can aggregate and disseminate health data from multiple sources direct to consumers in a standardized format.

And HIEs have good reasons to get involved in patient engagement. Grant funding is harder to come by and stimulus money is largely spent, leaving HIEs in search of reliable and recurring revenue streams. The ability to bring consumers into the mix can create value for the HIE’s provider base and deliver meaningful use at a lower cost.

Even providers eager to engage electronically with patients to meet Stage 2 Meaningful Use requirements are faced with the expense of setting up and operating patient portals. Here is where the HIE can play a significant — and valuable — role, providing the data the HIE is already aggregating from multiple providers and supplying it to patients.

Recent guidance from CMS indicates that if a patient views, downloads, or transmits (VDT) data from a shared portal (including one provided by an HIE) , each provider that contributed data to the shared portal can count that patient toward their individual five percent stage two meaningful use requirement (see FAQ7735 at CMS.gov). Whether served as a complement or alternative to tethered portals, an HIE portal can offer added value, created easily from existing data.

Make no mistake, developing and deploying an HIE patient engagement strategy is no cake walk. However, models for success do exist. In Indiana, we have worked over the last two years to make HIE data available to patients as part of an ONC Challenge Grant program. We have worked through any number of technical and policy challenges, collaborating with five Indiana HIEs and a dozen pilot sites. The results are encouraging and include measurable improvements in patient engagement levels and clinical outcomes. Now it’s time to share the lessons learned to help HIEs and other organizations address challenges and get further, faster.


Jeff Donnell is president of NoMoreClipboard, a web-based, Personal Health Record (PHR) management system designed to consolidate medical information in one convenient and secure location for easy retrieval and updates. NMC enables consumers to share personal or family member medical information with medical professionals electronically, reducing the need for repetitive medical paperwork.  Jeff and the company are committed to developing PHR applications that are consumer-friendly, interactive, secure, mobile and interoperable.


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