Patient Controlled Health Information Exchanges and the path to Interoperability
As the healthcare technology landscape has rapidly evolved, from EMRs, isolated to medical facilities, to HIEs, connecting groups of facilities together, to Population Health solutions, sharing data at population scales, interoperability has become an increasingly difficult proposition. There are a myriad of reasons why this transition is proving harder than expected but there is only one solution, a Patient Controlled Health Information Exchange (PCHIE).
PCHIEs aim to solve the complexity of information flow by putting the patient at the center of healthcare as opposed to the periphery. As patients traverse along their continuum of care, across multiple settings, they encounter artificially designed barriers. It is of little import and no discernible benefit to a patient what system a provider utilizes, yet this very scenario results in frustrating silos of data, incapable of exchanging data. A more elegant solution empowers the patient to own their record, allowing them to share with whomever they choose, enabling more effective and efficient care. By dissolving the barriers to information exchange between providers the patient provides a complete picture of their medical history.
This inadequate coordination of care costs between $25 and $45 billion per year. Luckily, the world is beginning to transition to a superior reimbursement model, rewarding health systems on outcomes versus quantity of tests and procedures. As organizations struggle to reign in wasteful and duplicative actions, having a holistic view of a patient's health will become increasingly vital. Whereas before pockets of valuable data were only visible at an institution level, now everything, from allergies to conditions to procedures will be available. This will vastly reduce duplication of tests and misdiagnosis. General practitioners will now understand the totality of their patients health by having a consolidated source of data from encounters with specialists and emergency visits across regions and borders.
As PCHIEs grow in popularity it will also be important to put the power of consent in the patient’s hands as well. A simple to understand and use distribution method will be required to give consumers the choice of what data they share and with whom. This power will enable more than the traditional view-only functionality of tethered patient portals. Patients will actively engage providers on treatment plans and even view notes regarding their diagnosis, as the OpenNotes movement is seeking to enable.
If the ultimate goal of healthcare is to lower cost, improve quality, and increase patient engagement through sharing of data, then the only answer is a patient controlled health information exchange.
Senior Director Solutions Design at Zus Health
8 年Thanks for all the comments and discussions. I tend to lean heavily towards patient empowerment, I do believe that giving the data to the consumers and letting them make decisions around their own health is the way forward. An engaged and educated patient is going to have much better outcomes. I'm glad that lots of comments are around consent and trust, this just happens to be the subject of my next post :)
Disambiguation Specialist
8 年David - You mentioned 'interoperability' as a bi-product of a PCHIE initiative, but I don't see it mentioned in the article. Can you elaborate on how you relate one to the other?
Laboratory Informatics Expert
8 年It is true that the airline industry works well with few risks. However, it is all behind the scenes of the passenger/patient. The passenger isn't seeing any of the cockpit "readings" per se and transferring alerts/normal values from pilot to copilot, like it is expected in healthcare when images or other health data are exchanged often by the patient from one health worker/provider to another. Similarly with the package transport example, the customer is not transferring their package from amazon's warehouse to the truck to the post office to their mailman to their address. It is handled behind the scenes within the system. The other point/difference between the patient centered model as was mentioned is the patient is the control tower and thing being moved/analyzed/processed- a dual role. There is significantly more risk too if an error occurs. If a box is damaged in shipment or doesn't reach it's destination, one can always re-order another replacement. With a patient, we can't reorder or recreate the same person. If the patient dies due to medical error, that is it. game over. some may feel that isn't a significant risk, but the IOM indicates that medical error is the 3rd leading cause of death, so I argue, it's a real and present danger! Who wants to be the guinea pig in testing out new processes? Doubt we'd find many volunteers.
Solutions Architect & Consultant | Finding a way to do more using less within the reason and the budget
8 年The very purpose of unified (integrated) healthcare information file - do not allow not-trusted (not certified) source to have even access to that system, leave aside ability to enter/modify records. Another story, that available on file information not matching to standards/requirements of particular medical institution..
Laboratory Informatics Expert
8 年Trust needed in the exchange of data too. There are some sources that clinicians cannot trust and given clinical decision making could based upon said data, from a medical-legal liability perspective, a clinician still may order the test or study themselves.