Attributes of the Patient Centric and Patient Portability Models

Health Information Exchange (HIE) is often defined as the process of sharing health-related information among organizations according to nationally recognized standards. HIE is one of the core building blocks to create an HIT infrastructure for the purpose of sharing relevant healthcare information among clinicians in different health facilities often throughout broad geographic areas for the purpose of improving quality of care.

The term, HIE, is also often used to refer to both a process and an entity. It is an integral component of the health information technology (HIT) infrastructure under development in the United States and the associated Nationwide Health Information Network (NwHIN). To meet both these requirements, HIE technology must enable the reliable and secure transfer of data between and among diverse systems and also facilitate the access and retrieval of data for the purpose of improving healthcare delivery through information gathering.

That said, HIE is now used as both a verb and a noun. The HIE verb describes the passing of healthcare data from one source system to another, either within a single entity or among owned or independent entities; while the noun describes an organization established to promote the exchange of healthcare data between entities, government organizations or other HIEs. No matter how the term is used, there is a need for the exchange of healthcare information at a local level, a regional level, a state level, across state boundaries or at a national level. And at each level, the concentration, scope of data, specificity and technique of exchange varies.

Local exchanges have a need to exchange comprehensive healthcare information in real time. The information must be available to physicians at the point-of-care at the moment-of-need. A physician without access to critical data may often re-order diagnostic tests and procedures, prescribe medications incorrectly, misdiagnose patients and/or develop a plan of treatment inappropriate for a patient’s overall health condition. Each of these factors contributes to increased cost, lower quality of care, potential morbidity or even mortality of each patient the physician encounters. Regional HIEs require a less comprehensive exchange of information because they generally follow the movement of a patient from location to location. In a regional setting, exchange needs are typically centered on comprehensive summaries of information associated with single encounters or the re-location of people within a discrete geographic area. At the state level, exchanges become more specific to immunization and other disease registries, bio-surveillance, public health reporting or quality monitoring. At the national level, exchange becomes even more specific to support communicable diseases, disability determination, pay-for-performance, quality monitoring, as well as other reportable events. These examples illustrate the variables in comprehensiveness and immediacy associated with the exchange of healthcare information.

HIE Infrastructures

Each of these exchange mechanisms or entities requires a certain infrastructure to support the particular exchange of healthcare data based on the scope and complexity involved. HIE infrastructures take two overarching forms: Patient Centric and Patient Portability. The patient centric model makes possible the delivery of individual patient information by multiple clinical providers to HIEs, ACOs, IDNs or other healthcare entities across the care continuum. This information can be viewed, downloaded, or consolidated for analysis to be used in clinical dashboards, bio-surveillance, and/or genomic research.

Patient Centric Model

A patient centric HIE contains a patient data repository that is configured to accept data into storage areas, or vaults, from various participating healthcare organizations so that data is not co-mingled, yet is readily available for viewing or analysis by authorized participants. These vaults can be centralized physically, or distributed among the participants.

This secure environment must have a patient matching and record locator service to be able to quickly respond to requests for information. In this model, the information is shared but not replicated at each participant location. Authorized participants are also able to modify patient information as it pertains to each clinical encounter. The patient centric model deals with both individual patient data and aggregated data so that it can be accessed across numerous care settings. Patient centric models are designed for local exchanges where the majority of care is delivered, and data is not replicated. Consequently, each provider’s EMR isn’t overloaded with extraneous data nor does it require a request for data on every patient encounter.

Patient Portability Model

The patient portability model simply enables the transfer of data from point-to-point in order to support the movement of patients from one care setting or geography to another. Patient portability models use standards-based methods to pass healthcare data between providers. Data can be transported via an XDS standard or through NwHIN Direct protocols. XDS methodologies are used to pull information between HIEs, or from an HIE to a state or federal agency. NwHIN Direct protocols are used to transmit data directly from one provider to another or from a compliant HIE to a compliant non-HIE provider. Order and result delivery from a provider to a laboratory, radiology center or other diagnostic organization also falls into the patient portability model.

Patient portability models, used at the state and federal levels, are necessary to transfer specific types of global and aggregated information. If used at a local level, this model causes replication of data into silos of information, creating the possibility of redundancies, inefficiencies, higher costs, and even in some cases, confusion as to which patient information may or may not be accurate.

Pros and Cons

The use of patient portability models at the state and federal level are designed to transfer specific types of information, while at a local level the replication of data, the need for true care coordination and clinical communication are essential. In the portability model, the data is replicated at each location in non-discrete formats so analysis and accommodation by various EMRs is difficult at best.

Patient centric models are designed for local application where the majority of care is delivered. Data is not replicated. Therefore each provider’s EMR is not clogged with extraneous information, especially the specialty physician who needs a view of a patient’s history, but does not necessarily want complete data on every patient they see. The essence of informed care coordination is the ability to perform analysis for quality improvement, population management and bio-surveillance combined with clinical communication.

The Holy Grail

Currently, HIEs that manage to successfully combine the attributes of both the patient centric and the patient portability models will ultimately give the market what it’s looking for and what it needs. Meeting the criteria for both models requires a system with a patient centered approach, as well as an NwHIN Gateway to accommodate patient portability needs. The ability to transport critical patient data when and where it is needed while at the same time preserving security and assuring absolute accuracy of individual patient data across a broad spectrum of users is key to the ultimate success of HIE, now and in the future. HIE must meet the specific and detailed needs of smaller, local populations, as well as the broader needs of widely dispersed geographies and densely populated metropolitan areas. The era of HIE is here and it is critical that solutions step up to deliver on both the micro and the macro potential of this magnificent information technology solution.

John Smith is Director of Communications at ICA. This blog post was first published on ICA’s HITme Blog on May 9, 2012. John has over 20 years of experience in healthcare communications with a focus on health information technology, having served as Senior Vice President and Healthcare Practice Leader at several communications firms, including Fleishmann Hillard, Manning Selvage and Lee and Brodeur Worldwide.