HIE offerings to satisfy patients and docs

As health information exchanges proliferate, they're also working to differentiate--by offering services and functionality to participants who are sharing data, including the physicians, hospitals, health systems and patients.

FierceHealthIT talked to Laura McCrary (right), executive director of Kansas Health Information Network about the organization's next steps--including plans for an online personal health record that will put a patient's data from a variety of providers all in one place. 

FierceHealthIT: You talked to us about setting up your information exchange and working to get physician and patients to participate. So what's up next for KHIN?

McCrary: We're putting in a state-wide patient portal. It's a personal health record that will connect to the health information exchange. Patients will be able to have their own information from the health information exchange and over time (we haven't quite figured this out yet) we plan to allow patients to see who's accessed their information in their personal health record.

Our vendor, ICA, has the ability to audit who has looked at an individual's record. That's a requirement. So it's not that hard to allow a patient to access that same information. That reassures patients a lot, that their providers have access to their information but that they also have that access to their own data.

FHIT: What's the benefit of an HIE-sponsored patient portal?

McCrary: There are two different kinds of patient portals. A personal health record allows you to enter information into the portal, such as over-the-counter medications, diet and exercise. We're implementing a personal health record. There are tethered and untethered portals. Tethered are tied to a product, to an individual practice or hospital. But information exchanges can use an untethered portal that allows the information to come from and share among all of the providers in the exchange. The problem for the patient is that if you don't have a regional or state-wide personal health record you may have to look at all three or four different portals to get all of your information.

FHIT: How does this help providers meet Meaningful Use requirements?

One of the Meaningful Use requirements is that 5 percent of your patients have to look at that portal or you don't get the Meaningful Use incentive payments.

Our providers who had tethered patient portals were having these competitions with each other to make sure theirs is cooler and sexier to get that 5 percent of patients. If patients are only going to go to one, they want them to go to theirs. When I heard that I said "time out. We're not pitting our providers against each other. We are about working together as a statewide exchange."

ONC has said that if a patient looks at a patient portal that covers many different providers, every single provider who sees that patient gets to count it toward the 5 percent. That will help all of our providers hit that 5 percent, which I'm not sure they would without a statewide PHR.

It's the right thing to do for the people of Kansas, too. We use No More Clipboard out of Indiana. It's hard to find a PHR company that knows how to work with HIEs. We want someone who understands HIE--problems with master patient indexing and matching. You can get multiple returns on a name and send those to the provider to choose the correct one. You can't do that with a patient.

McCrary: We've also had some fun things around public health. We've been able to send data to our state immunization registry. We've also been able to send data to the CDC for biosense, for syndromic surveillance. So we've helped all of our providers meet those two Stage 2 Meaningful Use requirements, too. We're working on the cancer registry and electronic lab reporting--that's way harder than I ever thought it was going to be.

FHIT: Judy Murphy, deputy national coordinator for program and policy at the Office of the National Coordinator for Health IT, recently talked about her experience of moving to a different state and trying to take her and her daughter's immunization records with her. She pointed out that 48 states have immunization databases but only three allow patients to look at them. Why is that?

McCrary: The reason they don't let you look at them is that the data is all wrong. The reason it's not correct is that most states, like mine, don't require their providers to send data to the registry. It's sometimes incomplete, duplicative or incorrect--sometimes all three.

You have to go into a web portal and manually enter the information to get it into the immunization registry. So #1, the providers won't do it. And #2, when they do, sometimes they goof it up. And a lot of times there's multiple entries, because maybe the child got an immunization at CVS and when they told the pediatrician and she entered it too, not knowing whether CVS had done it.

FHIT: What's the solution?

McCrary: Our goal is to get that information cleaned up. When you can send it electronically you take that burden of having to enter it off the provider. So we started with one of our federally qualified health centers that does 15,000 immunizations a year and had never sent any of it to the immunization registry because they didn't have the resources to hire a staff person to do it. It works great--all that information gets in there accurately, in a timely manner without any administration. And guess what? The registry starts getting better and pretty soon we will be able to give that mom her information. 

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