AMDIS 2014: Patient engagement and the future of HIE

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
 - Image Network

OJAI, CALIF.--Are patient engagement efforts the solution to health information exchange (HIE) efforts that are just becoming too complex? That‘s one question panelists looked at during a session on patient engagement and HIE last week at the AMDIS Physician-Computer Connection Symposium.

“The major assumption behind all of this is that combining all the records of the patient gets you to the truth,” observed Joseph Schneider, MD, vice president, CMIO, and medical director of clinical informatics for the Baylor Health Care System. “And that is not true.”

In fact, Schneider said, when it comes to HIE, patient disclosures could cause a patient some concern if they were a little bit more truthful.

According to Schneider, a more accurate disclosure might read: “We are going to manage your data, but there a is a good chance your data from different doctors is going to be conflicting. Your data may be too overwhelming for your doctor to use.  Your consents may be conflicting or impossible to follow, your data may be mixed with someone else or we won’t be able to match you with your data, your data may be lost or stolen, your data may be destroyed sooner than you want, and your doctor may not join an HIE because of liability issues. But trust us anyway.”

Patients may trust that the information that goes into an exchange will help doctors get to the truth, but what happens if there is conflicting information in the record?  For example, if a patient in Boston tells a physician he has an allergy that information will go into an EMR and then into a national network. But if that same patient goes to a doctor in Texas who tests that patient for allergies and concludes that patient has no allergies, that information also goes into a network.

So what happens, asked Schneider, when that patient ends up in Denver unconscious, and the record shows he is both allergic and non-allergic? “It’s a simple example,” he said. “But it exists for many other patient-level data type points—name changes, data, insurance.” And while it’s easy to suggest that the doctor in Boston should just go back and fix the record, “that’s never going to happen,” Schneider said.

With this in mind, Schneider asked whether it might be time to consider some new approaches. “We’ve talked about patient engagement for the longest time, it’s now time to fund it,” he said. “Let give [patients] the message that they are responsible for their data. Let’s give patients and physicians the tools to be able to manage that data and enable physicians to trust patients when they give them the data.”

Patients should have access to a single data repository, Schneider said. “One way to get there—now that we have all of these people signed up in insurance plans--is to have the insurers provide it to patients.” Once that data is in a single place patients should have the ability to add, modify, delete and prioritize data, he added.

Implementation of such a system would result in a number of questions that would need answering. For example, how can a physician trust that the information provided by a patient is accurate?

It wouldn’t be easy, and there are many other questions that need to be addressed, he said, but “unless we start putting some funding and dollars into this we are never going to get there.”

In a follow-up session, Larry Ozeran, MD, president of Clinical Informatics in Yuba City, Calif., also addressed the concept of patient engagement, and referred to the Accenture Consumer Survey on Patient Engagement that found that 57 percent of consumers track their own health data, 84 percent think they should have complete access to all of their EHR data, and 71 percent believe they should be able to update their EHRs.

Of particular concern to some healthcare organizations was a finding that 40 percent of consumers would consider switching providers if they couldn’t access their EHR data online.

These numbers become more significant when one considers the avenues with which consumers are now able to provide a significant amount of health data to their providers.

“There is a very fast growing ecosystem of personal health monitoring devices with digital output,” pointed out Ozeran. “And they’re not perfect, and a lot of them are nowhere as good as medical grade equipment, but they’re cheap . . . well within the budget of a population that has no problem spending two, three, four hundred dollars on a smartphone.”

Ozeran also referenced the fact that major technology companies like