Healthix Improves Care Coordination with HealthShare & Real-Time Clinical Alerts

In every healthcare system, there is a profound tension between the need to protect the privacy of personal health information and the need to share it for better care. In New York State, health information exchanges such as Healthix, in the greater New York City area, must have written consent from patients before clinicians can access their information.

Providers or facilities that share data with Healthix usually obtain consent during a patient’s visit. But what happens when the patient is admitted to an emergency department where he has not signed a Healthix consent form, and is unable to? What happens if he cannot convey critical information about his heart condition, for example?

Healthix — the largest public health information exchange in the U.S. — uses InterSystems HealthShare® to gather and maintain a unified health record for more than 16 million individuals, share data with more than 600 healthcare organizations, connect more than 6,000 sites, and send more than 7 million Clinical Event Alerts per year to providers.

Healthix system statistics show that important, actionable health information in this and many other cases often cannot be sent — nearly 6.5 million times in the year studied — for lack of a signed consent form. Clinicians, care managers, and patients may be missing an opportunity for better care and care coordination.

The State of New York has strict laws and policies governing health information exchanges, which includes patient consent for information sharing. Recognizing that broader sharing of health information improves patient safety, care coordination, and care outcomes, the state recently amended their policies for cases where a physician already has a care relationship with a patient, but the patient has not yet signed the Healthix consent form. With this change, Healthix used HealthShare to quickly create a new information sharing program called Essential Alerts.

Essential Alerts inform clinicians that have an existing relationship  with a patient about emergency department and many other types of changes to their patients’ care status in real time, while conforming to the state’s strict patient consent policies.

For example, a physician overseeing a patient’s care could be notified that the patient has been admitted to the emergency department of nearly any hospital in the New York City region with a complaint of chest pain, even if the patient has not yet given explicit permission on a Healthix consent form to share that information. The Essential  Alert provides a limited set of important and actionable information to the physician compared to what can be provided with consent. This information includes patient identity, location, date, and time of the event, chief complaint, initial diagnosis, and an indication that laboratory or other results will be available once the patient gives consent.

Providers and health care organizations participating in an Accountable Care Organization (ACO) or Performing Provider Systems (PPS), for example, can provide Healthix with a list of their high-risk patients or those with chronic conditions. With real-time data feeds from more than 180 organizations across the region, it’s likely that these patients are already part of the Healthix unified health record. When a patient of interest interacts with the healthcare system, Healthix recognizes the status change and can send an appropriate alert to the providers and care managers that need it.

The promise of electronic medical records (EMRs) is that all of the information needed to deliver the best, most coordinated care will always be available. But the reality is different. A typical Medicare patient, for example, sees an average of two primary care providers and five specialists, from four different organizations each year¹. For a panel of patients with four or more chronic conditions, primary care physicians need to coordinate care with 86 physicians in 36 different practices².

For all patients, health information becomes dispersed among the different EMRs used by different clinicians, care delivery systems, and medical, social, and behavioral care practices. Healthix complements the EMRs in use across the New York City region by creating a unified, full and aggregated patient record with HealthShare for better care coordination and patient safety.

^{1 New England Journal of Medicine. March 15, 2007. Care Patterns in Medicare and Their Implications for Pay for Performance. Hoangmai H. Pham, M.D., M.P.H., Deborah Schrag, M.D., M.P.H., Ann S. O’Malley, M.D., M.P.H., Beny Wu, M.S., and Peter B. Bach, M.D., M.A.P.P. http://www.nejm.org/doi/full/10.1056/NEJMsa063979}

^{² Ann Intern Med. 2009 Feb 17; 150(4): 236–242. Primary Care Physicians’ Links to Other Physicians through Medicare Patients: The Scope of Care Coordination. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718023/}