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The two primary and basic structures of health information exchanges (HIEs) are the patient centric model and the patient portability model. Blending the features of both models is what the market is looking for and needs. However, meeting the criteria for both models requires a system with a patient centered approach as well as standards-based data access to accommodate individual patient needs and differences.
Patient Centric Model
The patient centric model enables specific clinical patient information to be transferred and delivered by numerous clinical providers across the care continuum to HIEs, integrated delivery networks (IDN), risk-bearing health systems and other healthcare entities. This information then becomes available to be viewed, downloaded and consolidated for analysis and interpretation, and to be used in clinical dashboards, bio-surveillance, and even genomic research.
 Typically, a patient centric HIE contains a patient data repository that is organized to accept data into storage areas, or vaults, from the full range of healthcare organizations participating in the HIE. The repository is designed so that individual HIE participant data is kept separate, private and secure, and not intermingled, yet is also made readily available for viewing or analysis by authorized providers in a patient centered view.
These secure vaults can be centralized physically, or distributed among the HIE participants. They can also be a hybrid version where some data is stored centrally and some stored in separate virtual vaults where the data is catalogued and can be accessed from other systems within the participating organizations.
A rapid response to requests for patient information this secure setting requires patient matching and record locator abilities. The patient centric model is superior in this regard, in that it provides the ability to share data without duplicating it. This eliminates costs, redundancies and the possibility of confusion about the accuracy or staleness of patient information in the record. This feature also ensures that a clinician's EMR does not become overloaded with extraneous data, and does not need a separate request for data with every patient encounter.
Patient Portability Model
In contrast, the patient portability model simply facilitates the transfer of data from point to point to support the movement of patients between care settings and geographies. Patient portability models use industry standards to deliver healthcare data between practitioners. Used at the state and federal levels, this model is necessary to transfer specific types of global and aggregated information.
Patient portability is important for patients that travel from one location to another frequently, such as "snow birds," those who travel from location to location for specialty treatment, or those who are applying for disability determination. Patient portability is also essential in populating immunization and disease registries, consolidating communicable disease-reporting functions and other reporting requirements for reimbursement and quality determination.
However, used as a mechanism to facilitate health information exchange at a local level, portability models actually contribute negatively to data replication in traditional clinical silos.
Pros & Cons
The use of patient portability models at the state and federal levels are designed and required to transfer specific types of information. At the 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 are difficult at best. Patient portability also creates redundancies, inefficiencies, higher costs, and confusion associated with the accuracy of patient information, because it could have been revised in another setting and out of date in its current silo.
Patient centric models, on the other hand, are designed for local exchanges where the majority of care is delivered. They ensure that the most up-to-date information is being viewed and that data is not replicated. So the specialty physician who needs a view of a patient's history, but does not necessarily want complete data on every patient he or she sees, is not unduly overburdened with irrelevant information. The essence of informed care coordination is the ability to perform analysis for quality improvement in individual populations, population management in the aggregate, and bio-surveillance for regional populations, all combined with secure clinical communication.
Use of the Two Models
The chart illustrates the pros and cons of both models. However, as risk-bearing healthcare organizations, such as ACOs, emerge, and other "high patient affinity" models come to dominate healthcare, the patient centric model will prevail as providers and practitioners require specific patient data at the point-of-care at the moment of need.
Delivering individual patient data when and where it is needed, while ensuring security and critical accuracy of individual patient data across a broad spectrum of users, is key to the ultimate success of HIE, now and in the future.
A successful patient centric HIE will assure the quality, safety and efficiency of healthcare delivered in an IDN, community, region or state. It will enhance, or in some cases, create care coordination between patients, physicians and other healthcare providers, where before there was none. It will engender physician participation and patient engagement to ensure the final mark of success in the high quality and efficiency of care delivery. HIEs must meet the needs of smaller, local residents with attention paid to individual patient data, as well as the broader requirements of populations in widely dispersed geographies and densely populated metropolitan areas.
The era of HIE is upon us, and it is critical that information technology solutions step up to deliver on both the micro and the macro potential of this superb collaborative solution that facilitates true care coordination, quality improvement and reduced costs.
John Tempesco is the chief marketing officer at ICA.
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