How a Patient Record 'Snapshot' is Driving HIE Data Access

While health information exchange (HIE) can help drive patient-centered care, data access must be clinician-centered to realize the full benefits of interoperability.

Clinicians often must sign out of their EHR system into a separate HIE portal to search for patient information. Once they locate the patient, they must manually find the information they need amidst a set of discrete data elements.

To improve the end-user experience, Hixny, a health information network (HIN) serving providers across eastern New York, created a patient record snapshot tool.

"We heard from a lot of our users that one of the issues they were having is that when they went to get, for example, a discharge summary or an operative report, they didn't have those easily," said Julia Prusik, manager of product development at Hixny.

"They would see the encounter and then they'd have to go into the document section and sift through all of the documents in order to find which document matched that encounter," she explained.

Prusik noted that when they started working on the first iteration of the patient snapshot tool, they formed a focus group of providers from different facets of healthcare to see what patient information was important to them.

"Encounter data was extremely important," Prusik said. "Everybody wanted our labs and documents, and they really wanted to be able to sort and search through them, which we didn't natively have before."

"We had to really build our UI so that it was easily manipulated to show them the data that they wanted with keyword searches, filtering, and sorting options," she added. "It really was just a UI exercise at that point to get this data correct for them."

She noted that the focus groups were key for helping the network understand what information should be included in the patient snapshot and what information could be placed behind a few clicks.

For instance, Prusik said that Hixny considered putting allergies in the snapshot early in the application's development.

"Everybody in HIE thought allergies was the biggest, most important use case," she explained. "The traditional way of thinking is if a patient has fainted on the floor and all you have is their driver's license, you need to know their allergies," she explained.

However, the focus groups revealed that providers were not using the HIE for checking allergies as often as Hixny had thought. Instead, providers requested easy access to patient conditions, most recent visits, lab data, and documents.

"It was fun to ask people their opinions when we first started out because none of these people had ever been asked," she noted. "They all wanted to provide their opinion, but it usually fell on deaf ears."

The first iteration of the tool was well received by network members. However, providers still reported frustration with logging into a separate portal to access patient information.

Hixny got to work on integrating the tool with major EHR vendors through the SMART on FHIR data standard.

The HIN piloted the application at Ellis Hospital. Over the first year of use, the average time it took a provider to search for a patient's HIE data decreased by 30 seconds.

"30 seconds per patient is saving a ton of time per day," Prusik said. "That's more time that they can actually pay attention to their patient."

Perhaps even more impressive was the increase in provider usage upon integrating the tool into clinical workflows. Overall, Ellis Hospital saw a 674 percent increase in usage of the patient snapshot tool after it was available within their EHR.

"We found that EHR integration was key to actually getting people to use this data and make it relevant to their practice," Prusik said. "They used it tremendously more than they had ever been able to when they logged into the portal because it was just so much simpler."

Prusik noted that Hixny fosters ongoing input from its members through a monthly focus group.

"Anybody can join," she noted. "We just added a bunch of care managers to our focus group who are very excited and willing to discuss this. It's really nice to get everybody in the same space working towards the same goal of what we can do to serve the users."

Currently, Hixny is working to build out the patient record snapshot further based on focus group feedback.

"We're currently working with the Department of Health to put the prescription monitoring program in there, and we also have a referral tool," she said. "Hixny is becoming more relevant for bringing data into these providers that are not just the traditional data sources. With our focus groups, we're trying to find those data sources they're going out to anyway and bringing those back into their workflow."