CMIO: Patient portal a 'source of truth'

'Then I can really do population health, because I'm seeing the patient across the entire continuum of care'
By Mike Miliard
11:18 AM
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Hunterdon Healthcare System

At Flemington, N.J.-based Hunterdon Healthcare System, patient engagement is an all-hands-on-deck project, says its chief medical information officer, Wayne Fellmeth, MD.

Who leads engagement efforts there? It's a collaborative effort, says Fellmeth: "Our HIE director, nursing, clinicians in the offices, staff in the offices, clinicians in the hospital – it  involves almost everyone."

True engagement, after all, is a multifaceted enterprise – aimed at any number of folks in any number of care settings. That can make things complex.

[See also: Patient engagement means 'attitude adjustments' on both sides]

When Fellmeth signed on with Hunterdon, "we had three major EMRs: an inpatient system, an ED system, an ambulatory system. It just drove me crazy that we couldn't share data between them," he says.

"Rather than trying to get them to talk to each other horizontally, why can't I get them to talk to each other vertically, with a local, private cloud?" Fellmeth wondered. That's where Cambridge, Mass.-based InterSystems came in.

"We were already using InterSystems products for our interface and databases, Cache and and Ensemble," he says. "So it was kind of a natural to build out on top of that into HealthShare," InterSystems' HIE platform.

A year or so ago, Hunterdon learned that HealthShare would release a patient portal (it was unveiled to wide release at HIMSS15 this past month.)

"We begged and pleaded and cajoled and arm-twisted to get to be one of the sites that got to implement it while it was still in beta," says Fellmeth.

HealthShare Personal Community is an untethered portal that aims to offer a single point of access to personal health records irrespective of care settings, say InterSystems officials. Being built upon the HealthShare platform means it offers patients and families the ability to access data, make appointment, fill prescriptions and contact their providers in multiple formats and from many care settings.

"The vision behind HealthShare is simple: to transform healthcare by sharing health information and connecting communities," said Joe DeSantis, InterSystems' vice president of HealthShare Platforms in a press statement.

From Fellmeth's perspective, making broader use of his existing infrastructure made sense.

"I definitely wanted something that was going to be able to solve all my interoperability problems without bring in yet something out to interface with," he says. "I already knew I could do all the interfacing using the other InterSystems products, so why not build on that and keep the interfaces going and share it to even a higher level?"

HealthShare, he says, "allowed me to make a master patient index across all my EMRs, so when I start sending CCDs out to my regional HIE, it will be a composite CCD from all of my system, not one from my ambulatory, one from the hospital and one from the ER: They'll get a complete picture of the patient when they request a CCD from Hunterdon."

That same unanimity is planned as Hunterdon builds out its portal, he says. Its inpatient side has been live with Personal Community since this past June and has about 300 patients making use of it so far.

[See also: For portals, speak patients' language]
 

Those are "small numbers," Fellmeth concedes, because functionality is still limited to inpatient data. But Hunterdon's ambulatory system is "far more heavily used," he says, and "my goal in the long run is to merge these two portals into one – hopefully later this year."

The health system does about 30,000 ED visits a year, between 8,000 and 9,000 inpatient admissions annually, and has upwards of 200,000 ambulatory patients.

"There's a lot of overlap there, but at some point, getting 100,000 people on there would be ideal," says Fellmeth.

In the meantime, patients are making good use of the hospital portal – and even finding new functionalities they'd like to add to it.

"We had a wife of one of our inpatients call yesterday and ask why her husband's daily labs weren't available on this inpatient portal yet," he says. "We'd just never thought about putting them up there. His meds were there; his discharge summary will eventually be there – he just hasn't been discharged yet – but why don't we put this information there while he's still in the hospital? What a great idea."

[See also: Getting down to business with patient engagement]
 

As the portal is built out to include other care settings, the hope is to enable that sort of active engagement on a much wider scale – keeping patients involved in their care while also giving clinicians a more holistic and easily accessible view, says Fellmeth.

"I'm going to be able to have all of my patient information – it's not so much about the portal itself as it is about using HealthShare as my source of truth," he says.

"Because I have this MPI now, all of my EMRs are going to be sending their information, almost in real time, up to HealthShare. So when a patient or a clinician requests information, HealthShare doesn't really store it, but it knows where to find it.

"So it builds a CCD, on the fly if you will, when it's requested, so when a patient requests a personal health record via the portal, it's going to pull the most current data from all of the different systems it has access to, to make that PHR," says Fellmeth.

"Then I can really do population health, because I'm seeing the patient across the entire continuum of care, from being at home to their ambulatory provider to their acute care provider to their post-acute provider – and back into the community."