Nationwide Care Transitions: Empowering the Provider, Empowering the Patient

More than 2.5 million passengers fly domestically in the US every day. How many of those people do you think remember to bring their health records with them in case of emergency? While I don’t know of any source tracking that statistic, my personal experience would lend me to believe it is very few.

This time of year, it feels like even more people are traveling – holidays, business trips, a welcome escape from this brutal winter. And it also feels like this time of year is when most people come down with a cold, flu or something worse that requires them to seek medical attention.

What happens when those two collide – when you are sick or injured while traveling far from home?

Most likely you feel out of sorts, perhaps even somewhat helpless. You don’t have access to a familiar medical provider, so you find yourself at a local urgent care or ER trying to recall when you had your last tetanus or flu shot, or perhaps you are not even able to share or recall your medical history due to your current condition. In those circumstances, the attending provider also may feel helpless, or at least handicapped, to ensure they are providing you the best care for your situation.

At HIMSS13, CommonWell Health Alliance announced its formation and its mission to set aside competitive lines to help improve and facilitate the nationwide sharing of health data. Less than five years later, more than 8,000 provider sites are live on CommonWell services in all 50 states, Puerto Rico and D.C., and more than 23 million people have been enrolled. Together, with our nearly 80 members, we work to help bridge that gap and breakdown the silos of health data.

Seven of those members will be providing a live demo at the HIMSS18 Interoperability Showcase of their respective solutions utilizing CommonWell services to do just that – share a person’s medical records across providers, technologies and geographies. The Nationwide Care Transitions Use Case will highlight how the person is at the center of interoperability, including allowing her to access her own records via her connected PHR.

Meet Cynthia: Nationwide Care Transitions Use Case

HIMSS attendees will follow the story of Cynthia Garcia, a 66-year-old woman from Naples, Florida. As her story unfolds, the seven participating organizations – Brightree, Cerner, eClinicalWorks, Greenway Health, Imprivata, MEDITECH and OneRecord – will demonstrate how the CommonWell nationwide network and services are leveraged to improve care coordination and delivery when Cynthia faces an unexpected injury while visiting her daughter in Colorado.

Only a couple months before her injury, having experienced shortness of breath during her morning walk, she was diagnosed and treated for a pulmonary embolism, and then subsequently discharged on an anticoagulant. This adds not only depth to her medical history, but also a complexity that is more easily addressed with ready access to Cynthia’s recent health records.

Over the course of several months as Cynthia transitions through multiple settings of care in two different states, attendees will see how a national record locator, patient identification and linking, and data query and retrieval services work cooperatively through the CommonWell network across various end users, venues of care and health IT systems, including PHRs, EHRs and biometric solutions.

Specifically, some examples of the technology attendees will see in action include:

Modern, FHIR-based Access
As Cynthia’s story plays out following her initial visit to her local primary care provider, the hospital she is referred to both queries and retrieves important documents detailing Cynthia’s history from across the CommonWell network using FHIR (Fast Health Interoperability Resources), including records from her visit to her PCP earlier that same day. Ready access to this information permits Cynthia’s acute care provider to act swiftly and decisively with immediate testing to confirm the probable pulmonary embolism diagnosis that her PCP noted in the records from her visit.

Patient Linking
Once enrolled in CommonWell during a visit to her primary care provider, any participating provider can link Cynthia’s disparate records, creating a more complete health record available to the providers who need it – even at locations where she has not previously received care. Through unique innovations in patient linking, Cynthia’s provider can review her records even before the patient is seen, giving them invaluable insights regarding her medical care to date before the patient walks in through the door.

Record Locator Service
Throughout her journey across state lines and different venues of care, providers use the CommonWell Record Locator Service (RLS) to search for records linked to Cynthia’s identity within the CommonWell network, no matter where the care is delivered. This service is critical to keeping a person like Cynthia at the center of her care. With CommonWell RLS, Cynthia’s providers have a “virtual table of contents” at their disposal that specifies the available locations for her patient records.

Direct Patient Access to Consolidated Health Records
As she works toward a full recovery with a follow-up to a clinical specialist, Cynthia accesses her own health records right at home via her personal health record, which leverages the CommonWell network to pull in her health records from all her providers connected to CommonWell, regardless of their EHR. This allows Cynthia to proactively prepare for her appointment by reviewing and noting any necessary updates to her records. Having this information ahead of time not only allows Cynthia to make her provider aware of any changes, it empowers her to help take control of her own health.

From beginning to end, the demonstration will provide unique insights into what goes on behind-the-scenes of smooth care transitions fostered by collaboration, and the noticeable value it offers to both the provider’s workflow and the patient’s care.

I know we all hope to never experience an injury or sudden illness, particularly away from home, but life is unpredictable. With electronic access to their health records – for both patients and their providers, hopefully that feeling of helplessness will be lessened and Cynthia, or whoever the next person may be, can focus on getting back to her active life.

We looking forward to seeing you at the Nationwide Care Transitions Use Case in the Interoperability Showcase during HIMSS18. If you aren’t able to make it to HIMSS18 this year, or you would like to see a preview of how CommonWell members’ technologies share health data – you can watch a demo video of Jessica’s story, as she travels through the health care system as an expectant mom.

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