Data exchange exists on a continuum. At the most basic level, data exchange might mean a patient carries a physical CD of an X-ray from their PCP’s office to the orthopedic surgeon’s office and rehab clinic. It’s neither efficient nor patient-centered, but healthcare organizations still use this type of data exchange when there are no other options.
Data exchange facilitated by interoperability is more common. This refers to the ability to securely share electronic data using standards-based protocols, such as FHIR and HL7 v2. The scope of this method of sharing information might be as narrow as sharing patient-specific, clinical summaries (aka Continuity of Care Document (CCD)) between two unaffiliated providers. Or it might be broader and include leveraging state or regional Health Information Exchanges (HIEs) or vendor-developed data exchange applications.
Interoperability-enabled, standards-based data exchange is a vast improvement over previous methods. It is the foundation of most of the information sharing that takes place in today’s healthcare industry. Effective implementation requires a high degree of technical expertise, but organizations that invest in interoperability-enabled data exchange typically see significant ROI. The more comprehensive the patient record, the more likely a provider can deliver cost-effective, efficient care, resulting in positive patient outcomes.
But as important as standards-based interoperability-enabled data exchange is, an even more comprehensive and strategic method of information sharing exists in the healthcare ecosystem and is gaining increasing attention: the shared patient record model.
What is a shared patient record?
At the end of the day, data exchange is just that: a handshake between systems, the passing of specific types of patient information from one entity to another. The information exchanged might be a CCD, a medication list, diagnosis codes, or immunization data. But in most cases, data exchange involves a narrow slice of the patient record.
Furthermore, the data exchanged might or might not be current. Information sharing could occur in batches, and therefore represent daily (but not real-time) results. In addition, some data exchanges operate on a query-basis: in other words, the requesting provider must have some sense of what to request before they can pull the information into their system.
The shared patient record changes that, enabling all the organizations involved in a patient’s care to access a single patient record on a shared platform — typically a shared EHR. That means every entity providing care to a particular patient has access to complete, comprehensive, and real-time patient information. The shared patient record model is a game-changer.
Benefits of a shared patient record model
The most common approach to the shared patient record model is to leverage a proprietary EHR platform that has been purpose-built to support the shared patient record model. One example is Epic’s Community Connect program, which enables large healthcare providers to extend their Epic platform to independent practices, hospitals, and post-acute facilities. This means that each provider organization affiliated with a specific Community Connect program host has access to the same, complete, and updated patient record. This helps give providers a more comprehensive view of the patient, enhances provider-to-provider relationships, facilitates referrals, and helps providers close care gaps. In Epic’s shared patient record model, billing and scheduling functions are kept separate, so each organization can independently manage the financial aspects of patient care.
Community Connect relationships can be initiated by the host organization or sought by potential affiliate organizations. They may focus exclusively on ambulatory/outpatient provider care networks, such as those that make up Accountable Care Organizations (ACOs) or Clinically Integrated Networks (CINs). The Community Connect relationship can also be extended to include inpatient services as well, for example, when a Critical Access Hospital (CAH) affiliates with a larger medical center that serves as host for the platform.
In general, the more patient overlap any two or more entities have, the more sense it makes to explore a shared patient record model. Healthcare providers with patient overlap percentages of as low as 10% to 20% can realize significant benefits by implementing the shared patient record model.
Just as the large IDNs have invested over the years to get themselves onto a single, shared EHR across their service lines, extending that same EHR to strategic patient care partners within the community facilitates care efficiencies and the “stickiness” of partnerships. It also has the potential to increase the “stickiness” of participating organizations’ relationships with patients, as patients experience benefits including the ability to access their comprehensive health record via a single patient portal.
More than technology infrastructure
EHR platforms serve as a kind of central nervous system in healthcare organizations. They enable patient data to be shared throughout the organization so the organization can focus on delivering high-quality, cost-effective patient care. Likewise, in the shared patient record model, this “central nervous system” is extended to affiliated entities throughout the healthcare ecosystem.
However, it is important to understand enabling a successful shared patient record model requires more than deploying the appropriate technology infrastructure. Technology is only one aspect of the partnerships that support a shared patient record model. The planning and expertise required to successfully implement a shared patient record model between organizations is different from the expertise required to implement an EHR within one organization.
Community Connect implementation requires consideration of additional factors, including:
- Organizational goals — Whether an organization is a host or affiliate, it is important that participation in a shared patient record model advances the organization’s patient care and larger strategic goals.
- Strategic relationships — Whether an organization is an existing host or affiliate, or is considering becoming a host or affiliate, organizations must identify which strategic relationships are the most important to consider when rolling out a shared patient record model. For example, in a large metropolitan area, potential affiliates may have a choice of hosts. In that case, it would be important for the affiliate to determine which host best meets the organization’s goals and is best equipped to meet the affiliate’s support expectations. At the same time, hosts in a multi-host market need to consider how they can ensure the quality and competitiveness of their Community Connect offerings. Existing and new entrants in the hosting market — including Epic’s Garden Plot for larger ambulatory groups as well as offerings by other EHR vendors — mean that affiliates have many choices beyond Community Connect. That makes it especially important for hosts to elevate the Community Connect experience for existing and potential affiliates.
- Deployment and support — The host organization in a shared patient record model becomes the de facto EHR vendor. How will the host execute that role? Does the host have sufficient internal resources to provide high-quality support to one or more affiliate organizations? Would it make sense to consider a managed services model for long-term sustainability of the organization’s host role? For affiliate organizations, questions might include: What level of technology support is expected? What are the affiliate organization’s expectations regarding having a seat at the table for issues, such as data governance?
- Evolution and sustainability — The shared patient record model has been in use, in various forms, for nearly 20 years. But as healthcare technologies and the regulatory environment evolve, agreements that used to be adequate may no longer serve the host or affiliate organizations. It is important for both host and affiliate organizations to periodically review and refresh the business models, contractual agreements, workflows, and other aspects of the business relationship supporting the shared patient record model so it continues to provide value for both the hosting and affiliate organizations.
Ultimately, the shared patient record model involves much more than a technology platform, although the technology infrastructure is an essential component. This model serves the patient by literally placing the patient’s information at the center of care. It serves healthcare providers by enhancing strategic relationships and enabling them to become better healthcare partners.
Like all relationships, effective deployment of this model requires good communication, a commitment to improvement, and ongoing nurturing to meet the needs of all constituents: patients, hosting organizations, and affiliate organizations. But when properly deployed and maintained, the shared patient record model can be a powerful and effective tool for maximizing the benefits of information sharing.