HIE Patient Engagement Strategies
Case Studies: Summary &
Conclusion
HIMSS HIE inPractice Task Force
May 2016
©HIMSS 2016
Contents
Introduction.................................................................................................................................................. 2
Sites Interviewed ........................................................................................................................................ 2
Louisiana Health Care Quality Forum (LHCQF)................................................................................ 2
Northwest Permanente (Kaiser Permanente) .................................................................................... 3
University of Washington Medicine ..................................................................................................... 3
Healthcare Access San Antonio (HASA) ............................................................................................ 3
Greater Houston HealthConnect.......................................................................................................... 3
Summary of Success Strategies .............................................................................................................. 4
Patient Engagement Techniques......................................................................................................... 4
Generational Differences ...................................................................................................................... 4
Partnering Activities ............................................................................................................................... 4
Privacy Concerns ................................................................................................................................... 4
Patient Portal........................................................................................................................................... 5
Additional Information ............................................................................................................................ 5
Conclusions and Recommendations....................................................................................................... 5
Acknowledgements .................................................................................................................................... 6
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Introduction
Patient engagement in healthcare has recently become a priority as the nation moves
toward achieving improved patient outcomes. The focus stems in part from quality incentives
that increase the importance of patient satisfaction metrics that CMS will use in reimbursement
determinations for Medicare consumers. Another facet of these quality initiatives requires
improved communication and sharing of information with patients, their families or care-takers,
and other providers. Modern communication strategies, such as mobile apps and patient
portals, are prioritized by these quality initiatives. This necessitates that providers determine the
outreach and communication strategies that will enable them to attain goals for consumer
outreach and engagement.
The 2016 HIMSS HIE inPractice Task Force embarked on this initiative to discover ways
that Health Information Exchanges (HIEs) implement, collaborate, and engage patients on
behalf of the HIE. The HIMSS Task Force decided that the best way to accomplish this would
be to highlight what others have done and share their success strategies and lessons learned.
First, the HIMSS Task Force developed common interview questions to address patient
engagement activities. The members then interviewed five HIE entities in the southern and
western parts of the United States to discuss patient engagement techniques, generational
differences, partnering activities, privacy concerns, and patient portal features. These HIE
entities included a multi-state health maintenance organization and a multihospital/multi-clinic
enterprise; the group was unable to identify a clinical data-sharing HIE in the northwest region.
One northwest HIE was interviewed but was excluded from the case studies since they do not
employ direct patient engagement techniques but rather use a hub-and-spoke model and serve
as conduit for information exchange with no direct consumer engagement. The overall results
are summarized by each section. Individual HIE case studies are also available on the HIMSS
website here for more detailed information.
Sites Interviewed
Louisiana Health Care Quality Forum (LHCQF)
The Louisiana Health Care Quality Forum is a not-for-profit, private, neutral organization tasked
with planning, promoting, and conducting quality improvement initiatives in Louisiana. One of
those initiatives is the Louisiana Health Information Exchange (LaHIE), which went live in 2011.
LaHIE currently has more than 300 participants and more than 4.3 million unique patient
records.
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Northwest Permanente (Kaiser Permanente)
Kaiser Permanente is an integrated delivery system made up of three distinct entities: Kaiser
Foundation Health Plan Inc., Kaiser Foundation Hospitals, their subsidiaries and The
Permanente Medical Groups. The consortium offers health plan coverage in eight states serving
approximately 10.2 million members and includes 38 hospitals. Kaiser Permanente was chosen
for inclusion based on its large integrated delivery network and length of time using a vendormediated HIE. Kaiser’s patient portal experience can inform the implementation of patient
portals for HIEs.
University of Washington Medicine
University of Washington Medicine is a public entity including the following: UW School of
Medicine (serving the states of Washington, Wyoming, Alaska, Montana and Idaho), Harborview
Medical Center (Level 1 trauma and burn center), Northwest Hospital and Medical Center,
Valley Medical Center, UW Neighborhood Primary and Urgent Care Clinics, University of
Washington Medical Center and Airlift Northwest (serving Washington, Alaska, Montana, and
Idaho). In addition, UW Medicine is one of three partners in the Seattle Cancer Care Alliance
(SCCA). University of Washington Medicine was included in this study to further add to the
knowledge base of experience in use of patient portals in a multi-site health enterprise.
Healthcare Access San Antonio (HASA)
Healthcare Access San Antonio (HASA) is a non-profit 501 (c) community collaborative initiative
to enhance access to health and medical care for Central Texas residents through health
information exchange (HIE). As of 2010, HASA had become one of 16 statewide entities to
receive state funding for expansion. This expansion will allow HASA to become the health
information exchange for South/Central Texas (22 counties) while at the same time building
connectivity to other HIEs across the state. HASA has over 1.9 million unique patient records
and 30 hospitals connected with over 2,000 professionals currently using the HIE services.
Greater Houston HealthConnect
Greater Houston HealthConnect (HealthConnect) is a not-for-profit Health Information
Exchange (HIE) governed by a community volunteer board. HealthConnect’s goal is to enable
care coordination across the community through a secure network of electronic health record
(EHR) systems, linking all providers in Southeast Texas. HealthConnect covers a service area
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of 23 counties and nearly 7 million people. Participants of Healthconnect include 51% of the
hospital market and 39% of physicians in the region, including a majority of FQHC (Federally
Qualified Health Center) providers.
Summary of Success Strategies
Patient Engagement Techniques
Only one of the HIEs interviewed is involved with a statewide patient education
campaign about the advantages of HIE and patients’ access to their health records. Another
focuses on using physicians to initiate the patient engagement and portal access, with an
overall average of 70% of patient enrollment. The majority of other HIEs interviewed are not
involved with any current patient engagement activities. One HIE has plans for the future to use
the physician or the organization as the initiator of patient engagement activities.
Generational Differences
Two of the five HIEs interviewed had data detailing use by generation. One study
showed the 50-60 year-old age group to be active users and another HIE discovered the 45
year old and up group preferred to utilize mobile applications for various patient activities. There
is strong evidence that “Millennials” (born between 1982 and 2004) engage more through
social-media educational campaigns and smart phone technology.
Partnering Activities
Some of the sites interviewed are involved in activities where they partner and
collaborate with state organizations, pharmacies, employers, or payers to jointly address patient
engagement.
Privacy Concerns
There was a mixed response regarding privacy concerns. Most of the sites interviewed
saw more concerns from their stakeholders in the beginning stages of implementation than in
the later stages. One HIE indicates that patient portals are more secure if the provider or
organization assigns the patient access to the portal versus the HIE. One site mentioned privacy
concerns involving sensitive health information for certain patient populations such as trauma
victims or behavioral and mental health patients.
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Patient Portal
In general, all patients want their user interface to be easily accessible, understandable
and secure. A few of the HIEs interviewed utilize different platforms just for their patient portal.
Other sites are in the beginning stages of implementing their patient portal and currently do not
have any feedback about the portal usability. The consensus the HIMSS Task Force received
about portal utilization is that users would like to see other engaging activities within their portal
besides just accessing their records. Some portals provide only basic engagement tools (e.g.
the ability to receive test results), while others offer more flexibility in user design. Most offer
prescription refills, direct messaging, and photo uploads, as well as access to aggregated
records. One location has enabled Bluetooth connectivity with patient devices such as
glucometers, blood pressure, and activity trackers such as a Fitbit, etc.
The majority of HIEs interviewed had no response about the frequency of use by
patients. However, one respondent found its indigent population prefers communication and
contact through the patient portal due to a lack of a permanent address. Patients can access
their portal at the local library. The majority of HIEs interviewed do not provide direct patient
education on portal use. Some provide educational materials to the providers as pass-through
materials.
Additional Information
In general, concerns about privacy and physician buy-in are potential barriers to patient
engagement. One interviewee suggests that the use of smart phone apps and allowing patient
customization of goals could be the key to engaging younger users. Another interviewee shared
that executing effective change management procedures prior to portal implementation has
been effective.
Conclusions and Recommendations
The HIMSS HIE inPractice Task Force found that most of the HIEs interviewed
encourage the healthcare provider’s organization to directly engage patients while the HIE plays
the supporting role. There is also a consensus that providing mobile or smart phone apps and
allowing patients to customize their patient portals will be a key strategy to increase patient
engagement in HIE. While the group’s sample of five HIEs is small, it is clear that all HIE service
offerings are not the same. The HIMSS Task Force recommends expanding the scope of inquiry
to learn what other strategies beyond the HIE are proving successful in engaging patients in
their healthcare. Key activities in understanding how to incentivize healthcare providers to lead
innovation in patient engagement include:
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•
Exploring what new technologies are on the horizon.
•
Reviewing the quality approaches contained in the Notice of Proposed Rule
Making (NPRM) of the Medicare Access and CHIP Reauthorization Act
(MACRA), including the Merit-Based Incentive Payment System (MIPS) and
Alternative Payment Models (APMs).
Acknowledgements
2015-2016 HIMSS HIE inPractice Task Force
This resource was developed by the following volunteers from the Healthcare Information and
Management Systems Society (HIMSS).
Task Force Chair
Anne Marie Robertson
Chair, HIMSS HIE inPractice Task Force
Coastal Connect HIE
Anne Marie Robertson
[email protected]
Authors
Mishka Glaser
Deloitte
[email protected]
Ellen Remily, BS
University of Washington Medicine
[email protected]
M’Lynda Owens, PhD, MS, RN-BC, CHDA,
CHTS-CP
Cognosante
[email protected]
Helen Figge, MBA, CPHIMS, FHIMSS
LumiraDx, USA, Inc
[email protected]
Leta Cross-Gray, MSN, RN-BC, CHTS-CP
Healthcare Access San Antonio
[email protected]
Heather Marney
Children’s Healthcare of Atlanta
[email protected]
HIMSS Staff
Jessica Hout
Senior Manager, Interoperability & Standards
[email protected]
Mari Greenberger, MPPA
Director, Informatics
[email protected]
Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS,
Audrey Garnatz, PhD
Coordinator, Informatics
[email protected]
FAAN
Vice President, Informatics
[email protected]
HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology
(IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology. The
inclusion of an organization name, product or service in this publication should not be construed as
a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name,
product or service to be construed as disapproval. The views expressed in this white paper are those of the authors
and do not necessarily reflect the views of HIMSS. www.himss.org
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