California Health eQuality Project Summary
Health Information Home
January 2014
PROBLEM
At the onset of being diagnosed with a high impact condition (i.e. cancer), patients are often
examined by a multitude of physicians, specialists, and other health care providers.
It is
commonplace for these providers to recommend treatment and care coordination without access to
the patient’s most recent and health data with a bearing on the condition. Similarly, patients rely on
their doctors’ knowledge to help shed light on their situation without knowing what personal health
information is available or if the care team has consulted amongst themselves. In order to provide
the most effective, efficient and high quality treatment for a patient diagnosed with a high impact
condition, it is imperative for the caregivers to have an in depth view of the patient’s health records
pertaining to the diagnosis for continuity of care.
Many of these high-impact conditions are of interest to public health and the subject of public health
disease registries (i.e. the California Cancer Registry). Unfortunately, public health disease registries
suffer from poor reporting; much information is never reported, and what is usually not in a timely
manner. This is perhaps due in part to the fact that providers see little benefit from public health
reporting, as the information submitted by others is not available to them for patient care.
SOLUTION
A technology infrastructure comprising a central document repository system with a set of nationallyidentified technical standards content and interface standards, and secured exchange and patient
matching technologies was designed and implemented to support the coordinated care delivery with
technologies to help manage high impact/ condition-specified data services. The solution helps
clinicians, patients, and researchers share high impact condition-specific health information within
the community and across the community.
The solution also supports the cancer registry reporting to the public health agency by provisioning
an intelligent routing service that can take submissions to the Health Information Home and route
them to the public health registry. By existing outside of public health, the Health Information Home
provides a repository for information of interest to public health while maintaining provider access
for treatment purposes.
California Health eQuality Project Summary
Health Information Home
January 2014
RATIONALE FOR SOLUTION
The purpose of the Health Information Home is to increase the care coordination among participants
when treating a high-impact condition by creating a technical framework that organizes and
exchanges health information associated with high impact conditions to support healthcare. By being
coupled to registries and other public health systems, it also provides a means to support public
health objectives through more complete and more timely submissions.
It is envisioned that the Health Information Home will go far beyond a repository for data
traditionally associated with a disease registry, but will also include treatment plans and outcome
results that are more useful to supporting care coordination.
OUTCOME AND NEXT STEPS
A clinical document repository was built by utilizing open source technologies that conform to
recognized national standards required to meet Meaningful Use objectives and promoted for interHIO exchange in California. A pilot of the breast cancer use case was conducted and demonstrated
submitting, querying and viewing structured clinical data. In addition, a demonstration of cancer
reporting that conforms to the MU requirement was performed. The next step is to leverage the
knowledge and expertise gained during the pilot for enhancing the technical infrastructure of HIH
and to incorporate the security, privacy and policy framework that includes information exchanges of
unaffiliated entities.
Moving forward, there are plans to explore the use of the Health Information Home for other use
cases beyond cancer and breast cancer:
1. The capabilities identified for cancer can be extended to other high-impact conditions, such
as congestive heart failure, diabetes, asthma, stroke, autism, etc.
2. The secure document repository and patient matching capabilities can be used to implement
an electronic registry for Physicians Orders for Life Sustaining Treatment (POLST) forms. This
use extends beyond the high-impact conditions, to specialty data maintained for the public
good.
California Health eQuality Project Summary
Health Information Home
January 2014
3. The repository can also be expanded to support a longitudinal health record for specialty
populations such as foster children, where the state may have benefit to better health
information beyond the traditional services provided by community or enterprise HIE.
Further, the capabilities of the Health Information Home to support better consumer access, especially
of highly engaged patients surviving high-impact conditions, and its ability to support clinical and
academic research efforts should be explored.
BENEFIT
The Health Information Home aligns with the patient centered medical home model, placing patients
at the center of care and communication with their providers, caregivers, payers, and other members
of their care team. As a result, patients will become educated and empowered about their highimpact status; in near real-time, providers will have access to patient records specific to their patients’
high impact condition and/or population. Public Health departments and disease registries will
receive electronic submission of data. Overall, it enhances care coordination through transitions of
care.