eRegister and Get Rid of the Clipboard

The Real Use Case for Personal Health Records (PHR)

I have been at this, HIE game, for a few years or so now. And when I go out and meet new people, I get the typical, "so, what do you do" question. Once I tell them and give a little explanation of what it means, about half of them have a follow-up question. There is only ever one follow-up question and it is always the same question "so, are you going to get rid of that clipboard of paperwork that I have to do over and over again every time I go to see a doctor".

The fact that I only get one question from general consumers and it is always the same question tells me one thing. This is what matters to them. This is how they see their information making it from them to their provider today. This is what they want to eliminate by using HIE or a PHR.

In essence, I see the HIE and PHR as one in the same. The HIE, in a fixed repository model, is a collection of "views" of the patient. We have a primary care view from one doctor. We have a couple specialist views from some other doctors. We have a couple hospitals views from some inpatient and emergency encounters. The PHR is either the same as the HIE consolidated view of these, or in an improved form, it is the consumers view of themselves as a patient. In essence, it is what the patient would put on the registration/intake forms when presented with them.

For a few years now, I have been putting forth what I call the eRegistration use case. eRegistration is the elimination of paperwork and pre-population of the providers system. It populates the Contact Information, Health History, Family History, Social History, Other Providers, Employment, Insurance, Payment, Disclosures, Consents and any other necessary information.

Main Case:

1. Patient Enters Provider’s Waiting Room
2. Patient uses smartphone to scan a barcode on the wall with the provider's Direct address
3. Smartphone collects any relevant data from the patient (who is the request for – if multiple PHRs are registered on the same device, why are you here today, what payment do you want to use – if multiple are recorded)
4. Smartphone sends request to PHR/HIE cloud to share data
5. PHR/HIE cloud sends standardized message with XML Registration package containing:
1. Patient Direct Address
2. Health, Social, and Family History
3. Care Team info (including Direct addresses) and desire to share visit information with care team.
4. Insurance Info
5. Payment Info
6. Legal disclosures and consents
6. Provider PMS/EHR prepopulates the PMS/EHR system with the data.
7. Patient is seen by provider without having to fill-out the clipboard full of documents
8. Patient is discharged without having to stop and do any paperwork
9. Patient receives discharge instructions back via their contact address (PHR or HIE portal account)
10. Patients care team receives appropriate encounter data

The main issue is that eRegistration cannot be achieved in vacuum by the HIE or PHR system vendor or RHIO. We need to make a few, not many, decisions on what XML documents to put into the registration package. Every provider and their system vendors needs to work together to implement such a change. That said, my real use case contains some alternate paths so that providers can all participate regardless of their technical limitations. This is done by having the HIE fill in for the EHR where the provider may not have an EHR or the EHR may not support this use case yet. This way, we continue to not let the perfect get in the way of the good and adoption of new technology move faster.

The ability to scan a barcode on the wall of my provider's office and my paperwork is done is tangible to patients. It is self-enabling. The physical action delivers feelings of trust and ownership in the act of sharing private information. Since the data is in the HIE cloud and not on the smartphone the information is safe. I believe this to be an enabler of HIE that empowers and binds the consumer to the cost and sustainability of HIE. The consumer will now feel their self-interest in HIE in a tangible way if we create this system of empowerment.