Quality Patient Healthcare

Three Rivers Healthcare is a system with a medium-sized (350 beds) regional hospital that serves inpatients and outpatients. The system expanded in 2014 to include a rehab facility, an outpatient surgery center, and a multidisciplinary physician practice. Three Rivers uses an electronic health system that stores all the patient data for all facilities. Physicians can access patients’ health information from anywhere in the network, which connects all the facilities. When patients ask for copies of their records, there is a time-consuming and complicated procedure that results in paper records being mailed to the patient’s home, usually in four to six weeks. If there is an emergency need to access the records from an outside hospital, the records are faxed. Three Rivers has a central scheduling department, and when patients needs to schedule an appointment, they work through scheduling to find an opening that fits with their schedule. If they have a question for a physician, they call the office and receive a call back, usually in 24 to 48 hours.

Three Rivers Healthcare is moving forward with creating a patient portal to meet the requirements of meaningful use. Their intention to meet the requirements is aligned with their strategic plan for patient quality and outcomes. Management believes the portal will achieve more efficient and satisfying patient-provider interactions through asynchronous communication, health education opportunities, and patient access to records and appointments.

Three Rivers Healthcare has decided to join the Regional Health Information Organization (RHIO) that allows health provider entities in Ohio to participate in the health information exchange (HIE). After they join the RHIO, Three Rivers’ patient data will be available to all other health provider entities that have jointed the RHIO, as long as the patients give their consent to share their data. In return, if another health provider in the RHIO has seen the patient, that patient’s records will be available at Three Rivers. The ability to include health records from other entities in the RHIO network is a benefit for patients and healthcare providers. The HIE uses Clinical Document Architecture (CDA) for purposes of exchange. The CDA documents use HL7 Version 3 data types. The CDA is based on a flexible XML-based document architecture. It also supports Continuity of Care Document (CCD) exchange.

The Regional Health Information Organization (RHIO) offers a platform already set up for healthcare entities in the state to utilize in building their own patient portal. This platform allows organizations to design the look and select the data they would like to show on the patient portal. The patient portal platform is already securely connected to outside links that allow patients to better understand their disease processes and healthy options. The RHIO patient portal is an option that Three Rivers Healthcare is considering to build its patient portal. Another option is to build their own for the company that provides their EHR. The patient portal team needs to review each option and recommend the best one to use, with clear justification. If they select the RHIO portal option, the project will cost less and be easier to implement, but Three Rivers may not be able to customize the portal to meet all their requirements. If they decide to design and implement a custom portal, all their requirements can be met, but the cost will be greater and they may have to work in a longer timeline for completion of the project.

Three Rivers Healthcare plans to begin development of the patient portal by July, and to begin the certification process by November 1. To be able to do this, all the preparation work needs to be completed by July, and the actual building of the portal and marketing materials must begin in July. The testing of patient portal for logging in, viewing, and use is expected to occur by August 15. The pilot of

the fully functioning patient portal is expected to be live at the same time as the certification process, which must begin by November 1. The project will need to have the key tasks, milestones, deliverables, assumptions, and risks completely outlined.

Three Rivers administrators are concerned about the speed of access to the patient portal, which will be a typical tier three internet connection from the portal to the patient’s computer or mobile device. If the portal is attached to the RHIO, will the patients see the same speeds, or will data transfer be delayed as it is transferred to the RHIO?

The patient portal team will need to develop a statement of work with a timeline for the expected project. The statement of work should include recommendations for portal data and display requirements, including the data that will be included for viewing by the patient, and how that data will be displayed to optimize understanding. Three Rivers administrators have indicated that they wish to incorporate developing artificial intelligence technology and tools, and they need a recommendation for how these things can be integrated into the portal. One of the responsibilities of the patient portal team is to recommend policy and procedure changes that will be needed to facilitate the development and use of the portal and to encourage patient engagement.