HIE Case Study: Patient and Caregiver Engagement Strategies - Lewis and Clark Information Exchange

Lewis And Clark Information Exchange (LACIE) is a nonprofit 501(c)(3) organization. It is governed by a collaborative of board of directors that consists of hospitals, providers, large employers, consumer advocates, and Federally Qualified Health Centers (FQHC). LACIE participants are from both Kansas and Missouri and range from small physician practices to large hospital systems. LACIE was formed in 2009 and has been exchanging data since 2010. LACIE is a regional health information exchange (HIE) committed to enhancing patient safety by eliminating obsolete paper-based medical records and combining patient data into a single, widely available digital record.

LACIE’s mission is to improve the overall health and economic status of the region through the facilitation of data sharing across the community. LACIE delivers a set of common capabilities that citizens, providers, and institutes are able to use.

For this case study, Mike Dittemore, Executive Director of LACIE, was interviewed about their patient and provider engagement efforts.

LACIE has mostly focused on engaging caregivers with the strategy of using a designated clinical champion who promotes the value of HIE and advocates for its adoption within his or her own organization. All participant organizations involved in LACIE determine an internal physician champion from each organization and utilize this individual to head the adoption campaign. The designated champion helps with training and education of other caregivers in the organization. Most champions are part of the client’s senior leadership team and represent their organizations as LACIE board members. LACIE does not focus on engaging the patient or consumers of HIE directly. Instead, they allow participating organizations to drive their own consumer engagement initiatives.

Turnover among leadership and project management resources has been a barrier to caregiver engagement. Replacements for such resources are hard to find in the industry and new hires can face a steep learning curve once recruited. Industry-wide, the resources with the expertise to understand HIEs is limited; thus losing qualified talent is a barrier to service and ultimately impacts adoption.

It has been challenging to engage third party electronic medical record (EMR) resources and the high interface costs to connect to them has also been a barrier. Additionally, access to data has also been a challenge. For example, one EHR only allows patient data to be queried for 90 days after an event occurs. However, long-term access to data is essential for many applications of HIE, as specialist follow-up appointments, such as dermatology consultations, can take place 5-6 months after an initial diagnosis.

Another challenge has been scalability. For instance, connecting with other regional or national HIEs is both resource and time intensive; the costs quoted by at least one HIE for LACIE to connect were untenable.

Caregivers using LACIE have been able to realize many different uses for the HIE. In an emergency, a patient may not be responsive. The HIE allows the caregiver to query a patient’s information in order to provide the right care in these situations. Care managers also use the HIE for information to tend to patients in specialty acute care settings.

Unfortunately, not all patients are good historians of their own medical information or may have erroneous information, having access to past patient historical records from primary care providers is often beneficial. The HIE can also help identify the risk of a patient for fall and injuries.

The Kansas City Missouri Head Start program uses LACIE to collect patient health histories on children who are participating in their program. These data are used to provide the required information to the Office of Head Start, an Office of the Administration for Children and Families Early Childhood Learning and Knowledge Center (ECLKC), a component of the U.S. Department of Health and Human Services. If the government determines that effectiveness of treatment was lower than it should have been due to lack of education of the parent or guardian, follow-ups with health coaches are advised.

LACIE took a collaborative approach to implementing HIE and was thus able to avoid some of the pain points other HIEs faced at their inception. The LACIE Board of Directors includes representations from major EHRs such as Cerner, EPIC and Meditech as well as business leaders and clinicians. LACIE took advantage of their access to sound learning models and best practices when setting up their systems. LACIE learned from the industry’s successful HIE entities and used their networks to share ideas and gain feedback. However, some lessons were still learned by trial and error. LACIE took bold approaches and was not afraid to experiment and continuously improve processes. LACIE has a sustainable business model and is flexible enough to accommodate organizations such as hospitals, physician clinics, state immunization registries, prescription monitoring program (PMP) data banks and Long Term Post-Acute Care facilities. ;

One of the elements that has played an important role in LACIE’s success has been an excellent partnership with service providers and area care providers. This collaboration has helped LACIE quickly connect many provider organizations. Several clinicians on LACIE’s Board of Directors have been instrumental in guiding the HIE to serve the region to achieve better clinical care.

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.


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