The PCDH project is a straightforward interoperability project that connects multiple disparate HIE’s together in order to allow for the aggregation of data from any participating HIE into the HIE provider community providing care – whether at a “home HIE” or an “away HIE.”
At a high level, PCDH is a monitoring system based upon industry standards and practices that leverages the ability of HIEs to:
- Gather data from multiple disparate sources in real time
- Identify the individual the data is about
- Identify the provider serving the individual or patient
- Identify where the event occurred
- Distribute that data in real time to those who need to know (e.g. the patient’s care team).
The PCDH architecture leverages the identity management and patient consent systems unique to each participating HIE while allowing for the rationalization of patient identities shared among the HIEs - without having a single “universal” identifier. PCDH uses industry standard push and pull (query) methods for data distribution and aggregations.
Many SHIEC HIEs have been successful in the real time collection and distribution of data from clinical events that occur from outpatient and/or inpatient facilities such as hospital admissions, discharges or transfers (ADTs). This means that when a patient presents for treatment, the healthcare provider system generates an ADT that can be used to automatically trigger alerts and Continuity of Care Document (CCD) data exchanges between care providers, even if the providers do not participate in the same HIE.
Our members wanted to implement a simple-yet-elegant approach for exchanging patient information across different HIEs and service areas. A participating HIE defines a “data home” for patients in their geographic area using the patient’s home ZIP code. Using triggering episode alerts (ADTs), providers are notified of patient care events which may occur outside of the patient’s “data home” and confirm the availability and specific location of the clinical data for both “home” and “away” HIEs. This enables either automated or manual query to access information – in real time – across state and regional lines as well as across providers within the care continuum.
In the pilot program, the original participating HIEs served as nodes for sending and receiving patient information. As other HIEs were added, they were connected to one of the nodes, creating a mini hub. The national expansion creates a national network with data flowing through these hubs, similar to how banking systems route transactions. The result will mean that a patient from Baltimore could be treated in a hospital in San Diego that could exchange patient information with the patient’s home HIE, but the data may pass through one or more HIE hubs along the way.
In 2016, PCDH pilots were launched among 15 HIEs in three disparate regions – a Western Region (Utah, Arizona, western Colorado), Central Region (Oklahoma and Arkansas), and Heartland Region (Michigan, Indiana, Ohio, Kentucky, Tennessee). The initial PCDH pilots supported a total population of about 34 million, and since the PCDH initiative began, over 1.5 million alerts have been exchanged. Since the initial launch, an additional five (5) HIEs are now “live” and 11 more have pledged to join implementation efforts soon.
The pilot programs demonstrated that this system of exchanging information allows patients’ information to wrap around them – whether their travel be for traditional tourism purposes or for “medical tourism” purposes. PCDH can successfully provide real-time information and meet all state laws and local requirements.
We have chosen to make the PCDH initiative a priority because nationally we have a very mobile population; we believe that a patient’s health information should follow the patient wherever the patient receives care. In addition, this innovation does not require new technology or organization.