Marcia Frellick

February 22, 2017

ORLANDO — Patients in Kansas can view all their health data in one certified record because the Kansas Health Information Network — a state health-information exchange — is linked to a statewide patient portal.

"We felt strongly that patients needed to have one place they could go to receive all of their health information, rather than having multiple patient portals in the primary care office, the hospital, and specialty care," said Laura McCrary, EdD, executive director of the network.

"I believe we're the only exchange in the nation trying this," she told Medscape Medical News here at the Healthcare Information and Management Systems Society 2017 Conference.

It has been years in the making. In 2010, a contract was signed with NoMore Clipboard, a portal company; in 2016, the third phase of the project was launched.

"Patients are going to need to take a more active role in managing their own healthcare," Dr McCrary explained. "This is one of the ways we can help them do that."

 
I believe we're the only exchange in the nation trying this.
 

The system will help the transition to value-based care and alternative payment models. It also meets new quality-reporting requirements, and physicians using the system will earn points under the new Merit-Based Incentive Payment System (MIPS).

"If you're using an enhanced patient portal and you're doing secure clinical messaging with the patients, you're providing patient education and you're providing View, Download and Transmit (VDT) — those are all things that are going to earn doctors extra points on the advancing-care-information component, as well as the improvement activities," she pointed out.

The network is also linked to the state immunization registry, so people with a patient portal who are immunized in Kansas can retrieve printable certified copies of their immunization history for themselves and their children.

School nurses are especially excited about this feature. They can now point parents to the portal to retrieve immunization records, which prevents delays in school enrolment, Dr McCrary said.

Physicians and hospitals also benefit, because they don't have to buy a personal health record addition to their electronic health record system, and a hospital system can run nearly $500,000, she reported. The statewide portal is part of their KHIN membership.

She acknowledged that there is a considerable amount of work for physicians associated with the project, but the tradeoff is an affordable option.

Currently, 59 organizations use the statewide personal health record as their only personal health record, she noted.

Problems With Patient Authentication

One of the primary obstacles encountered when the system was being set up was the authentication of patients who wanted to use the system only online, and didn't want to meet with a provider in person.

The idea of using vendors to do credit checks was considered, but some patients were too young to have credit histories and some elderly patients with diminished memories could not provide essential details.

Developers finally settled on the use of information from the exchange. Patients who call are asked to provide information such as a doctor's name or the last time they accessed the health system.

Olson works with a nonprofit health alliance of 26 hospitals in Kansas and Nebraska, 25 of which are critical-access hospitals with 25 or fewer beds.

The critical-access hospitals have been using the portal since 2010, she reported.

Another problem encountered was that an email address is required to enter the portal and to meet meaningful use requirements. The system assigns an address for people who do not have one, but if they decline to enter it on subsequent visits, access is denied, which can be an issue for people who are not regular computer users.

"There will continue to be problems to solve because no one else out there is trying to solve this," said Dr McCrary. But the effort continues to pay off.

Funding the Project

Setting up the statewide portal cost an estimated $750,000 over the past 5 years. Initial funds came from grants from the Office of the National Coordinator; when the grant money ended in 2014, funding came from subscriptions from providers, hospitals, and other organizations.

"I'm happy to say that this year we finally broke even," Dr McCrary said.

Because payers have access to the health information of their members, they also pay to support it, she added.

"In Kansas, Blue Cross Blue Shield provides a 6% incentive payment to any doctor or hospital on any claim they make if they are contributing data to the health-information exchange," she explained.

Funding sources for the nationwide expansion of exchanges have dried up, so there is interest in the Kansas system, said Mary Anne Leach, director of the Office of eHealth Innovation in Colorado.

Colorado has two health-information exchanges, "but we don't have payers paying," she told Medscape Medical News. "That's brilliant. We might have to think about that."

"We're also looking at how we add value to health-information exchanges, so we're looking at integrating social determinants of health data," such as housing, nutrition, and transportation, Leach explained. "We know that all contributes to health."

Dr McCrary and Ms Leach have disclosed no relevant financial relationships.

Healthcare Information and Management Systems Society (HIMSS) 2017 Conference: Session 15. Presented February 20, 2017.

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