Flow health: patient-centered health information exchange

David Harlow david@harlowgroup.net
Robert Rowley robert@flowhealth.com


ONC has announced a 10-year roadmap for electronic health record interoperability.

Why wait?

Tools exist today that solve for interoperability and are capable of rolling out a patient-centered health information exchange layer that connects diverse EHRs to create a patient-controlled longitudinal health record. Flow Health’s core offering and related applications are provided free of charge to patients and their caregivers, health care providers and payors. Existing data standards are leveraged in order to enable the free flow of information, to enable clinical insights and better care management.

Flow Health enables patient-centered collaboration by solving several intransigent problems:

(1)   Ensuring patient identity matching across providers

(2)   Creating a universal clinical data architecture that accommodates data from multiple sources, and tracking provenance of each data element

(3)   Managing patient-centered consent so that the patient controls who sees what

Flow Health has an installed user base of 9000 physicians, and deals are in place that will double that number in the near term. Flow Health is reaching PCPs through payors, ACOs, group practices, EHR vendors and other channels. Patients will be enrolled through PCPs, payors, or other channels.

While other communication software is on the market already – services that gather records from multiple providers, or that in some cases enable communications within or even across institutions – Flow Health is different because it is a platform for collaboration: a discharge notification, or a lab test result, is pushed to the patient feed for all clinicians, caregivers and the patient herself. Significantly, the note can be pushed regardless of whether clinicians are in the same provider organization. That post is an integral part of a longitudinal, institution-agnostic, patient data layer, which is the foundation upon which additional forms of collaborative care may be built.

The first of these is Flow Health’s outsourced Chronic Care Management service, providing 24/7 access to nurse case managers and care coordinators. The CCM service accommodates Medicare beneficiaries with multiple chronic conditions, but is flexible enough to help manage the care of other populations. Primary care physicians are able to outsource their care coordination needs without increasing their staff head count, pay for the service through the Medicare reimbursement for CCM (new in 2015), and retain approximately 25% of the reimbursement. The CCM call center professionals have access to patient health data from the patient-centered HIE, and are trained to facilitate referrals and the communications surrounding them, as well as medication management and broader care management issues.

The system benefits by an increase in efficiency -- health data gets to the right place at the right time, improving quality and cost-effectiveness of care; better transitions of care, better care coordination, especially for the highest-acuity, highest-cost patients, benefit health care payors and providers as our system transitions away from fee-for-service to a value-based payment system of care.

The end result for the patient is the other side of the coin: transparency of information and communication, better-supported care transitions and, ultimately, better quality and more cost-effective care.

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