After several years working to ensure the data flowing through Hixny is the highest quality available, we’ve made solutions available to ensure that access to that information is integrated into a variety of workflows for a host of users.
Hixny is differentiated from most health information networks (HIN) in the state and the country by our dual focus on integrating our tools into clinical and payer workflows, and integrating high-quality information into an easy-to-understand snapshot view across platforms, using future-focused technology. Here are just a few of the advancements we’ve made this year.
Consent by Text or Email
In accordance with New York’s opt-in consent process, providers have had only two ways to gain and record patient consent to access their records using Hixny: paper forms or an electronic signature pad. Both of those relied on the patient physically being in the office to give consent— or required practices to send forms to new patients by mail, a costly and time-consuming process. As a result, at the critical first visit, nearly all providers had no chance to pre-review the patient’s records and familiarize themselves with any conditions or concerns. We understood that this was a barrier to using Hixny, especially in facilities where pre-visit planning and records review are necessary to provide the highest quality care.
To ensure that Hixny data could be fully integrated at the right points in the care continuum, we developed a secure method of gaining consent remotely using text or email. When a patient schedules a provider visit, the provider can verify their identity and immediately send them a unique link by email or text to gain their consent to use Hixny. That’s a rare benefit. So is each patient’s ability to download the completed form for their records, which is not an option in person—and about 25 percent take advantage of this option.
The system takes advantage of a highly secure method of gaining consent that relies on social engineering—that is, details that only the patient would know—to keep health information in the right hands. If there’s a mismatch in information, our support team is set up to help the patient determine how best to fill out the online form.
While New York approved the acceptance of verbal consent during the COVID-19 pandemic, and Hixny will offer that option as long as the state allows it, we believe this new consent option will continue to provide a valuable option for care managers, telehealth providers and any other providers who choose to use it, even after the verbal consent public health order may expire.
While post-adjudicated claims are often made available through Hixny by payers, the delay between the patient’s appointment and the processing of the claim can render the data outdated for providers who may interact with the patient in the interim or for quality reporting purposes. In comparison, pre-adjudicated (837) claims are usually of similar quality to clinical data and more timely than post-adjudicated claims. The only information that may be missing is how much the payer paid the provider, the amount of the patient’s copay and the acceptance or rejection status.
This year, we’ve been able to gain access to the pre-adjudicated claims from several large hospital systems. These claims have given us the ability to fill holes in clinical data and timing— and to reflect information from the increasingly small percentage of providers who are not connected to Hixny.
The Patient Record Snapshot
In a significant step beyond the single sign-on process, the team that took part in our hackathon (see page 6) found a way to enhance not only the visibility of clinical reports and gaps in standards of care related to quality reporting, but the most commonly needed information in each patient record. From a user interface (UI) perspective, the goal was to deliver the information in a way that users familiar with consumer apps could understand quickly.
For the first time, we could use the data we receive to make changes for providers by identifying that an individual patient needs to come in because, for example, they have a high A1C and have not been diagnosed with diabetes—which indicates a gap in care. And we could make the patient’s most recent labs and encounter notes available alongside that information. To achieve that, Hixny staff worked with several hospitals and larger provider practices to be sure we interpreted their data correctly. We expect that the patient record snapshot and integrated gaps list will be particularly useful in care management, call preparation and relationship building between providers and patients.
From a technical perspective, the snapshot and the integration of the gaps list began with the creation of condition registries and alerts several years ago. Developers reverse-engineered the registry lists to show gaps in standards of care for individual patients in the snapshot. In the process, they took the opportunity to develop the whole technology stack needed to accomplish the goal—a first for Hixny, which has largely built on top of its existing technology platform, with all of the opportunities and limitations that presents.
Ultimately, the snapshot currently ensures that clinicians can gain all the most urgent information about their patient in the first 15 to 20 seconds of viewing. Making use of FHIR and SMART workflows puts patient and user context into the same user experience (UX) for the first time.
It also opens the door for more front-end development and enhancements to Hixny services in the future. The team is working toward a patient-specific dashboard of essential information drawn from multiple sources—including claims and clinical data, the Department of Health, patient-contributed information and more—that will give providers an at-a-glance view of information they need to know, but don’t know, and may not realize they need to know until they see it.
CURES Act Compliance
The federal 21st Century CURES Act is intended to standardize and modernize information sharing across the healthcare industry. Although we’re still determining exactly how Hixny can support organizations bringing themselves into compliance with these regulations, we know that one of the primary areas in which we’ll play a part is the elimination of info-blocking.
Specifically, the Centers for Medicare and Medicaid Services (CMS) is requiring payers to provide greater clinical and claims transparency to patients and to other health plans and organizations at patient request. In addition, CMS is requiring hospitals to send notifications to other providers on patient admission, discharge and transfer—as well as whether someone is an inpatient, emergency admission or meets other criteria. And, perhaps most importantly, CMS is calling for overall greater transparency to patients about what is in their health records, including provider notes.
We’ve begun working to ensure that everyone involved in patient care and using Hixny is aware of the way their interaction with the health information network (HIN) may define the way information is shared with others, including both clinicians and patients.
Single Sign-On for Simplicity
Until recently, users at several major medical systems connected to Hixny faced a significant barrier to using the HIN. Although two-factor authentication is the standard for security, it doesn’t sync well with hospital information technology systems that require unique sign-ins to each device a clinician may use.
To overcome the challenge, Hixny worked with these medical systems to allow users to log into their electronic health records (EHR) system as usual and, when clicking the Hixny button, to be presented with the information for the patient whose record they were viewing at the time of the click. This removes two barriers— the separate login to Hixny and the need to conduct a separate patient search after accessing Hixny.
Within just one of these medical systems, some 400 users now have single sign-on (SSO) access to their patients’ data through Hixny, streamlining the time and effort required to integrate that data into their decision making.
The Cerner Snapshot
One of the most important aspects of the patient record snapshot is that SMART on FHIR technology allows the information to appear to both online provider portal users and EHR users in the same format. We worked closely with Cerner, a leading EHR vendor, to test and launch this capability, with others rapidly following.
Our collaborators at Cerner have developed a great deal of structure around apps to make information access more efficient for their users. As a result, they were greatly in favor of offering visibility into this project, which ensures that a click of the Hixny button within Cerner brings up the Hixny patient record snapshot within the EHR. Clicking the information in the snapshot drives directly to Hixny for details.
The greatest efficiency we expect to see users realize for this capability is a significant decrease in duplicate testing, because they can identify results faster—for COVID tests, chronic condition monitoring and more. Our ideal vision is that providers will collaborate more based on the data now easily available to them—so, for example, an inpatient provider could close gaps in standards of care (such as colon cancer or breast cancer screenings) while they have the patient, increasing compliance and decreasing patient inconvenience.