Posted on: September 12, 2018

I didn’t know I had an allergy to hornet stings. Until Labor Day, when I went out to pick some berries in my garden and put my hand right into a nest.

I’ve had bee stings before, and I have other allergies, so I didn’t expect anything out of the ordinary. By chance, I’d just read a story from a concierge medicine participant in Hixny about a girl stung by a bee who used her EpiPen and Benadryl to stave off a reaction, so my wife and I headed to Target to pick up Benadryl as a precaution.

By the time my wife came out of the store, I could feel the reaction beginning. Just minutes later, I walked into the urgent care center in my neighborhood, which is associated with my primary care provider’s (PCP’s) practice. I could already feel my face, lips and the roof of my mouth swelling. The team rushed me in for treatment without stopping at registration.

Immediately, the nurses gave me three shots: epinephrine, Benadryl and solumedrol. They placed a tongue depressor in my throat to check my airway and called 911 to have paramedics transport me to the local emergency department (ED) for further care. I was already feeling better, at that point, but I still got to ride out on a gurney.

At the ED, nurses took over from the paramedics, again skipping the ambulatory registration and triage process. As one of them checked my condition, I was asked for a printed list of all of my allergies and medications. In return, I told her that all of that information was available through Hixny. While she’d heard of Hixny, though, she said that only doctors had access to it—which is something I’ve heard anecdotally from others who have visited area urgent care facilities and EDs. Once she was convinced that I was stable, she moved on to another task and the registration staff came back to have me fill out all of my paperwork, including a Hixny consent form.

Let’s cut to the chase. I’m fine. I also had the rare opportunity to see what healthcare—and interaction with Hixny—is like from the patient side. Thankfully, being a pretty healthy 50-year-old guy, I haven’t found myself on an ED bed since joining Hixny, so this experience raised two major questions for me.

First, what role does my doctor play in all of this?

From the urgent care staff, to the paramedics, to the emergency department team, the care I received was outstanding. At the same time, I now have a previously undiagnosed allergy that requires me to take specific steps if I have another standoff with a hornet. My primary care provider should know I was in the ED and help me navigate the necessary follow-up.

Hixny touts that PCPs who subscribe to our alerts find out when their patients are admitted to the ED, but my doctor doesn’t collect consent for Hixny. Does he know I was in the ED, or not? Does he know I was prescribed prednisone, Benadryl and a stomach-soothing medication to counteract side effects? Does he know I was prescribed an EpiPen to carry from now on?

Value-based care calls for PCPs to help prevent avoidable ED visits. I have the EpiPen and Benadryl, but I don’t know what to do next time I get stung. (Come to find out, I’ll have to use the EpiPen and Benadryl and go to the ED immediately for two to four hours of observation in case the reaction continues past the drugs’ active window.)

We need to close the loop to keep costs down in the future. Will the doctor call me? If he doesn’t collect Hixny consent, how will he know he should call me? Should I make an appointment with him? Because, honestly, if it’s left up to me as a typical guy, I probably won’t.

This is why Hixny consent needs to be collected everywhere health records may be needed and intervention may be appropriate. It’s why PCPs need to subscribe to and watch for alerts.

Second, why isn’t Hixny being used to its full potential in clinical workflows?

Being the curious person I am, I spent my time in urgent care and the ED—and spare moments since then—tracking the flow of information about me through Hixny For You, the portal that makes Hixny data available to patients. I took the opportunity to see what I could expect my doctors to know, what information seemed to flow through Hixny, what information is available to a patient (and when) and what information doesn’t appear.

What I found was that the urgent care information never appeared that day or through the writing of this post—and although I received an automated email from the facility’s patient portal within hours to tell me that my electronic health record had been updated.

I also found that the workflow in the ED didn’t take advantage of the valuable information that was available in Hixny. The nurse there didn’t have access to Hixny, if you recall. If I’d been unconscious, she had the right to “Break The Glass” and access my records through Hixny without my consent to provide more informed treatment—but she had neither the knowledge nor ability to do that. She was also forced to rely on me, anaphylactic reaction in progress and all, to give her a complete list of my allergies and medications.

As I followed along on Hixny For You, I could see that once the ED registration was complete and I’d signed the Hixny consent form, my updated height and weight did appear instantly, along with some additional data from that encounter. However, even several days later, Hixny For You still doesn’t show information from either the urgent care or the ED. And, most importantly, I’ve had no phone call from my PCP’s office to indicate that any of that information reached him, either.

The system works in real time if it’s used in real time, consistently, by every provider.

Ultimately, Hixny exists for the benefit of the patient—and I was able to see how it works or should work from this perspective. So we’re taking another look at what and how data flows to us from contributors, what we display to patients and providers, why and how. We’re also looking at the accuracy, volume and timeliness of data points being reported by our participants.

Because patients expect to see—and for their providers to see—complete data at all times. In real time.

Hixny will be performing extended maintenance beginning Thursday, December 31 through Friday, January 1. During this time, all services
will be impacted and unavailable—including access to the provider portal.