Chief Among Friends: A nurse’s perspective on HIEs and population health

In his podcast series titled ‘Chief Among Friends’, Orion Health Chief Medical Officer Dr Chris Hobson discusses topics ranging from technology priorities to new innovations in integrated and coordinated care to healthcare sustainability.

In the November 2020 episode of the Chief Among Friends podcast, Chris had a virtual chat with Alberta-based Registered Nurse, Karla Vermeer about the critical role of nurses in healthcare and their perspectives on the role of Health Information Exchanges (HIEs).

Chris and Karla discuss how HIEs have impacted the role of nurses, the patient experience, and the circle of care surrounding patients as a whole. The following is a summary of the full podcast, found here.

Streamlining work for nurses

“The health information exchange in my mind is purely a gift”, says Karla.

HIEs like Alberta’s Netcare, a province-wide Electronic Health Record, or HIE, have played a large role in streamlining the work that nurses like Karla do every day. Before introducing the HIE, nurses would have to sit down with each new patient and spend time discussing their entire medical history. This history would include specific details like their care teams, history of diagnosis and previous medications taken. These details can often be forgotten or misremembered by patients and therefore reported inaccurately.

With the introduction of Netcare in the province, the new patient onboarding process has been optimized to take less time and be easier for both patients and clinicians. Now, nurses can review a patient’s entire history of care across the entire province of Alberta through Netcare before their appointment. Karla says that she can “…learn so much before you’ve even sat down with the patient, with all this information already in front of you, which you can validate when the patient comes in.” 

Nurse’s ability to review a patient’s entire medical history also means that less testing is repeated. In the past, clinicians may need to re-order tests patients have previously had at another clinic as they didn’t have access to their test history.  

Providing care proactively

One of the most valuable features of an HIE like Netcare is its machine learning capabilities. Given a list of patients, clinical teams can use Netcare to auto-populate indicators that pertain to conditions like diabetes, and create dashboards that can be per patient, per physician, per clinic or even per region. Using these dashboards, clinicians can identify cohorts of patients at risk for diabetes and put together a care pathway to manage these cohorts. 

The HIE can also be leveraged to understand patients at a population level who might be due for routine screening tests, identifying those who might be of a certain age who require a mammogram, pap smear, lipid check, glucose checks, and also understanding who might not have had these tests in the recommended time frames. Karla describes, “because of leveraging databases, we could auto populate these lists and start navigating populations of health,” something which wasn’t available under previous systems.

HIEs give nurses access to a wealth of valuable information such as lab results, medications dispensed and ADT feeds. Having all of this data and information right there with them when they are with patients gives them the capability to have conversations with patients about their condition and quickly validate their information. 

Evolving in tandem with healthcare

As healthcare becomes more team-based for healthcare professionals with patients being seen across a number of settings from hospitals and speciality clinics to primary care, the role of HIEs becomes more important. In the past, different caregivers had different information and were using that to chart separately. With the HIE, everyone involved in a patient’s care across the region has access to the same information. 

“Now, it’s about the patient at the center, let’s look at the information that we need and let’s filter and look at what’s going to help us help the patient,” says Karla.

In the full podcast, Chris and Karla talk about these topics in detail plus discuss HIE security and privacy, coordinating care from hospitals to the community, clinician input when building an HIE, and more.