Children’s Hospital Links Affilates into Indivo PHP

by | Sep 25, 2009

Nurse & Baby Boy008_WebsiteOn September 14th, Children’s Hospital of Boston made a joint announcement with eClinicalWorks (eCW) whereby ambulatory practices affiliated with Children’s using eCW will be able to export patient data into “MyChildren’s.” MyChildren’s is the personal health platform (PHP) that Children’s Hospital provides for its customers and is based on Indivo, the open source PHP that was developed at Children’s and is the foundation for Dossia.  On Friday, Sept 18th, Chilmark Research had the opportunity to speak with the key people at Children’s who are behind this initiative (Dan Nigrin, CIO, Greg Young, heads up PPOC (affiliated practices) and Ken Mandl, Harvard Prof and key person behind Indivo) to gain a better understanding of what they are doing and its significance. Here’s what we learned.

Some background:

Children’s Hospital, which is affiliated with Harvard has the Children’s Hospital Informatics Program (CHIP) which developed the Indivo platform and has always been a very strong advocate of the concept of the “patient-controlled medical record.”  Their initial work, both technology and policy, led to Microsoft’s HealthVault, Google Health and Dossia, all of whom have adopted similar platform models and policies regarding consumer access and control of their personal health information (PHI).

About 3 years ago, Children’s group of affiliated ambulatory practices, PPOC, (about 75 in all) made the joint decision to go digital and adopt an EMR solution, in this case eCW in a hosted delivery model (ASP).  Today, the majority are now live with eCW and the balance, with exception of ~5 practices who have chosen not to adopt, will be live by Sept 2010.  Children’s Hospital uses Cerner as its EMR.

Children’s did a “soft” release of MyChildren’s in mid-April’09.  Little promotion to date and currently about 1200 users.  Soft launch was intentional to understand user needs and desires as well as await a larger, more aggressive launch in late 2009.  In early 2010, MyChildren’s will transition to the latest Indivo release, IndivoX.  It is also in early 2010, that data will begin flowing from eCW EMRs in affiliated practices into a patient’s MyChildren’s account.

The Offering: eCW, Cerner and MyChildren’s:

By connecting the affiliate practice EMRs to MyChildren’s a parent will be able have a more complete longitudinal record of their child.  The data elements that will flow into a MyChildre’sn record include immunization records, allergies, ambulatory lab data, meds, basic physical measurements (height, weight, BP, etc.) and problem lists. An interesting tidbit we learned during the call is that growth data is absolutely critical in evaluating the health of a child.  Thus, getting this data from the ambulatory setting is an important objective for Children’s in monitoring the long-term health of its patients.

MyChildren’s will support the creation of specific care plans based on specific diseases/conditions, e.g. asthma, that are a combination of template and physician input drawing data from the MyChildren’s platform that is specific to the patient/child.  MyChildren’s will also enable a parent to automatically create school and camp health forms.  Like the care plans, the school/camp forms will draw upon the data MyChildren’s collects from both ambulatory (eCW) and inpatient (Cerner) encounters to populate the forms which can then be printed and submitted to the requesting body.

Inpatient lab data will not be imported into MyChildren’s, which we found odd.  Children’s explained that in the inpatient setting a significant amount of lab data is generated and they did not want to overload a given patient’s account.  This may indeed be true, but can they not at least provide a subset of that data, that which is most critical to both a parent and possibly an affiliated practice?  This has come up in internal discussions and is being evaluated.

In the future, they will also be importing pathology results, images and clinical notes into a MyChildren’s account.  When asked about after visit summaries (AVSs), Children’s stated that this is another element they are considering but do not have specific plans today. They have purposely decided not to import genetic data into MyChildren’s.

One of the more interesting aspects of this announcement is their intention to use Indivo (MyChildren’s) in an HIE capacity.  Specifically, inpatient Cerner data will pass through Indivo and on out to affiliated practices and vice versa.  EMR users in either setting, inpatient or outpatient will be able to readily pull-up data within their native EMR (that is parsed through MyChildren’S) thereby minimizing disruption to existing work-flow practices.   Granted, this is not as high-powered as say a native HIE solution from someone like Axolotl or Medicity, but it does solve the immediate needs of Children’s for a very nominal cost.

The Wrap:

Besides walking the talk by supporting consumer access to and control of their PHI, Children’s Hospital is putting these processes and practices in place via MyChildren’s to support the patient-centric medical home concept which they believe will continue to gain acceptance and support among policy makers. Here in Massachusetts where healthcare costs have continued to escalate at an alarming rate, payment reform is now a top discussion topic with the medical home concept receiving significant consideration.  Children’s sees the writing on the wall and is taking a proactive approach.  Hat’s off to them.

It is also good to see how a PHP (MyChildren’ in this case) can become the nexus for care, a nexus where the patient is truly at the center, where they are in control of their PHI.  Supporting this patient-centric care model is rare.  Sure, many healthcare providers will state that they support the concept, but it is hard to find many that actually put it into practice.  Children’s Hospital of Boston, along with others such as Kaiser-Permanente, Beth Israel, Cleveland Clinic, Mayo, and even more recently New York Presbyterian are leading the way.  Question now is: How far back are the followers and how quickly will they come and join this growing and inevitable trend with more than words, but actions?


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