Health Information Exchange ++, for whole communities

Wikis > Health Information Exchange ++, for whole communities
  1. Learning Layer: Sofi and Genomics; System Dynamics Modeling; Community Organizaing;
  2. Coaching and Support Layer: Answers Media
  3. Coordination Layer: Congral’s “Coordinators”
  4. Analytic Layer: MS Amalga
  5. Data Repository Layer: MS Amalga
  6. Place of Employment / School Layer: Answers Media + Congral’s SCP
  7. Patient and Family Layer: Congral’s SCP and MS HealthVault; Genomics
  8. Community-wide (Health System) Patient Portal Layer: MS HealthVault, MS SharePoint and Amalga (Now an Amalga use case, previously HealtVault Community Connect)
  9. Community-wide Provider Portal Layer: Health Unity, MS SharePoint Site, Relay Health
  10. Clinical Data Exchange Layer: Health Unity
  11. EMR Transaction Layer: Certified EMRs

Things to think about when choosing which layers your community or organization should select:

  • Most organizations are only focused on layers 11 and 10.
  • Layers 11, 10, 5, and 4 are what is currently considered to be a full blown community HIE.
  • Managing a level 4 ACO requires layers 4 and 5.
  • To improve population outcomes requires care coordination and behavior change and for this one must add layers 8, 7, 6, 3, and 2.
  • Advancement of a community at the highest rate requires the tools in layer 1.

The holy grail under the new payment incentives will be behavior change at the population level. HIE investments that are driven solely by organizational efficiency and HITECH meaningful use dollars will fall short of business success. One must get to the very top of the “Human Stack” below to reap the benefits of your investments under triple aim incentives.

Sustained behavior change is the gaol of the new health care system and therefore the goal of clinical and social information technology investments.


There is a socio-technical Infrastructure needed for the  Triple Aim that goes far beyond the HIE required for incremental improvement in the current health care system.

Technical Infrastructure to support current illness-based, visit-based system (status quo).
  • Certified EMRs
  • Community connections between EMRs (HIE)
  • Organizational portals for providers and families

Socio-technical support for the new (near term future) Triple Aim based health care system

  • Begins in earnest ONLY when financial reimbursement aligned with the community members–Triple Aim
  • Data repository and analytics for early pattern detection of managing a network or system
  • Care coordination (case management and beyond) that engages the patients
  • Patient and family health engagement tools
  • Engagement of people at work and at school (health, flourishing, and illness prevention)
  • Broad based support whole community policy creation and action