July 30, 2012

Partnership Aims to Boost Community Health
By Greg Goth
For The Record
Vol. 24 No. 14 P. 6

While the lion’s share of attention to the panoply of EHRs and PHRs is focused on traditional clinical providers and health information exchanges, a new paradigm, one meant to engage patients with community organizations and public health officials, is emerging.

One pioneering example of the new community-based health information infrastructure is a joint pilot project sponsored by the New York City Department of Health and Mental Hygiene, PHR platform Dossia, application vendor NexJ, and five churches that are taking an active interest in congregants’ health through health ministries. The project’s backers hope the payoff will be data on the usability of various PHR platforms, growth potential for application vendors, and a technology-assisted sense of community among consumers and those in a position to counsel and coach them toward healthier lives.

“One of the potential growth areas for Dossia is to work with people who are providing screening and immunization services outside of traditional clinical settings,” says Michael Critelli, the company’s CEO. While the creation of a PHR is an obvious benefit of such an effort, Critelli says the more profound shift is the concurrent creation of a direct communication channel.

“Our goal is to get people to have a reason to visit that portal regularly,” he says. “If you’re doing news feeds and education and providing nutrition advice and recipes and so on, then you start to develop a relationship between the public health authority and the members of the public.”

Foremost among the goals of developing that relationship is the building of trust between the individuals who will be putting their data into the platform, the lay health workers charged with interpreting that data, and the health department. To that end, the health department is not going to view any clinical data. Thomas Cannell, director of community engagement for the health department’s Primary Care Information Project, says the department will see only the raw utilization data of the PHR platform. The church health ministries’ lay workers will be able to see both personal and aggregate health data, but Cannell says the department’s goal is much more abstract.

“We are most interested in overall utilization, how many health records are created,” he says, “and if it were zero or close to zero or it declines over time in a way that didn’t make sense, then it would be a very concrete way to draw conclusions about the usability of the tool.”

The second goal of the pilot, funded under a small part of a larger New York State health department grant that Cannell expects to last through 2013, is to offer the lay workers access to their participating congregants’ longitudinal blood pressure readings. Cannell hopes such access will instill a culture of regular readings instead of a “one-and-done” capture.

“That was the main problem the churches are trying to solve by partnering with us,” Cannell says. “They want their lay workers to have the information they need to encourage routine follow-up. We think that provides the social support that is conducive to people having healthy behavior and managing conditions.”

Built on Faith
The new project, which enrolled about 72 participants in its first month, is an extension of the city health department’s Keep On Track initiative in which church-affiliated lay health workers help congregants track their blood pressure and offer counseling when necessary. The initiative, however, is all paper based, and Cannell says the electronic extension into the churches’ existing programs was a touch serendipitous.

“For whatever reason, 95% of the organizations participating in that program are churches,” he notes, “but there is absolutely no reason this model is theologically specific.”

However, Cannell says the churches’ traditional mission of community outreach lends itself to establishing the new PHR-enabled relationship with the health department. The inherent relationship of trust between a church and its members should also help with acceptance. As an example of that faith, he says parishioners have expressed few concerns about data security.

“Honestly, this is a context in which people trust each other,” Cannell says. “I think people want to understand what they’re signing up for, and we do everything we can to make sure they understand that. But concerns about security have not been foremost.”

Eric Gombrich, general manager of NexJ’s health solutions group, says the cloud-based Connected Wellness platform on which the patient information will reside is fully HIPAA compliant and messaging is encrypted on both ends. In fact, he says the platform’s cloud architecture is central not only to the company’s vision but also to the dictates of expanding health information beyond the “one provider on one application” concept on which traditional EHR portals have been based.

“One of our fundamental premises is that no patient will ever have a single PHR, and they will never be interacting with a single enterprise that may have a single EHR,” Gombrich says. The modular nature of the NexJ platform breaks essential data elements, such as blood pressure measurements, into what Gombrich calls trackers. Those tracker elements are then made available to any application within the patient’s personal aggregate platform that needs them.

“Let’s say you’re trying to lose weight and you have an app for that,” Gombrich says, “and you also have high blood pressure and you’re trying to manage that. Both of those scenarios are interested in your weight, your weight being a tracker. Regardless of how your data is updated, through the portal or through an app a health coach might have given you, it becomes available to all the applications that are interested in that tracker.”

Ideally, the confederation of applications on each patient’s platform will enable those individuals and everyone with whom they interact about their health to create a holistic environment of healthy behavior buttressed by data.

“What we are moving to do is to try to make this an information platform that allows organizations that have some influence and a lot of credibility in their communities to tangibly—with regular feedback—try to improve the environment for health, the food environment, the environment in terms of opportunities for physical activity, and less tangible things like social norms and social support that are really important to efforts like blood pressure control,” Cannell says.

— Greg Goth is a freelance journalist from Oakville, Connecticut, specializing in technology and healthcare policy issues.