Overview

A common desire for apps that integrate with the EHR is to share materials (brochures, instructions, results, questionnaires) with the patient. This recipe describes several approaches to distribute education materials to the patient.  Your solution could include one or more of the sharing features listed below.

Features

• interopiO Content Sharing Engine
  • Sharing content
  • Tracking what has been shared and received
  • Analytics and reports
• Sharing directly with the patient via:
  • Download and print
  • SMS (text) message
  • QR Code scanned by patient's mobile device
  • eMail 
• Sharing with the patient through the EHR
  • Included in the EHR Discharge Instructions handout given to the patient
  • Delivered to the EHR Patient Portal (ex: Epic MyChart) as an attachment to the patient's visit that can be viewed/downloaded by the patient

Benefits

There are many benefits to using interopiO's Content Sharing Engine to share your educational material with your patients.

Clinician EHR Workflow Integration

First, clinicians utilize your application within their EHR system to browse, select, and share your materials without leaving their EHR.  This provides many benefits including:

• Your clinician doesn't need to go to a separate website or application
• Your clinician doesn't need an additional login beyond their EHR login
• Your clinician can view your material without selecting a patient (a "user-context")
• Your clinician can view your material after selecting a patient (a "patient-context")
  • From within the patient-context, your application can look up the patient's chart (details such as age, gender, conditions, medications, and many others), look up the clinician's details (such as name and specialty) and any organizational details (such as department or subscription).  Using this context information, you can provide targeted material for your clinician to share with their patient.
  • From within the patient-context, your application can document to the EHR what material was shared with the patient including any notes or instructions provided by the clinician.
  • From within the patient-context, your application can record data (usage, statistical, metadata) within your system.
  • From within the patient-context, your application can use the patient's contact information (email, text) to send your material with their patient.

Patient Access on their Mobile Device

Second, patients can receive messages from their clinician from your application on their mobile device.  These messages can include the material directly (for example, an email attachment) or securely (for example, a link to a web page where the patient must enter their name and birthdate prior to viewing the material).

EHR Patient Chart Documentation and EHR Sharing

Third, your application can document the material to the patient's chart within the EHR.  This documentation can be associated with a visit/encounter allowing your material to be included in the EHR Discharge Report and also be available at the patient portal (ex: Epic MyChart) as part of the visit/encounter for viewing and downloading.

Material Usage Reports

Fourth, you can gather, analyze, and report on usage of your material including:

• Which material is being handed out by which clinicians
• Of material sent to patients, which material is being accessed by the patient
• When searching for your material, which search terms are used most often
• When searching for your material by filtering on attributes from the patient's chart, which attributes are being selected or de-selected by the clinicians.

Requirements

Required

• Your application maintains an interopiO subscription
• Your application uses the HL7 FHIR Launch flow (SMART app)
• Your application uses the HL7 FHIR API for writing your material to the EHR using the DocumentReference FHIR resource (interopiO will translate to HL7 V2 as required)
• Your healthcare site configures your application

Optional

• Your healthcare site configures an HL7 V2 interface for interopiO for attaching material to the patient's encounter
• Your healthcare site configures on a storage model for your material when attaching to the patient's encounter
• Your material is publicly available so it can be resolved by link from the patient's device
• If your material is hosted from interopiO, we can provide a challenge question for accessing your material on a public URL (such as last name and birth date)

Recipe

Sending material directly to the patient using interopiO

It is often desired to send material (brochures, guides, instructions, etc.) directly to a patient via print, SMS, email, or QR Code. This workflow is usually part of an office visit using an application.  For this feature, we recommend the application provide a share screen similar to this screen we have built for some of our applications:

As you can see from the statements on this screen, we send a link to the patient using an SMS or email channel using the patient's phone number and email from their EHR patient demographics record (as default values). The patient or provider may also use the QR code to access the material.  When the patient clicks on the link, they will be required to prove their identity by providing their date of birth that we compare to the patient's EHR record date of birth.

With this model, the application retrieves the patient's chart including demographics from the EHR (via interopiO Gateway), displays the share screen to the provider, and submits the "send" request to the EHR (via the interopiO Gateway).

When interopiO receives the "send" request, interopiO will handle it using our Messaging component directly (and not send it on to the EHR). interopiO will send the secured link to the patient using the requested channel (SMS or email).

In this data flow model, the material is stored in an interopiO CDR.

 

Sending material to a patient using the EHR Discharge Instructions handout

It is often desired to include your material in the EHR Discharge Instructions that is printed and given to the patient as they leave the facility. This is similar to the concept of your application including provider notes as part of the visit. However, provider notes are generally text or RTF while materials are generally binary files (PDF, images, etc.).

To associate materials, brochures, and pamphlets with a patient's chart during a visit, we utilize the EHR's workflow for attaching a document o the patient's encounter. This workflow utilizes an HL7 interface and requires a storage option . The HL7 interface to the EHR is in incoming interface that will include a message with an encapsulated (Base 64-encoded) value or a hyperlink to the material. In either case, the EHR will associate this document/your material (embedded or linked) with the patient's visit as an attachment.

Storage of the document/your material at a healthcare site may configure the site's EHR system in one of several ways:

1. EHR Binary Storage Drive.  The healthcare site may store the scan within the EHR's on binary storage drive. This option assumes the material is included in the HL7 incoming message as base-64 encapsulated data.  This option is a great option for patient-specific material (possibly including PHI or personal instructions). This option may introduce a scaling challenge well if many patients are receiving the same material as it will be stored repeatedly within each patient's chart.  Consider if this scaling issue represents an actual problem given your use case.
2. Enterprise Document Management (EDM) System. The healthcare site may have an Enterprise Document Management (EDM) solution already such as OnBase. In this model, OnBase will already have established the interface between itself and the EHR System. Your application (via interopiO) would need to send the material to the EDM using whatever API or interface the EDM has available. Contact us to discuss options for integrating with a healthcare site's EDM.
3. External Storage Location. The final option is to store the material in an external location (such as an interopiO CDR) and provide a link to the EHR system using their HL7 scanned image interface. This model is similar to the first option, but with the storage location residing outside the EHR. This option is great for healthcare systems that can't or won't provide an internal storage option, possibly due to scalability concerns regarding attaching the same materials to each patient's chart.

Sending material to a patient using the Patient Portal (ex: Epic MyChart)

A patient often desires to be able to access their material from the Patient Portal after their visit and subsequently.  The Patient Portal provides a great sharing solution as it will show as attachments, any documents associated with the patient's visit.  The patient can sign into their portal, select the visit, and see your material to view or download.  The patient can access this material any time they would like using any device.  

Most EHR systems already provide documents associated with a visit to their patient portal.  We leverage this existing workflow to send your material to the patient portal. To implement this model, we utilize the same flow to include your material on the EHR Discharge Instructions handout. This flow does require additional configuration to make sure the patient already has an account at the patient portal (or at least a patient ID that will work for the patient portal). 

After this integration is accomplished, the patient will see your material as attachments to the visit when they log into the patient portal which they can download or view from their convenient device and at convenient time.

 

Collecting usage reports when sharing material with patients

When the App sends usage statistics request, the interopiO will query the information based on the received context information and will respond with usage data which can be displayed in the App's admin dashboard as shown above.  Content tracking information (such as who accessed it, when it was accessed, etc.) can be retrieved from interopiO.

 

How to manage your education material using interopiO

We have several options for storage and location including , an AWS S3 bucket, an AWS CDN, an interopiO CDR, an Interopion Health Cloud database, or your own hosting of the material. We would be happy to explore other storage options based on your application and network requirements.  This information is stored on HIPAA compliant cloud storage in interopiO environment.