Defragmenting Heart Failure Care: Medical Records Integration

Abstract

Heart failure management requires intensive care coordination. Guideline-directed medical therapies have been shown to save lives but are practically challenging to implement because of the fragmented care that heart failure patients experience. Electronic health record adoption has transformed the collection and storage of clinical data, but accessing these data often remains prohibitively difficult. Current legislation aims to increase the interoperability of software systems so that providers and patients can easily access the clinical information they desire. Novel heart failure devices and technologies leverage patient-generated data to manage heart failure patients, whereas new data standards make it possible for this information to guide clinical decision-making.

Keywords: Data; EHR; Electronic health record; Fragmented; Informatics; Interoperability; ONC; Regulation.

Figure 1.

Models of health information exchange. Green arrows: legislation tied to health provider reimbursement motivates the use of interoperable health IT; agreed upon data standards and record linkage provide the framework to securely transmit digitized health information. Thin arrows represent direction of information exchange. A) Directed exchange: participants directly send clinical information to and from each other. B) Query-based exchange: multiple data sources (i.e. patient data from different hospitals) are stored in a repository that users can request specific information from. C) Consumer-mediated exchange: health data is collected and stored by the patient who controls who uses the data.

Figure 2.

Comprehensive heart failure care requires interoperability between fragmented data sources. A) Medication management data includes prescription information, refill history, insurance copay, and pharmacist documentation. B) Social determinants of health include patient-reported and census-derived information on poverty, insurance status, food available, living environment, and community resources. C) Patient-generated data includes readings from home scales or blood pressure cuffs, sensor data from wearable devices like watches, data from implantable cardiac devices, and information entered through web portal and smartphone apps. D) These data can be transmitted using through FHIR resources to a central database or EHR where they can be used by patients, researchers, and healthcare providers.