Community Care

PatientShare enables a new model of health data exchange designed with the patient at the center.

Learn about Innovative models to meet the needs of your organization.

The Problem

Effective healthcare delivery is plagued by data silos and the lack of efficient data exchange within communities and across facilities. 

  • Fragmented and disparate data increases provider burden and impedes successful outcomes, care coordination, and quality improvement.
  • Patients who experience an acute episode, resulting in transitions of care, often find that their clinical data is not available across care facilities, making it difficult for their doctors to provide informed care.
  • Health inequities exist across US populations. Tools that enable collaboration between health care entities and social service agencies or other community resources are needed to address whole-person care.
  • Information needs to be exchanged with care providers outside of the normal healthcare paradigms
  • Each of these issues result in gaps in care that could be avoided

The Solution

Enabling local/state care collaboration across organizations supports the ability to provide patient-centered care.  There are many initiatives around data exchange and PCS provides the technology to support these goals. 

Two concepts enable this vision

  • A FHIR-based bi-directional data hub to support person-centered data exchange across organizations.
  • Workflows to support sharing and collaboration across care providers and community agencies.

A bi-directional person-centered data hub provides a common repository for a combined patient history. This could be deployed as a stand-alone hub or as an extension to an HIE or hospital system.  A FHIR-based bi-directional hub can enable authorized exchange across organizations to address many gaps experienced today.  API-based workflows support more cross-organization collaboration and can be made available to the entire community to extend whole-person care and address current health inequalities.  Purpose driven hubs can be created to address the needs of targeted populations, such as aging populations, adolescent behavioral health, social determinants of health, and patients experiencing acute episodes of care, or transitions of care.

 

All of our products are standard’s based so that they easily interact with other standard’s based products. Because our solutions meet modern interoperbiltiy standards, they are easily extenable outside of "only medical" based system, including other social services to contribute to Whole-person Care.

PatientShare app to share and exchange data

The PatientShare app allows authorized users to view data and import data, if supported by the EMR, providing the necessary data to inform care.  The PatientShare Exchange solution allows patients, or their delegates, to define what data can be shared with whom so that everyone that needs to know will have the necessary access. Healthcare data may also be exchanged with authorized social services agencies to ensure that care and treatment are coordinated and effective.

Click on any image to expand

Create Create teams

Patients or Care Coordinators can create care teams, by adding care team members from a directory or on an ad hoc basis. The care team notification feature supports informing care team members and providing links to access updated data.  All members of the care team, including patients and family care givers can be informed and participate in collaborative care.

Care Plans and Long-Term Services and Support

The PatientShare electronic Long-Term Services and Support (eLTSS) Care Plan can create and update a collaborative care plan to share across care facilities as needed.  When coupled with our patient-mediated exchange solution, the care plan is securely exchanged with those who need it.

Services

The Patient Centric Solutions team is here to help whether it be by providing product or services to assist you on your journey towards innovative solutions to meet patient needs.

Want to see it in action?