PATH 5 Appropriate
Allocation of Resources
Community HIEs allow providers
to stratify patient populations
into risk levels based on condition
(e.g., number of chronic conditions)
and utilization (e.g., number of
ED visits or inpatient admissions).
This enables providers to target
resource allocation and outreach
efforts for maximum impact.
Patient care and outcomes improve,
and the potential for unnecessary
expense is reduced.
Many chronic disease patients
who present to the ED will be
admitted to the hospital, but not all
require hospital care. This creates
unnecessary expense and care. At
HMG, we’ve developed an extensivist
clinic that serves as an alternative to hospitalization, providing
treatment for pneumonia, exacerbations of heart failure or chronic
obstructive pulmonary disease,
refractory cellulitis, sepsis, delirium, renal failure, dehydration, and
more. Resources in the extensivist
clinic are like those available on a
hospital general medical floor, and
patients are monitored frequently
throughout the day. If a patient
does not feel comfortable returning
home when the clinic closes at 8:00
p.m. or if the condition deteriorates,
the patient will be admitted. Among
patients treated in the extensivist
clinic, 80% return home and 20%
are admitted to the hospital.
1. J. Walker. 2018. Why Americans Spend So Much on Health Care—
In 12 Charts. Wall Street Journal, July 31, 2018. Accessed August
9, 2018 at wsj.com/articles/why-americans-spend-so-much-on-
2. American Heart Association. 2017. Cardiovascular
Disease Costs Will Exceed $1 Trillion by 2035, Warns the
American Heart Association: Nearly Half of Americans Will
Develop Pre-existing CVD Conditions. February 14, 2017.
Accessed August 9, 2018 at newsroom.heart.org/news/
PATH 4 Less Fragmented Care
A Critical Investment
The continued rise in healthcare costs without corresponding
improvements in outcomes makes it imperative that providers
approach patient care holistically, using data and insights
from multiple points on the care continuum. A community HIE
strengthens providers’ ability to make a significant impact at
the point of care by bringing together a comprehensive view
of the patient’s medical history, needs, and challenges. The
result is care that is consistent, coordinated, cost-effective,
and highly personal. This highly collaborative approach energizes, engages, and satisfies patients, physicians, and nurses.
Investment in community HIE data sharing is critical to realizing the potential for value-based transformation.
Wesley Combs is chief information officer at Holston Medical Group.
3. J. Karsten. 2017. Health Information Exchanges Reduce
Redundant Medical Procedures. The Brookings Institution,
May 26, 2017. Accessed August 9, 2018 at brookings.edu/blog/
4. J. Bresnick. 2015. Are There Financial Benefits to Health
Information Exchange? HealthIT Analytics, May 29, 2015.
Accessed August 9, 2018 at healthitanalytics.com/news/
5. B. Goulart. 2016. Value: The Next Frontier in Cancer Care.
Oncologist, 21( 6): 651–653. Accessed August 9, 2018 at ncbi.nlm.
Continuity of care is critical for
improved health outcomes and key
to achieving value, especially for
patients with complex care needs.
Access to a community HIE improves
care coordination and continuity of
care between physicians, specialists,
hospitals, and others. Community
HIE access also helps to identify
gaps in care that could result in
hospitalization if not addressed.
For example, research shows a
fragmented care delivery system
is a primary driver of rising cancer
care costs. 5 Fragmented care also
is associated with decreased qual-
ity of care, high rates of preventable
hospitalization, and increased
potential that a patient will leave
a practice for another provider.
When non-oncologists who treat
cancer patients have access to
a patient’s medical history, this
improves physician awareness
and productivity; reduces the risk
of duplicative, unnecessary, or
even harmful care and treatment;
reduces the risk of preventable
hospitalization; and helps to avoid
gaps in care. Patient care improves,
and patient satisfaction increases.
At HMG, patients undergoing
oncology treatment see special-
ists outside of our practice. Having
access to their records is critical
to supporting their whole health
needs when they come to us with