Posted on: December 20, 2019

“There was a gentleman I was following for many years after a workers comp injury. He’d also been diagnosed with lung cancer, been treated and been through his five-year follow-up. So he was carrying all of that as history,” says Dave Welch, M.D.

“He called me one day because he’d been back to his primary care doctor where he lived in Plattsburgh, 50 miles from my office in Saranac Lake. An MRI of his chest showed recurrent metastases in his lung and liver,” Welch continues. “While we were on the phone, I was able to go into Hixny and pull up his imaging reports from that morning. With those in front of me, I could have a meaningful conversation with him and his wife about the findings. Unfortunately, he passed away shortly afterward—but I heard from his wife later. She said that conversation with me had been the most valuable in those last weeks.”

For Welch, the medical director for Hamilton County Public Health Nursing and a retired physiatrist, stories like that show just how critical Hixny can be in providing high-quality patient care—not just in terms of outcomes, but in supporting the human connection between a trusted provider and their patients. It’s the way he’d like to see all of the nurses he works with using the health information exchange (HIE) to support their daily efforts in the field.

A History with Hixny
In the last two years he was in private practice, Welch had developed a routine for himself. He’d get to his office 90 minutes before the first patient visit and review the information available about every patient on the schedule that day from four different sources:

  • Records from his own practice, which specialized in internal medicine and pediatrics, from both his previous interactions and those of his colleagues
  • The state prescription monitoring system for anyone on controlled substances, to see if anyone else was prescribing for them—because he frequently needed to prescribe those medications for pain management
  • Hixny, especially for patients who were not known in his practice or who were also being followed by a specialist or primary care provider outside his practice
  • Imaging studies from the hospital where he had privileges

Through all of this, his goal was to see what had happened in the preceding one to six months, including changes in medications, lab work results and follow-ups. Having that information at hand meant Welch could chat with patients on arrival and check up on anything unresolved in their record.

In his public health role, Welch sees the opportunity for nurses to use Hixny in much the same way.

Caring for the Riskiest Patients
Hamilton County, deep in the Adirondacks, has no hospital, no nursing home and no pharmacy. It’s fairly normal for residents to use a pharmacy in Tupper Lake, 20 miles or more from home—and to see some doctors even farther away in Glens Falls or at the urban hospitals and practices in Albany.

Because of the geographic distance and disparities, Hixny is the only means by which patient records can be exchanged efficiently with front-line providers, like public health nurses, who often care for patients in the greatest need of assistance. These, Welch says, fall into two main groups.

The first are people with purely medical issues who require periodic lab work and follow-ups, such as people with chronic congestive heart failure complicated by uncontrolled diabetes. They may see a primary care provider, cardiologist and endocrinologist—and have a public health nurse visiting them regularly to check and modify their care plan in the field, with the appropriate doctor’s knowledge and signature. Hixny helps the nurses check for new labs or imaging and, more importantly, be aware of medication changes. All of this helps make the visit more meaningful and allows them to modify the care plan appropriately.

The second are people who call with a new concern or a possible medication problem. In a similar way, the nurses need Hixny to see what actions may have been taken since the last home visit so that they can follow up effectively.

In both cases, Welch says, patients usually reach his agency through a direct referral from social services at a hospital. And these referrals provide good information—a discharge summary and results of any lab work or imaging done—before the first home visit, which is legally required to occur within 48 hours of discharge. However, Welch noted that after the initial referral, it’s rare to receive information from follow-up visits with the referring provider. And, he adds, many of their patients are followed by multiple other providers. All of that makes Hixny critical in filling information gaps.

Even with Hixny, though, Welch and his team are reliant upon the rest of the healthcare community to ensure information enters Hixny as quickly as they need to be able to view it through Hixny.

“Lab work and imaging—as long as it’s dictated and transcribed—are usually available through Hixny as soon as they’re filed and definitely within 24 hours of discharge,” he says. “Almost nothing is available from follow-up docs and consulting physicians, although some are better than others. And things in the hospital are often dictated, typed after a few days and delivered a week later.”

The Case for Better Care
Putting on his medical director hat, Welch points out that these gaps in information caused by delays on the part of other providers are not only challenging for his team, but potentially dangerous for patients. So too, he says, is disregarding the information that is available through Hixny, which he considers to be a failure in providing quality care.

“Malpractice carriers are telling us that a failure to make use of such data could be difficult to defend in malpractice cases where such information could have changed the outcome,” Welch says. “It is imperative that we make use of any and all information to which we have access—and it’s expected that we’re doing so through a source like Hixny. As doctors and nurses, we need to change—we need to scan the data related to every visit, every time. The days of relying on patients for updates is gone.”

After working in public health for more than 40 years, he explains that Hixny has been a game changer. Without Hixny, patients’ records would be spread across separate systems in multiple facilities that are an hour or more distant from one another, as they were before the advent of the HIE. For remote providers like Welch and the nursing team, that essentially meant the information was completely unavailable before Hixny brought it all together. That’s especially important for the nurses, who need to have all of their patients’ information to provide well-informed, evidence-based, compassionate care.

“It allows someone who has an intimate relationship with the patient to have a meaningful conversation in real time,” he explains. “If the nurse arrives at the house, they need to know what happened with appointments, why a bone isn’t healing or what last week’s image shows so they can have that conversation.”

Please be advised that this Saturday, January 25, we will be performing scheduled maintenance for Albany Medical Center from 7:00 a.m. until 11:00 a.m.  Data from the hospital will be unavailable during this time. 
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