Addressing Health System Fragmentation with Care Mapping

An interview with Dr. Tim Pletcher

Due to the fragmentation of the U.S. health care system, providers often lack information they need about a patient in order to connect them with the best care. Still, sharing longitudinal health records with all providers may present privacy and usability concerns. One way to address this is with care mapping that shares important context about a patient with the providers who need it. 

C4BH spoke with Dr. Tim Pletcher, executive director of the Michigan Health Information Network Shared Services (MiHIN) about care mapping. MiHIN is building an Active Care Relationship Service to provide context as to how individuals fit into the health and social services universe. 

C4BH: How can care mapping help address pressing health care problems?

Pletcher: Care mapping is important–and needed–because, in the United States, we have an extremely fragmented health care system. A patient may seek services from a variety of providers, doctors, health plans, and social services, which means providers don’t have the data to understand what’s really going on with that patient. 

C4BH: How does care mapping help address this problem?

Pletcher: You can’t assume a provider organization knows everything about a patient’s care. That’s why we round up all the data points and touch points. Then we connect those dots and what pops out is a care map or what we call the Active Care Relationship Service. That tells us which providers and community based organizations are connected to a patient, what services a patient receives, and where a patient’s data is located. 

C4BH: MiHIN has taken a patient-centered approach to this problem. What does this mean?

Pletcher: Our industry is generally focused on provider directories and resource directories, but these services aren’t patient-centric. What’s needed is a patient-focused care map that connects all the services and providers that an individual accesses. Building this care map takes work, but it’s a minimum necessary infrastructure to get the information needed to ensure an individual’s access to the best care.

C4BH: Why is sharing the context about a patient an important part of the Active Care Relationship Service?

Pletcher: Many people jump to the idea that you need a longitudinal medical record for everybody. But for a state as large as California, that would be a political, technical, and financial challenge to build. Instead, we create a minimum necessary data structure to assemble the most important context a provider needs to be able to best serve a patient.

This structured context has three pieces: linkages, preferences, and attributes. Linkages are the organizations a patient is connected to. Preferences are the services a patient wants to opt in to or choices about who has access to specially protected information. Attributes about the patient could be a diabetes diagnosis, a 30-day mortality prediction, or that they’re a high utilizer of health care services. We want providers to be able to quickly find the relevant information they need about a patient without sifting through their entire medical record.

C4BH: How does the care mapping service address issues around consent?

Pletcher: Consent is how patients express their preferences. We keep track of not just whether there was consent, but what the consent was for and how it links to the care the patient is receiving. This includes treatment preferences such as do-not-resuscitate orders. It also includes data sharing preferences around behavioral health, substance use disorder, and other specialty protected areas. For example, a patient can choose which of their providers have access to their substance use history. In addition, a patient can see what providers claim to have a relationship with them and contest that, if needed. Care mapping can also help a patient remember the names of their many providers to assist with choosing who can access their data. 

C4BH: How will providers use the Active Care Relationship Service?

Pletcher: There are multiple layers of use. First, providers can receive alerts, such as that one of their patients went to the emergency department. That might be particularly important to a foster care program or a primary care physician. The access control component monitors the providers who have access to a particular patient’s record. To note, providers will need to demonstrate a relationship with the patient and a reason to need access before they can see their longitudinal record. The care mapping service solves several problems for providers. Important context about their patient is surfaced, and they have a specific place to go to query for information.

C4BH: What are your most valuable learning experiences in this work?

Pletcher: Every state should have a care mapping service. In many cases, a provider either has access to the full longitudinal record or nothing. We’re advocating for a layer in between. From a policy perspective, it reduces costs and privacy concerns. We can focus on sharing context about our constituents without necessarily exposing all of their data. This is an attractive approach because it works with both existing and future technology. There’s also an equity benefit to care mapping. The pathway that people take through our health care ecosystem is as important as the treatment they receive. By tracking the care map, you can see the trajectory that somebody took through the health care system. Over time, you’ll be able to predict what kind of outcomes someone will have based on the touch points they experience. Policy makers can use this to deduce what combination of services lead to the best outcomes and any disparities in access to these services. 


For more information about MiHIN and the Active Care Relationship Service, visit their website.


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