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A Model for Establishing a Community Health Information Exchange Using a Community’s Medical Home Practitioners and their Patients’ Network of Care

Authors: Adinarayana Kadapa, MD, M

Primary Advisor: Kimberly Dunn, MD, PhD (co-author)

Committee Members: Sandi Peterson, DNP (co-author)

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.


Outpatient care is primarily managed through referrals from physician or patient self-referral in the present day health care practice. An effective referral process requires Health Information Exchange as health related data is exchanged between two providers about a patient to improve and coordinate the care. Given disparate workflows at multiple referral locations in this process, there is a greater chance for loss of information and duplication of tests. With the advent of the medical home concept, the process of information management and care coordination for a patient becomes a shared responsibility between the medical home, the patient and referral subspecialists. A method of referral management needs to be proposed for a medical home service aimed at improving care coordination. This provides an additional opportunity to improve quality of patient care and ensure care continuity. A literature review suggests communication barriers as an important cause of dissatisfaction among users (patients, primary care physicians and subspecialists) of the current referral system. A new model is proposed that overcomes different workflows, clinical settings, and patient populations. The model involves modifications of the present day referral process by establishing a patient’s network of physicians and physician’s network of physicians across multiple primary care practitioners. The resulting physician network provides a model to implement health information exchange based on the clinical care network which would be clinically useful to both patients and physicians and supports a sustainability model.