Copyright X4 Health Inc.

1. Requesting
Health Records
in the Modern
Era
A new model for patient
records requests in digital
and other formats

2. Available Tools & Resources
www.x4health.com/healthrecords
Research Findings &
Recommendations
Overview of purpose,
process, partners and
research findings
Wizard Prototype
Live prototype for
exploration
healthrecordwizard.com
Implementation
Tour
Screen by screen
insights and
recommendations
Navigation Flow
Map of branch logic and
skip patterns

3. Structure of This Report
How We Got Here
and Why This
Matters
Slides 4-14
Key Insights and
Guidance
Slides 15-22
Looking Forward
Slides 23-25
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4. How We Got Here & Why
This Matters
Why, How, Who, and What
4

5. Patients Need Digital, Portable Health Records
5
Why?
• To build a longitudinal
picture of health over time
and across entities
• To manage an episode
of care or a life
threatening or chronic
condition
• To donate data to
researchers to develop new
insights

6. But Compiling Records Today is a Challenge
6
Despite HIPAA rights, patients are rarely offered electronic formats they can put in one place.
I attempted to get my data from my primary care doc in an electronic
file …the doctors’ admin staff did not understand. After some
discussion, the best they could offer was a CD….I received it shortly
thereafter in the mail—it is a 47 page PDF of many things …that I had
to expand a thousand percent to read. Incomplete at best. Nothing
readable or computable.
I asked the doctor’s office if I could have my
blood test results emailed to me. They told
me that they were not allowed to email that
information, and that my only option was to
come in to receive a printout.
“
”
“
”
Source: GetMyHealthData Campaign
Two binders, 6 discs, 4 patient portals,
and still no longitudinal health record.
”
“
Here’s what real patients experienced under traditional request models:

7. The Path
We Set Out to….
○ Help more patients get access to their health
records in electronic formats by re-engineering
individual patient access requests under HIPAA.
• Find ways to incentivize data downloads to apps.
• Contribute to the vision of a digital health advisor for
every patient.
○ Create a simple, well-designed, consumer-tested
form and workflow for requesting records that:
1. Incentivizes consumers to request records in
electronic formats, including for apps.
2. Helps health care institutions understand that they
can and should offer these e-formats under the law.
3. Helps health care institutions meet more patient
access requests electronically, and not just through
their patient portals.
But We Found That….
○ Today’s paper or PDF-based forms aren’t working
for professionals OR patients.
○ Records systems are highly complex during this
time of transition from paper to electronic
• It’s impossible to engineer a “simple form” – whether
paper or digital.
○ Health records managers spend a ton of time
clarifying and following up on individual requests.
○ If even a small % of requests received were
exquisitely clear, it could:
• Save time and money for records managers and
health systems.
• Get records into the hands of patients faster.
• Improve patient experience and satisfaction.
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8. The Purpose
Our Research Objectives
1. Build on the model form created by the health
information management professionals of AHIMA.
2. Examine ways to promote digital records.
• Can we encourage electronic formats?
• What happens when we focus on apps?
3. Understand consumer experiences when
requesting their medical record.
• What is happening today, what they want in the future
4. Explore stakeholder needs – records managers,
CIOs, app companies, and more.
• How to simplify the process for the health care facility
AHIMA’s Model Patient Access Form
8

9. The Approach
User Centered
Design is based upon an
explicit understanding of
users, tasks, and
environments and
addresses the whole
user experience.
Driven by Real
People
Face-to-face interviews
with consumers who
have requested records
to understand their
needs, contexts,
behaviors.
Informed by
Current State
Starting with paper
forms helps define a
version that will address
the whole user
experience.
Modernized
Digital prototype created
based on research,
stakeholder input.
Observations of
consumers using the tool
generate design
changes.
Open to the Public
Iterative rounds of
consumer testing result
in publication of the
wizard’s branch logic,
language, features, and
functions.
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10. User-Centered Design
Participant Criteria
○ Requested health record for themselves or another
family member in last 18 months
○ Interested in improving the process and their
experience
○ Relatively comfortable with technology
○ Age range: 25–75
○ Mix of male and female
○ 3 Markets: Denver, Washington, D.C., and New
York metro areas
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• Female
• Working mother
• Ages 40-59
• Responsible for her own
medical information, as well as
that of children and aging
parents
Leading User Persona

11. The Result
Digital Wizard Prototype
○ A smart form that uses branch logic and skip
patterns to help consumers articulate what they
need, in what format, by when.
○ Results in a digital PDF request including photo
ID, verified phone number, signature and
documentation attachments for caregivers.
○ Focused on individual patient access requests
only (vs. third party authorizations).
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www.healthrecordwizard.com

12. Our Partners & Key Stakeholders
The Project Team
○ X4 Health, Christine Bechtel, Project Director
○ Swellbox, Brian Korb and Jeff Marrone, Wizard
Architects
○ Customer Sense Consulting, Nicole Rubin, NY and DC
Research
○ Teri Clough LLC, Denver Metro Research
○ Waldo Law Offices, Ann Waldo, HIPAA Expert
○ Lauren Sogor, Communications and Marketing
○ NewWave, Aaron Seib, Technical Advisor
Key Stakeholders
○ American Health Information Management Association
(AHIMA) leaders, staff, and members
○ CARIN Alliance staff Ryan Howells and David Lee, and
members
○ Care Journey
○ Cedars Sinai Medical Center
○ Cone Health
○ Children’s Medical Center
○ Ciitizen
○ Hyland
○ Marshfield Clinic
○ Memorial Sloan Kettering Cancer Center
○ National Partnership for Women & Families
○ Norton Health Care
○ Texas State University
○ U.S. Department of Health & Human Services
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13. Special Thanks to…
○ AHIMA and the AHIMA members who worked diligently
to create the first model form paper version, and who
provided several rounds of ideas and feedback on the
Wizard tool.
○ CARIN Alliance and its members, including Aneesh
Chopra, Ryan Howells, and David Lee, who provided
feedback on the model form, Wizard concept and tool,
and ideas about the future.
○ Swellbox’s Brian Korb and Jeff Marrone who generously
served as technical experts and developers of the
Wizard prototype.
○ Commonwealth Fund and its talented staff for their
funding support and vision.
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14. Key Insights & Guidance
Research Findings & Implementation
Recommendations
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15. Summary of Key Findings – Model Form (Paper)
Simplicity
Make it easy for me to
request and receive. I
am juggling many
things.
Purpose
I’d like to tell you why
I’m requesting so you
can help me best.
Timeliness
Please give me 24/7
access to request
process so I can do it on
my own time.
15
Communication
Patients want to be
helped through the
request process. They
also want to be notified
as the request
progresses.
Consumers believe they
should get their health
information at no cost.
Cost

16. www.healthrecordwizard.com
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The prototype is now live – take
a tour and see what you can
learn!

17. 10 Basic Functions of the Wizard
1. Determine which institution/data source the requester is inquiring about
2. Collect information about who is making the request (patient or other individual)
3. Collect information about who’s data is being requested
4. Determine what data is being requested, and why (optional)
5. Determine the timeframe of the request – e.g. the date range of the records
6. Select the types of records being requested, including optional free form information from the requestor
7. Determine whether there are any deadlines for receiving the request – e.g. upcoming appointment
8. Determine who the data is to be delivered to and how, prioritizing electronic options through design
9. Collect additional supporting documentation if requester isn’t also the patient, such as power of attorney
10.to support the remote identity verification of the requester
11.Generate a well structured request form sent to the medical records department to be processed
12.PDF copy of Medical Record Request sent to Requester
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The prototype is
intentionally designed to
operate without requiring
integration to an EMR.

18. Summary of Key Findings – Digital Request Wizard
Findings from research with consumers and medical records professionals
Simple & Easy
The wizard made it easy
for consumers to request
records without confusion.
It also generated a more
clear request, making it
easier for records
professionals.
Efficient & Clear
The wizard guided the
consumer through the
process and shielded
them from some of the
complexity of today’s
process. Skip logic made
it efficient, and helped
clarify their needs.
Timeliness
Consumers can request
24/7. Including a “date
needed by” helps records
departments prioritize.
Wizard also directs
people to the patient
portal for immediate
needs.
18
Trusted
Consumers thought they
were more likely to “get
it right” using the
wizard. They also had
more trust in the
delivery of the electronic
request than paper.
Consumers liked digital
options, but few in our
testing had an app.
Almost all had a portal or
email.
Choices
“This is like a bouquet of roses! I want to do this right now
for our staff and patients!” – HIM Department Director

19. User Reactions
I thought it was great. I loved
how interactive it was and how
it moved you to the next field
to complete!
“ ”
Female, 40-49, Aurora, CO
The different validation points
made me feel confident that
not anyone could request my
information.
“ ”
Male, 40-49, Lone Tree, CO
Very cool! Loved that I could
do it electronically anytime of
the day.
“ ”
Female, 30-39, Littleton, CO
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20. User Reactions
One doctor has asked me 2 or 3
times to get my records from
another doctor. I just don’t have
time. But something like this I
could do quickly at the dinner
table.
“ ”
Male, 50-59, Washington D.C.
I think this is really clear. I love
it. I look forward to using
something like this in the
future – it would make things
so much easier … this would
really help us.
“ ”
Female, 50-59, Washington D.C.
Last time, I called them, they
put me through 15 different
people, and it costed an
obscene amount of money to
have the records printed and
mailed to me. This is way
better.
“ ”
Female, 40-49, Washington D.C.
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21. Big Picture Takeaways
HIM departments will benefit
from clarity and automation.
If even a small percentage of
requests can be clear, requiring no
further back and forth with individuals, it
can save time, money and resources for
staff and patients alike.
Processes can be further automated to
save more time and money.
Consumers want their records in
one place, but need guidance to
make selecting an app easy.
Consumers need recommendations on
how to find and connect an app to
specific records, and records from multiple
settings.
Health systems should consider
patients’ needs for a comprehensive
longitudinal health record.
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Consumers value
simplicity and ease.
While providers should proactively
arm consumers with their own data,
still many patients will ask for it from
records departments.
HIPAA requests should be viewed as
an opportunity for health
empowerment and excellent
customer service/patient experience.

22. Looking Forward
The next phase of evolution could revolutionize requests
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23. Roadmap to Revolution: Recommendations
1. Pilot workflow changes and wizard prototype elements in at least five settings:
• 2 large health systems or hospitals
• 2 large physician practices
• 1 records “outsourcing” company
2. Create an “all-comers” solution.
• Study how to develop a basic version for use by small- and medium-sized physician practices.
• Develop implementation toolkit they can adopt with only basic IT support, including how requests can be
easily tracked and managed by the practice staff.
3. Build toward a fully automated process using FHIR standards.
• For the percentage of requests where the request is clear, the requestor’s identity is verified using patient
portal login credentials, and the request is being sent to a connected health app, ensure the request is
filled automatically and instantaneously without human intervention.
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Reimagining individual HIPAA records requests as an opportunity to empower patients with their own data

24. Calls to Action
Next Generation: ”All Comers”
○ We call on health systems and records
outsourcing companies to use the prototype
wizard as a model for replacing their paper and
PDF request forms.
○ Make a public commitment via info@x4health.com.
○ The implementation package provides :
• The user interface design
• The navigation flow (branch logic and skip patterns)
• The user questions/language and rationale
• The desired functions (ID capture, signature, etc.)
○ Entities should integrate their own wizard that
produces a digital PDF request including photo ID,
verified phone number, and documentation of
caregiver status.
Next Generation: “FHIR-Enabled”
○ We call on stakeholders, including the standards
community, to develop and test ways to automate
data delivery using FHIR standards and open APIs
in all their data requests – HIPAA or otherwise.
○ We call on entities that have implemented FHIR
standards in their EHRs to:
• Develop and test ways to deliver data automatically to
an app in real time for consumers whose requests are
clear and whose identity is authenticated.
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25. Questions?
Email info@x4health.com
Visit www.healthrecordwizard.com to test the prototype
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