The primary goal of the independent community-based population health management (PHM) hub leverages an innovative model for delivering comprehensive care for epilepsy-related challenges. The PHM hub forms the foundation of our CARF-accredited rural population health initiative. This platform catalyzes comprehensive patient-centered care in rural Northeastern Illinois.

The clinical implementation of such a PHM strategy hinges on the scalability of inter-community networking. Specifically, the hub coordinates near real-time matching of local psychosocial services, and geographically distant medical specialty needs for children (Rossi, 2014) and adults residing in these rural regions. Health information technologies bridge our patient-centered PHM presence with Rush University Medical Center (RUMC), an urban-based tertiary care medical center located about 70-80 miles away from these communities.

The McHenry County-based PHM initiative combines the following 5 innovative components:

(1) A HIPAA-compliant portable video-conferencing communication protocol and technology bridges on-demand access of patients in ambulatory and rural emergency department settings with specialists based at RUMC. Care also relies heavily on community-based healthcare providers and psychosocial agencies.

(2) A novel HIPAA-compliant web-based networking technology and electronic health record (EHR) connects patients in real-time with all available community-based resources,

(3) Ambulatory biosensor monitoring & internet of things (IoT) integrated data streaming are leveraged. Specifically, ultra-portable EEG telemetry, total body motion capture sensors for assessing seizure-like spells, and holographic based neurocognitive assessment tech are incorporated into the IoT integrated workflow.

(4) A personalized interactive 3D-animation website based on a computer-intensive gaming platform is employed. Its education-rich content targets epilepsy and mental health therapies. This platform also accommodates a closed virtual classroom for live dynamic educational sessions,

(5) Finally, the independent community-based CARF-certified PHM hub (operated by the Epilepsy Foundation of North Central Illinois) coordinates the above innovative components.

This health information technology-intensive rural outreach care delivery model overcomes numerous barriers. The hub bridges coordinated geographically-remote comprehensive medical, surgical and psychosocial care. It significantly expands the geographic reach of a distant tertiary care medical center to rural regions lacking specialty care. Preliminary data suggest that such an independent commubnity-based platform efficiently maximizes patient access to community resources, medical and mental health expertise, and customized patient education (Rossi et al, 2017; 2018).

Pertinent References