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Primary Care


Primary care recognizes that the status of a person’s health is more than just the sum of their clinical encounters. People aren’t just seen as “patients” – they’re family members and friends, neighbors and community advocates, colleagues and caregivers. At HealthInfoNet, we believe that transparency into a person’s comprehensive care is critical to effectively manage and improve their risks and outcomes. Our services help primary care teams empower their patients, build informed care plans, and establish timely communication – all with the hope of helping improve persons’ health, wellness, and wellbeing.

Top Use Cases & Interventions

Practice Whole-Person Care

  • Deliver comprehensive patient care by understanding patients’ behavioral health and community health services in addition to their medical events and conditions

  • Reinforce tighter integration among disparate providers both within and across systems of care to enable more collaborative approaches to delivering services

  • Promote shared decision-making (SDM) practices by providing care teams with the tools necessary to mentor and teach their patients on how to use and make decisions about primary care services

Monitor Population Health

  • Assist in the proactive identification of patients who need evidence-based chronic or preventive health services such as routine tests and screenings

  • Give care teams complete views into their patients’ health, wellness, and wellbeing to better monitor progress, identify available care plans, and make informed recommendations

  • Measure and respond to patient experiences and satisfaction in various care settings with greater oversight into care activities

Manage Chronic Conditions

  • Identify gaps in care and track patients’ conditions (e.g., diabetes, CAD, CHF, hypertension, asthma, etc.) between scheduled visits to prevent exacerbation of conditions and emergency room visits

  • Provide ongoing treatment and monitoring of patients’ disease processes (e.g., screenings, regular office visits) to help minimize symptoms and maintain health over time

  • Improve outcomes for chronic disease management by establishing a “partnership” with patients in their healthcare activities and decision-making processes

Promote Prevention & Education

  • Keep up with patients’ age- and gender-appropriate lifestyle changes, vaccinations, screening tests, and other measures

  • Identify major risk factors through routine screenings to prevent disease and lessen the severity of illness through early detection and preventive screenings

  • Help patients understand common health concerns by addressing tobacco use, drug abuse, and vaccinations – “an ounce of prevention is worth a pound of cure!”

Improve Continuity of Care

  • Provide 24x7x365 secure access to patients’ electronic health records in support of care teams’ abilities to engage patients when it matters most

  • Allow care teams to identify and assign active patients to a panel to track and monitor their time-sensitive healthcare activitiesin real-time over the course of their treating relationship

  • Enhance and expand communication methods and data accessibility across diverse providers and systems of care

Enhance Care Coordination

  • Increase collaboration among primary care, specialty care, subspecialty care, and other care locations to improve the quality and safety of patients’ care interactions and experiences

  • Manage patients’ care transitions, care coordination agreements, and other protocols to support how care teams work together

  • Enable care teams to guide and follow up with patients in their journeys through systems of care, including overseeing and tracking the status of referrals and consultations

Support Performance Measurement

  • Supports various performance reporting initiatives (e.g., ACO, CMS, MIPS, NCQA, etc.) by providing access to a centralized and comprehensive clinical data repository to fill in data gaps and longitudinal information

  • Produces a variety of quality, utilization, and predictive risk measures to help providers identify weaknesses, prioritize opportunities, and identify improvement areas

  • Tracks health outcomes and equity based on both clinical and community activities and determinants of health and wellbeing

Participant Testimonial

“HealthInfoNet makes a big difference on a daily basis in allowing us to be on top of our patients’ care. The HIE Clinical Portal is great in allowing us to look up results/reports quickly without needing to wait for a facility’s medical records department to send them.”

– McKenzie Parr-Morton, Care Manager, Bethel Family Health Center

Additional Case Study Resources



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How HealthInfoNet Can Help Primary Care Organizations In Their Clinical Workflows


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Using HealthInfoNet to Support Primary Care Use Cases & Interventions


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Using HealthInfoNet to Support Primary Care Use Cases & Interventions


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Other Relevant Training/Education Resources

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