Although earlier efforts to create a statewide health information exchange stalled, the State of Connecticut is getting ready to make another attempt. Rather than offering services that others already provide, it will focus on connecting existing HIEs to each other and to national HIEs, as well as provide an on-ramp for providers that are not already connected to an HIE.
A new report from the Connecticut Health Foundation describes some of the history: In 2011, the state established a quasi-state agency called the Health Information Technology Exchange of CT (HITE-CT). However, with no functioning network or source of sustainable operating funds, the legislature eliminated HITE-CT in 2014, the report noted. Frustrated with the lack of progress, several major healthcare delivery systems, as well as the Connecticut State Medical Society, the Connecticut Hospital Association, and the Connecticut Department of Social Services, invested in their own initiatives to exchange information for their patient populations or beneficiaries.
The Connecticut Health Foundation notes that the “connected networks” technology approach can work alongside other initiatives and bridge gaps where they exist, noting that other states, including Michigan, Minnesota, New Jersey, New York, and Texas, have taken this approach.
These efforts are being led by the state’s health information technology officer (HITO), and overseen by the Health Information Technology Advisory Council, both of which are part of the state’s Office of Health Strategy.
The statewide HIE will function as a nonprofit called the Health Information Alliance, which was incorporated in July 2019 and is expected to begin testing the first use case by February 2020. Its board includes ex officio state employees, including the HITO (who will serve as the board chairman), and private sector representatives
The report notes that the Alliance faces a challenge: It will need to secure enough participation in its early years of operation to demonstrate value, but in order to demonstrate value it has to achieve a critical mass of participants. It has to do a good job of clearly communicating its role as a neutral player in the healthcare landscape, demonstrating the advantages of its structure and services, and facilitating financial and technical assistance to bring users aboard.
Once the HIE goes live, the Alliance will have leverage to require providers to use it: Legislation passed in 2015 requires Connecticut hospitals and clinical laboratories to connect to the statewide HIE within one year of it becoming operational, and healthcare providers with electronic health records will be required to connect within two years.
If all goes according to plan, the new HIE will allow authorized users to see where and when individual patients have received care—a full view that is not available anywhere else—and will be able to generate summarized data on topics including health outcomes and costs.
One use case is exchanging summaries of patient care, known as Consolidated Clinical Document Architecture. This refers to the capability of organizations to “pull” (access through a query) standardized patient health summaries (called C-CDAs).
The HIE will also offer two shared services that were specifically chosen to demonstrate the value a statewide HIE can provide. They are functions that no single organization can currently do by itself—provide a full view of where patients are receiving care and provide summarized data from multiple sources for analysis. They are:
• Identity and Care Map. This service keeps track of patients’ consent to sharing and accessing information through an HIE and allows users who have permission to see a universal view of where individual patients are receiving care. The care map identifies all of a patient’s relationships with active caregivers, including where and when that patient received care.
• Core Data Analytic Solution (CDAS). This service allows users who have received permission to report and analyze summarized data from various sources to answer questions about topics such as health outcomes, disparities, or healthcare costs for a specific population.
