In Columbia, Mo., the Missouri Health Connection (MHC)—the state-designated health information exchange (HIE) network—was started in 2011 as an executive order by former Gov. Jay Nixon as part of the HITECH Act. But once federal funding dried up, as it did for many HIEs across the country, MHC’s strategy needed to shift to remain sustainable in a competitive landscape. The organization hired Angie Bass—previously a health policy research analyst for the Missouri House of Representatives and a project analyst for the Missouri Department of Mental Health—in 2012 as program manager, but Bass quickly rose through the ranks to become MHC’s president and CEO.
Under Bass’s leadership, MHC has become one of the nation’s largest health information exchanges, covering a territory of more than 69,000 square miles with more than 22 million patients in its network. Bass, who is speaking at Healthcare Innovation’s Midwest Health IT Summit on March 19 about the future of health data exchange, recently spoke with Managing Editor Rajiv Leventhal about MHC’s journey, the biggest challenges that exist today for HIEs, and how the organization is providing value for its members.
What kind of data is currently being exchanged via your network?
The quality of data is our highest priority. The type of data being exchanged includes everything in ADT [admission, discharge, transfer] feeds [using HL7 standards], as well as in continuity of care documents [CCDs]. And then we have some public health interfacing for meaningful use. From an HIE perspective, we can transact anything.
The limitation is not on our ability to be interoperable between disparate systems, but [rather] the limitation is the vendors being able to export the data out of their own systems, and then allowing the customers they are serving—the healthcare providers—to be interoperable.
For instance, the meaningful use certification around what should be included in a CCD is not the entire patient record; it’s just a subset of data. The meaningful use certified version doesn’t include the critical pieces of information that most every clinician wants, such as discharge summaries, notes, and H&Ps [histories and physicals]—all the things that are very relevant and necessary for good care coordination and transitions of care.
What we have been very focused on in the last 18 months is going back to each of our data contributing participants—so everyone who is giving us an ADT and everyone who is sending us CCDs—and expanding those interfaces so that we are getting the most robust data. This [involves] going back and working with them to see how we can extract the most data out, such as going back to a raw ADT feed and adding in those notes and other content that’s necessary. Sometimes that’s challenging, not necessarily because it’s the healthcare providers pushing back, but the vendors who are pushing back.
This speaks to the HIE’s value proposition. Can you discuss that further?
One of the things we always stress is the niche that an HIE serves is doing the data normalization of disparate systems. So, being able to extract from one EHR [electronic health record] and normalize the data in a way that makes sense for another EHR vendor to ingest. Inherently, the EHR vendors are not incentivized to do that with each other on their own, though through CommonWell and Carequality, that is what [those associated vendors] are portraying as the goal of that relationship. But it isn’t happening in the real world; it’s not happening from urban to rural, from acute to ambulatory, or between behavioral health and post-acute care. That’s why an HIE is necessary.
Meaningful use [regulations and incentives] left out post-acute and behavioral health providers, meaning none of the EHR vendors [in that space] need to be meaningful use-certified, so they are playing catch-up. That has been devastating to the industry from an interoperability perspective. Where are the vendors stepping up to help serve [these providers]? But the HIEs are; they are helping these providers with transitions of care as they move onto EHR systems.
Do you see HIEs as being sustainable in the long-term?
HIEs are, for the most part, vendor-agnostic, not-for-profits that are truly doing a community good and service for providers that need to be interoperable because not everyone will be on an Epic or Cerner EHR. There are going to be those specialty and rural practices that need all the help they can get from a health IT perspective, and that’s what an HIE is there for: to be the intermediary for state agencies to interact with HIEs, and also with the federal government.
We are competing against those large EHR vendors that are aligning for their own self-interest needs. And that’s kind of how the game is played, but we aren’t going anywhere. I am confident about that.
How are federal policies such as TEFCA (ONC’s Trusted Exchange Framework and Common Agreement) playing a role in your operations?
The first draft of TEFCA did not take into consideration these vendor requirement pieces. It’s all the HIEs’ responsibility to make sure they can transact every specific piece of data, but there is no teeth in requiring the EHR vendors to be able to send that data out to an HIE, without charging their customers an obscene amount of money for an additional interface cost. So I think the intention of TEFCA is good to increase interoperability on a national scope, but I think the framework on the initial release was flawed.
