HealtHIE Nevada’s Quest to Remain Sustainable—And Why it Must Keep Innovating

Sept. 24, 2019
The HIE recently went live on a connection with the statewide immunization information system

Nearly a decade ago, the Department of Health and Human Services (HHS) launched its Healthy People 2020 initiative, setting the goal of attaining high-quality longer lives free of preventable disease.

Part of that outlook includes increasing immunization rates to reduce preventable infectious diseases, which remain a major cause of illness, disability and death across the U.S. As such, with HHS advising that improved immunization can lead to better health of patient populations, doctors need to be armed with the most current patient records when possible.

To this end, a recent collaboration between HealtHIE Nevada, a statewide health information exchange (HIE) and Nevada WebIZ, the statewide immunization information system, is aiming to allow healthcare providers the ability to retrieve immunization data quickly and securely. The connection went live a few months back, and was established using funds obtained through a $1.2 million grant supported by the HITECH Act.

Senior leaders from HealtHIE Nevada, which currently partners with more than 70 organizations across the state, note that HealtHIE Chart, the HIE’s view-only clinical portal which allows providers to access a patient’s clinical information, will now be able to display all of a patient’s updated immunization data. Since the WebIZ search is instantaneous, electronic records will always include a patient’s most current data from the registry, they say.

One of those leaders, Michael Gagnon, executive director of HealtHIE Nevada, recently spoke with Healthcare Innovation about the motivation to partner with Nevada WebIZ, how things are going following the connection go-live, and other health information exchange-related considerations. Below are excerpts of that interview.

Can you discuss the driving force behind partnering with Nevada WebIZ?

The HIE has had a fair amount of success in Nevada and the state has done a good job of collecting immunization records from providers for quite some time. It has a solid registry, a good staff that understands interoperability, and [state leaders] wanted a way to expose those immunizations to providers who need them, in the most efficient way possible. The [state] has its own portal and folks do use that regularly, but they were looking for other ways to spread the information they have so that more people could gain access to the fact that patients have had immunizations.

So we partnered with Nevada WebIZ via the HITECH 90-10 grant, looking to connect the state immunization registry to the HealthHIE Nevada system so that there would be another avenue for providers to get that immunization data when they get the rest of the medical records that we provide through the HIE. We developed interface capabilities, and now [members] can access the immunization registry, and it’s on-the-fly access, meaning the provider can see the most recent immunization history. We don’t store anything on our network, but we query the [records] in real-time, and now providers are starting to use them. It was the second most important thing that providers were asking for from the state; the first was access to PDMP database.

How were providers previously gathering immunization data?

Providers struggle with the fact that they have so many places they have to go to look for medical information. While registry organizations do a great job of collecting, aggregating, and normalizing the data, they do have trouble getting individuals to use their portals. For example, you have to go the cancer registry for one thing, the immunization registry for another, and the HIE portal for a third. And then you have to look for medication information somewhere else. Providers don’t have the time to do all that, so the more they can get [important] data from a single source, the better.

How will you measure progress, now that the connection has gone live?

We do have a way to measure each time a provider uses our portal to look at the immunization data. How many queries are performed of the state’s immunization registry, or how many are performed if they’re using the [HIE’s] portal? So we measure the outgoing queries against the hits that come back that [contain] actual information. We will have an ability to produce that information later this year. And we do measure other queries, so we know that we can do it; it’s just a matter of putting it into our dashboard.

Can you talk about some of the other innovation that the HIE is working on right now?

We recently put out a grant [request]—and other HIEs have done this too—to broaden our scope by looking more at the homeless population and social determinants of health. Others might be ahead of us in this, and others in the HIE space are moving in this direction, but we are looking to create a relationship with the Homeless Management Information System in Clark County, the largest county in Nevada. Folks who are in need of housing often show up in a medical facility, but the housing [officials] often can’t get in touch with them. However, at times there are touch points and we might be able to inform those people that there is housing [available], which can really help them. So we are broadening our scope with the information we pull into the HIE in order to serve the population more effectively.

We are also looking at how we can keep helping providers by narrowing the scope of the information they see. HIEs can run into a problem of ending up with too much information at times, with summary documents that get to be big and verbose.

So with partner HIEs, we are working on [developing] a slimmed down version of key patient data that goes to specific provider types. For example, an OB/GYN might care about five or six different data fields on a patient, so can we pull the raw data and give them a single summary sheet of the data they might care about. If one of those [fields] sparks the provider’s interest, then you can go to the rest of the medical record to figure out what kind of treatment the patient had, or they might say, everything is OK, and they don’t need to look at the full care summary and dig through all the information. That makes the provider’s job easier. We have a clinical practice committee that is currently looking at how to take subsets of data for specialty groups, start to give them more of a snapshot of information, and push that to them, as opposed to have them query it out of us.

How has the HIE responded to TEFCA?

We submitted comments both to TEFCA Drafts 1 and 2, and we had good things to say about the changes they made from the first draft to the second. They added message delivery—sometimes called event notification—which is essentially pushing messages to people. Based on trigger events, you can help providers learn what they need to know. And they also added something called targeted query, in addition to the broadcast query that they had. So that means if you are already aware of where a patient’s medical record is, via the record locator service, then you can be more effective in collecting information.  

HealthHIE Nevada is probably too small to become a QHIN (Qualified Health Information Network) alone. But we are working with several other organizations here in the West who run HIEs, and through SHIEC (the Strategic Health Information Exchange Collaborative),  we are considering how to become a QHIN moving forward.

What that might look like remains to be seen. It could be one [bigger organization, comprised of multiple HIEs], or there could be regional versions. And that is a logical extension of what we are already doing with patient-centered data home concept that is underway. In the West, we are already exchanging ADT messages with each other so that when a patient  visits a [provider] on an HIE that isn’t his or her “home” HIE, the patient’s care summary can be pushed back to the “away” doctor so he or she will have real-time information on that patient.  

Do you think TEFCA infringes at all on the progress that some HIEs have already made?

Federal policy always creates angst amongst people, but it also causes things to happen in terms of how you need to mature what you do. Many of us believe that for the most part, the ONC proposed rules in its implementation of the 21st Century Cures Act, as well as TEFCA, are generally good. They are trying to improve interoperability, so we need to embrace that and think about what we need to improve [as HIEs] to make that happen.

And there are challenges around that, of course. It might change the business model a bit around what HIEs do in order to band together more so we can then create this QHIN and benefit from it. We have done a lot of the building block work, so we need to be proud of that and figure out what the next steps are. I view it more as an evolution and less of a threat.

What advice can you offer for HIEs to remain sustainable and continue to provide value for their members?

Every state and region is different, but I think the way to be successful is to figure out how to do two things when it comes to financing your HIE. First, you need to establish a clear, ongoing sustainable funding source. In our case, that comes from the payers and providers. We’ve gotten a small amount of money in HITECH 90-10 funding compared to what some states get, so I’d [advise] to use that funding money from grants and such to build your infrastructure, grow your network, and add services. But you first need the sustainable model of your providers and payers paying you in order to be successful going forward. So, you need an operating fund and then a capital fund, essentially.

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