HealthInfoNet, the health information exchange for the state of Maine, has been working to determine ways that HIEs can integrate social health data to support meaningful workflows for stakeholders within and across systems of care.
During a session at the recent SHIEC conference, Chad MacLeod, director of product and communication for HealthInfoNet, described how the organization has been working to Identify opportunities for how HIEs can best engage primary care associations and Federally Qualified Health Centers (FQHCs) to consider the role that HIEs can play in the transformation of data strategies to align with ‘Community Health Information Exchange’ models.
Since 2016, HealthInfoNet has participated in the Robert Wood Johnson Foundation’s Data Across Sectors for Health (DASH), which is a learning network seeking to assist communities across the country with technical and engagement foundations for neighboring multi-sector data sharing practices. The organization has created a learning group charged with understanding the use of social health information among the Maine Primary Care Association’s FQHC members and shared some recommendations about establishing a unified set of related data collection, exchange, and operationalization strategies.
Among the groups they worked with is York County Community Action Corp., which serves as both the community action agency and as an FQHC called Nasaan Health Care.
The project examined FQHCs’ challenges in terms of sharing individual-level information between clinical and community settings. “We're also just beginning discussions about how the statewide HIE infrastructure could be leveraged to collect discrete social risk factor data elements received from FQHCs for care management and population health management purposes,” MacLeod said.
The project’s three primary objectives included:
• Assessing each FQHC participant’s capacity to identify where social risk factor data elements are stored in internal technical systems,
• Identifying which social factor data elements are actively shared with the HIE and which ones are not being exchanged that could be shared,
• For those different types of social risk factor data elements that are not being shared, identifying what's the most appropriate data submission method to get them to the HIE.
“We prioritize the collection of social risk factor data elements for care management, population health management or value-based purchasing purposes,” MacLeod said. They also developed recommendations outlining a core set of social risk factor data elements that could be collected, stored and exchanged among the majority of Maine’s FQHC communities.
Several Maine FQHCs engaged in a six-month convening process held between January and June 2021, with some limitations caused by the pandemic.
MacLeod noted that in Maine, and nationally, FQHCs are on the front lines of addressing and improving the quality and cost-effectiveness of care for individuals with complex medical and social risks and conditions and outcomes by augmenting their traditional medical, behavioral health and dental services with partnerships among community-based organizations and social services. FQHCs are able to form cross-sector dialogue geared toward addressing emerging person-centered strategies.
Maine’s FQHC network establishes a comprehensive safety net design with diverse geographic locales, different patient demographic profiles and assorted community-based partnerships, he said. Maine’s FQHCs are uniquely and strategically positioned to shift the paradigm of how care is delivered. For these reasons, he said, the FQHCs in Maine and beyond should be considered as innovators and leaders in this work for which other systems of care could learn, adopt and evolve. He quoted one FQHC participant speaking during the convening effort’s collaborative forum, “Were designed to do this work.”
Among participants, the clear priority is to share social risk information with other entities such as community action agencies and area agencies on aging and even serve as coordinating agencies, MacLeod said. However, due to limitations in resources, infrastructure, and data governance, such strategies have stalled.
“Even in cases where the data does begin flowing across sectors, as one participant observed, figuring out how to leverage the information is like trying to put a Band-Aid on some of their community's biggest systemic problems,” MacLeod said. The ability to connect individuals with the necessary resources to address the health-related risks, conditions and outcomes highlighted as a result of the assessments is often presented with the same set of challenges that were experienced when implementing the tools themselves — limited clinical staff, limited technical resources and limited patient time. “Although FQHC agencies are naturally suited as community-based healthcare providers to pilot social health data strategies, all project participants agreed that they need external assistance strategically, technically, operationally, and financially in order to be successful in their endeavors,” he said.
Also speaking during the SHIEC webinar, Martin Sabol, director of health services at Nasson Health Care, said they have great relationships with other social services and healthcare partners. “We certainly are participating in health information exchange, so medical information is available to other medical providers who ought to have access to that information. In terms of the other social service agencies, though, data sharing is really quite limited,” he said. “Healthcare is one division of York County Community Action. Other divisions include transportation, children's services, and economic opportunity, which is case management services. To the extent that we are identifying social risk factors through our screening efforts, we actually have a pretty strong referral base that we can direct people to. Externally, though, we don't really have this electronic referral network in place. We basically just provide contact information to the patient. Sometimes a care manager will step in and facilitate those referrals but it's not a data-sharing arrangement.”
To proceed in the development of community health information exchanges, HealthInfoNet said that collaborative design is required among the HIE, MPCA, the state’s FQHCs, cross-sector partners, and community members with lived experience.
To determine how social risk factor data sets will be incorporated within healthcare and finance existing health information services, the HealthInfoNet report offers a variety of use cases for each of the priority risk domains — food insecurity, housing stability and transportation access.
“There is much left to be done in the domain of social health data strategies. For HealthInfoNet and other peers approaching the field from a technological perspective, overcoming these challenges are akin to how today's HIE model currently supports medical care workflows by connecting disparate EHR systems to share clinical data among diverse stakeholders,” MacLeod said. “If the outputs from social risk screening tools can be exchanged and compiled in a comparable method, with underlying terminology processes in place, then a CHIE model is technically feasible.”
MacLeod said that evolving the existing HIE into a full CHIE model, enabling the exchange of sensitive and potentially stigmatic social risk factor information with the statewide HIE for expansive cross-sector use, calls for a deeper dive into the related complexities of privacy and confidentiality laws on consent management and information-sharing protocols.
Another risk to the continued planning and eventual implementation of HealthInfoNet’s recommendations is funding. In order for FQHCs to be successful in the various strategic, tactical and operational data strategies under consideration, external financial assistance is required, MacLeod said.
Among the project’s recommendations are:
Data Operationalization: Identify common social health risk domains challenging Maine’s FQHCs and expand the HIE’s existing health information services to supplement internal care management and population health management efforts.
Data Exchange: Exchange discretely stored social risk factor data sets with the statewide HIE for further normalization, standardization, and aggregation in support of actionable downstream use cases and services.
Data Collection: Collect and store a unified social risk factor data set through an electronic-based social risk screening tool that is achievable and actionable within each FQHC’s current model of staff, time, and resources.
Sabol summarized the urgent need to continue doing this work. “Here in the United States, we kind of missed the boat in terms of allocation of resources for social services relative to medical services,” he said. “Elsewhere in the developed world, there's much more of a balance, and there's much more of a focus on hitting all the social needs that people have, or as many as possible. And there's also evidence that there are better health outcomes when that work is done. So to the extent that we may not have the resources here in this country, right now, it's still definitely worthwhile collecting the data to justify expanding services and extending housing opportunities here in Maine.”