Some health information exchanges have started referring to themselves as “health data utilities” because the term accentuates the central role they are playing in exchanging and enhancing health data in their states. At the Civitas Networks for Health annual meeting, leaders from Vermont, Rhode Island and Nebraska described what the shift in terminology means in their contexts.
Beth Anderson is president and CEO of Vermont Information Technology Leaders (VITL), the legislatively designated operator of the Vermont Health Information Exchange (VHIE).
Vermont has approached HIE as a public good from the inception of HIE activities in the state, she said. HIE is largely funded by the state through a portion of a dedicated tax on healthcare claims, which the state uses to leverage federal funding in support of HIE activities.
But Vermont has taken efforts in recent years to reorganize HIE activities across the state in line with a public utility model, Anderson added. “One of the most significant changes we made was in 2017 when a multi-stakeholder governance infrastructure was put in place that includes representation from stakeholders across the healthcare ecosystem in Vermont. It is really charged with guiding and prioritizing the state's activities and investments in health information exchange.”
VITL is looking for new opportunities to leverage the HIE to meet some of the state's needs for data utility beyond the traditional use cases. The state Medicaid agency has used VHIE data for many years, for things like informing complex care management for Medicaid patients, to provide comparative performance analytics for the patient-centered medical homes and also to calculate their performance payments. “In the spring, we received CMS certification as a module of the Medicaid enterprise, which further strengthened our partnership,” Anderson said. “We're continuing to look at opportunities to enhance and grow the Medicaid operations. Ideas that we're looking at right now include using the VHIE to inform prior authorization decisions, to support HEDIS reporting, as well as to serve as a data warehouse for their new Medicaid enterprise system analytics and reporting program. We're also looking at working with the Medicaid agency to think about health equity.”
In addition, Vermont has many providers who were left behind in terms of Meaningful Use incentives. “We have a lot of providers who have not been able to connect to the HIE, and they have patients who really struggle with access to care and incomplete care,” she said. “One step we'll be taking over the next couple of years is implementing a program that the state will sponsor that will enable those providers to connect to the HIE and have access to the services to help them really support their more rural communities.”
Neil Sarkar, Ph.D., is the president and CEO of the Rhode Island Quality Institute (RIQI), which serves as Rhode Island’s regional health information organization. Prior to his current role at RIQI, he was the founding director of the Brown University Center for Biomedical Informatics.
One focus of RIQI is to help individuals aggregate their own data. “We serve essentially as the state's longitudinal medical record. People only think of their electronic health record or an HIE in times of need, but we are still there even in between those times. The health data flows all the time and that builds into this principle of a health data utility,” Sarkar said. “We look at how we can better engage the patient in their care. We're really proud that we have an untethered patient portal that's attached to the HIE that allows an individual to log into their longitudinal record and see the latest information about them.”
Sarkar recounted being in a hospital bed himself and being able to find his own lab results through the HIE portal even before the clinical team in the hospital had told him the results.
“It was at that moment that I really appreciated, not just what we do as an HIE, but what it means in terms of being able to engage me as a patient in the dialog with my care team, he recalled. In addition, by listening to providers during the pandemic RIQI was able to create the kinds of dashboards primary care offices needed as well as providing valuable information to the Department of Health.
“If you're a utility, and you think about things like electricity or water, there should be standards behind that,” Sarkar said. “We've never really thought of it until just recently with the national discussion of health data utilities — could you actually plug something into a receptacle? So we're very bullish on Smart on FHIR, so we wondered if we could take a Smart on FHIR app from one of the Smart galleries and attach it to the HIE. We just implemented that in our clinical viewer where providers can log in and can see information pulled together by an off-the-shelf Smart on FHIR app.”
Earlier this summer, the HIEs in Vermont, Maine and Rhode Island announced a partnership. “We realized, given the things that we were all trying to achieve, as well as the scale of our organizations, that it would make sense for us to partner to think about how we could work together both to enhance or advance the needs of our individual communities, but also to think about the region and how we can enhance interoperability and support our patients across the region,” Anderson said. “We're in the early stages of figuring out what all of that means and taking time to share information, or best practices and learn lessons from one another. We're really excited about the opportunity that we have to work together to implement some new capabilities that we maybe couldn't do on our own and that will be more successful together, and also to tackle some of the gaps we have in data, particularly specialty care that many of our patients from across our states receive in neighboring urban areas.”
Jaime Bland, D.N.P., R.N., is president and CEO of CyncHealth, which operates the health information exchange for Nebraska. she has piloted CyncHealth’s strategic growth beyond the established health information exchange and Prescription Drug Monitoring Program to include three new entities – CyncHealth Advisors, the CyncHealth Foundation, and Nebraska Healthcare Collaborative. In addition, the Iowa Health Information Network recently joined CyncHealth.
She was asked about the efficiencies gained in providing the back-end infrastructure for the HIEs in both Nebraska and Iowa.
Bland said the value was less in getting both states on the same platform and disrupting that legacy technology in Iowa. “Most of our use cases are not driving providers to a portal. That definitely occurs, but we do single sign-on workflow integration components and API integrations. That's where most of our utilization of the data comes from, from a provider perspective.” She also said they have launched a patient portal and are working through some of the nuances of engagement with that.
“If we think about what a health data utility really means, we focus on the data aggregation, and more of our work is based on that cloud environment vs. what technology our portal is,” Bland said. “We are really focusing on those data-as-a-service use cases that we can use to serve our multiple stakeholder portfolio. We have got to be able to pivot and flex for every one of those use cases, and that doesn't come by pushing people to a portal to query for one patient at a time. The majority of the work that we're doing is leveraging those cloud-based infrastructures and data so that we can fulfill those multiple use cases, as well as public health, Medicaid, and the provider community.”
