How CRISP Shared Services Is Approaching Public Health Data Modernization
Last year nonprofit HIE infrastructure company CRISP Shared Services (CSS) was named one of three Implementation Centers for the CDC’s Public Health Infrastructure Grant program to help with public health data modernization. The organization’s public health leader, Sheena Patel, M.D., recently spoke with Healthcare Innovation about her team’s efforts to engage public health agencies to identify and close data gaps.
CSS supports health information exchange organizations in several states, including CRISP, Maryland’s state-designated health information exchange (HIE) and Health Data Utility (HDU); CRISP DC, serving the District of Columbia; Connie, Connecticut’s state-designated HIE; Virginia Health Information, the state-designated health data organization in Virginia; West Virginia Health Information Network, which serves as the state’s only HIE; and healthEconnect, Alaska’s state-designated HIE.
The infrastructure grant program, funded by the U.S. Centers for Disease Control and Prevention, tasks CSS with providing infrastructure and implementation services to dozens of public health agencies over the next three years.
Prior to leading public health efforts at CSS, Patel managed the HIE Projects and Provider Relations teams, and was one of CRISP's behavioral health subject matter experts.
Healthcare Innovation: Your title is Executive Director of Public Health Modernization. Is that a fairly new role at CRISP Shared Services and can you talk a little bit about what it entails?
Patel. It is a new role. It was conceived once we started to talk about the Implementation Center project, knowing that that was going to be a big lift. But as things have evolved over the last year, I think we're realizing more and more that public health, generally, is an important piece of our puzzle. It is a critical part of the infrastructure and what we're hoping to accomplish.
HCI: Is standing up that Implementation Center taking up a lot of your time, or are you also reaching out to public health agency executives in states where CSS is working with state HIEs?
Patel: We're doing both. With the Implementation Center, we are making sure that the governance is in place. But as we think about public health generally, from the CSS lens, we are looking at our overall strategy — what tools do we want to provide? How does this work for our existing partners? That's kind of where my team is going to come into play. We are very much in our infancy, and still trying to figure it out, but I imagine it's just going to be like another work stream or product line that we offer.
HCI: Public health agencies exist on the state and local level. Are their data interoperability issues and challenges and resource issues similar or somewhat different? When you talk to the execs of those agencies, do the same type of pain points rise to the surface as far as data modernization efforts go?
Patel: There are common challenges. Everyone needs data, and it's a challenge to get that data, but at the same time, we do understand that every state and every jurisdiction has their limitations in terms of how they obtain that data. We have a really robust project team that's prepared to wade through any legal challenges or policy challenges that folks face.
HCI: Are there also financial issues that they're talking about — not enough staffing or resources to tackle these issues?
Patel: From the public health agency side, there's always a resourcing challenge. They have 100 priorities, and only so many people to be able to fulfill those. So we try to fill those gaps where appropriate. But yes, resourcing and finances are always a challenge. I don't think that this program itself is going to solve that.
HCI: Were there some lessons learned coming out of the pandemic about gaps in data sharing, and have some of those already started to be addressed, or is there still a lot of work to do?
Patel: Coming out of the pandemic, people are realizing the benefit of an HIE or health data utility and realizing that there is a source of data that can provide information for case investigations, reporting, analytics, and other things. At the same time, I think that there is a gap in workflow that needs to be addressed at the public health agency level. I think they would acknowledge that they just don't have the information they need. There are standards that are always changing; there are technologies that are always changing, so they're trying to keep up with those. Hopefully, CSS can provide some level of a stop-gap when they need that information.
HCI: One thing that we've heard as a complaint from health system execs is that the data sharing is too much in one direction— flowing from their organizations to the public health agencies, but not the other way. Is that a legitimate gripe on their part? And if so, are there efforts to make the data flow more bidirectional?
Patel: When you think about serving the patient, I think that there is an opportunity to build on that bi-directional workflow. Everyone knows you have to report public health things to public health, but where there's an opportunity for public health to make providers aware of certain things, I think that we should do that, and we are doing that. A great example from CRISP in Maryland is that we are doing things like infectious disease alerts. The Maryland Department of Health is giving us information about patients who are experiencing a specific infectious disease. We are displaying that for providers in the ED and for all of our clinical providers to see so that they can put in place isolation protocols or whatever they need to do. They are getting that information upfront, when they see the patient, before they have to call somebody with the Health Department. I think that's something we could really build on.
HCI: I read that CSS supported Maryland in becoming the first state public health agency to implement TEFCA and is working with other public health authorities on that. What are some ways participating in TEFCA will be valuable to state health agencies?
Patel: I think there's a lot of benefit in TEFCA when it comes from an inter-jurisdictional perspective. When you think about a Florida or a Las Vegas or an LA, it would be so fantastic to be able to leverage a national network to get information about people who are transient, who maybe you don't have another way of getting information about because they're not from your state and they're not part of your local exchange. I think there's real opportunity to build on the cross-jurisdictional nature of it.
HCI: Then the providers in the other jurisdiction would not only get data that's flowing out of their clinicians’ offices, but the data that's flowing out of public health as well?
Patel: Exactly. Doctors get to talk back and forth. They have a clinical use case to share information about. But if I am an epidemiologist in the public health space, even within my own state, I don't have that level of ease technology-wise to share data. If TEFCA can provide that kind of easy mechanism to help with case investigations, to help address outbreaks, I think there's a real opportunity.
HCI: Were there any challenges to getting that set up? And if so, were they more policy or legal issues vs. technical ones?
Patel: I don't think it was a technical issue. We were able to set up the technical pipelines. I think we had a really great partner in eHealth Exchange, our QHIN. I think the key challenge here is working through policy and procedure in terms of what clinical data is appropriate for public health to see, and working through those types of details and opening up the doors so that when you do query, there's actually data available for you to see.
HCI: I've read a bit about the work of a public health FHIR implementation collaborative, and I think there's a public health FHIR accelerator at HL7. Does FHIR have a role to play in the future of public health, data sharing?
Patel: I don't think FHIR is the next thing that's going to solve all the problems. I think FHIR is an additional tool that will either create efficiencies or create less burden in terms of workflows, and hopefully we'll get better data in. I don't think it is a replacement for current workflows, but I think where possible, we should work towards implementing FHIR.
HCI: As one of three Implementation Centers, are you working with some subset of the states or with all of the states? Is it divvied up in some way?
Patel: Essentially the Implementation Center is working in what we're calling waves. We have wave one, which is essentially the first year or so of implementations. CSS will be working with 14 public health agencies during that time to advance their projects. And generally, those projects for this first wave have been within the electronic case reporting (ECR) and immunization space. The way the program is outlined, outcome one means using the best possible technology, essentially, for data exchange. Outcome two leverages TEFCA for data exchange. So essentially, they could, be pursuing outcome one, two or both in those priority use case categories.
HCI: Are there multiple ways to do ECR, or is there a best practice or standard that most people are using to do that?
Patel: There are standards involved like USCDI, but we are very much in a mindset of “meet them where the are.” So if they are in a space where they are not even doing ECR yet, they're just receiving faxed case reports, maybe their project is just to get themselves to a point of ECR. Maybe somebody else who's doing ECRs is really trying to move toward being able to create reporting and analytics based on their ECRs. We are really trying to meet them where they are and fulfill the project that they're proposing.
HCI: Is there an overlap between the people you are working on these projects with and the broader public health efforts in the states where CSS provides HIE services?
Patel: There’s definitely overlap, especially in this first cohort. We are working really closely with the HIE leaders in each state to make sure that they're aware of what's happening in their health departments that we're working with, and we're hoping that there are synergies, and I'll say, especially in the sustainability side of things. There may be funding for this specific endeavor, but at the end of the day, in 12 months, they have to make this solution keep moving. And so we are very much working in tandem with the HIEs, especially those that have Medicaid funding and other funding mechanisms, to make sure that those things start to get looped in and folded in for sustainability.
HCI: Well, it sounds like you're very busy. Is there anything else that I haven't asked about yet that you'd want to mention?
Patel: No. But you’ve caught us at a really good time, because next week there's a welcome webinar to get everyone on board to understand what they're signing up for, and then we're off the races.
