At the June meeting of Oregon Health Information Technology Oversight Council (HITOC), stakeholders described where progress has been made on health data interoperability and where there are still gaps and frustrations. 

HITOC is a committee of the Oregon Health Policy Board responsible for setting health IT strategies for Oregon that advance health equity and improve the health system. The Oregon Legislature created HITOC in 2009 to ensure that health system improvement efforts were supported by health IT.

During a panel session, health system executives were asked what they think is needed to support interoperability maturity in Oregon.

Seth Harriff, manager of information systems applications for Portland-based Legacy Health System, spoke about the health system’s evolution with interoperability. “I’ve been with Legacy for nine years now, and over that time, I think we've approached interoperability as a maturing care delivery capability, as opposed to an IT product or service. It is something that augments the care that is delivered by giving people information that they wouldn't otherwise have access to.”

He said Legacy has been an early adopter of exchanging with the VA, the Department of Defense, Social Security Administration, and referral exchanges with OCHIN, as well as around infectious disease reporting and electronic case reporting. Legacy was an early adopter of TEFCA as well. “Now we're contemplating the potential of harm that comes with sharing a lot of information about our patient population,” he added. 

One of the challenges, Harriff said, is being able to discern the signal from the noise. “There’s a lot of noise in the data that is exchanged between organizations. TEFCA is supposed to be a single connection that solves most, if not all problems, and it is not there yet,” he said, adding a list of other areas that still need work. “There are lots of pockets where we're unable to get information that is important to our ability to deliver care, and those pockets can be geographic, they can be socioeconomic, they can be the mode that care is delivered in,” he said. “We still have big gaps in our ability to exchange data with long-term care and skilled nursing facilities. There's good work happening, but we're not there yet around exchanging information with transport and emergency medical services. There are real barriers to exchanging behavioral health and substance use disorder information. There are real substantial gaps around information we don't have about what patients are doing outside of the normal healthcare ecosystem, and that is leading to harm.”

Nick Powers is the CEO at Winding Waters Clinic, a small Federally Qualified Health Center in rural Wallowa County in Eastern Oregon. He said Winding Waters has a lot of connectivity opportunities and is having to get much more thoughtful about where data goes. “We need to make sure we're doing our due diligence as a really small, remote organization. We rely on expertise from OCHIN primarily for interoperability.” (Portland-based OCHIN hosts Epic and provides other health IT services for community health centers and other providers across the country.)

He stressed that his small staff can’t be moving in and out of lots of different platforms. “The fastest way to hear concerns from a workforce or to burn out a workforce is to have them trying to switch platforms. We see that a lot as we've taken on state public health work. Our teams are jumping between a lot of platforms,” Powers said. “Because we are a very small organization, we need the scale that a large vendor provides, and the integrations that that large vendor can support at a cost we can sustain. So almost exclusively interoperability for us has meant OCHIN Epic.”

David Dorr, M.D., M.S., chief research information officer at Oregon Health & Science University, spoke about progress OHSU has made as well as some frustrations with TEFCA. 
 
He said the group at OHSU in charge of protecting patient privacy and confidentiality has had “consistent concerns about the rollout of TEFCA and the people who can jump on to the network, and the issues around privacy for that.”

OHSU belongs to the Epic QHIN and has historically been engaged with Carequality. “We’ve adopted the things that we've needed to adopt, but we continue to advocate for clearer, safer rules," he said. "However, I would say that identifying the use cases where a lack of interoperability is very harmful to people and communities is useful and we've done a lot of work with that.”

Dorr said OHSU has several projects with behavioral health sites, where they are trying to figure out if they can improve the interoperability and access to information that would help those people and the people they serve take better care of their patients. That could lead to standardized assessments of significant mental health needs over time, which is an evidence-based approach to managing those needs and medications. “To do that, you really need to be able to have access to concrete structured information that you can then incorporate, and there are just big gaps there,” he said. 

Dorr said OHSU continues to monitor what he called the the TEFCA “roller coaster.” 

“We have been working with our own QHIN as well as directly with ONC and others to talk about what should be the highest priority and how do we really create a feasible ecosystem that isn’t somehow worsening fragmentation or actually worsening disparities and access to the data,” he added. “We’ll push for better patient access through individual access services through TEFCA. We want patients to be able to direct this when it's really important. On the other hand, we want the ability to have clearly structured information available through these QHINs so that we can perform decision support on it, so that there's a complete record of the actual data, and honestly our QHIN doesn't do that. We don't own the data, so we can actually perform decision support on it, so we could have inferences that are incorrect.”

Dorr said “the fragmentation of rules and policies has led to a pretty challenging system of interoperability in which to interact, and we probably need to really address that, not just at the state but the federal level.”

Ravi Nanayakkara is IT manager, data integration services, for PacificSource, which runs coordinated care organizations in Central Oregon, the Columbia Gorge, Marion County, and Polk County. 

He said keeping up with the investment associated with interoperability on an enterprise infrastructure level is challenging. His organization is currently enabling API features. “We are partnering with Epic, and then we're also looking at our tech stack, for example, because upkeep of that is a lot of overhead. I think where we will see true value is probably with the prior authorization data. That will really support a member fairly well, but with others we're not seeing the level of traction that we would hope to see. Maybe that will change.”

Dorr suggested that for the state of Oregon, a way forward would be not to try to boil the ocean but to figure out where the biggest gaps are. “I would say that behavioral health is one. We have really vulnerable people there, and the gaps are enormous. The work on health-related social needs is really good. There's a huge gap there that continues, so maybe thinking of a system where those groups are lifted up is important.”