Traditionally, state Medicaid organizations don’t have reputations for technology innovation, but they are well positioned to incentivize data sharing and play a catalytic role for providers. Informatics executives from Minnesota and Mississippi recently discussed how the pandemic has spurred their ongoing efforts to share clinical data with providers.
Speaking at a virtual State Health IT Connect Summit on Aug. 6, Jacqueline Sias, provider informatics lead for the Minnesota Department of Human Services (DHS), described how the pandemic had allowed DHS to expand an encounter alerting service it had created.
Sias started by providing some background on Minnesota’s unique landscape around health information exchange. In general, Minnesota is proud of its leadership in healthcare improvement, “but when it comes to HIE we have not been leading,” she said. “We lack trust between payers, providers and government. We also have strict privacy laws and are an opt-in state. Some groups feel strongly about not sharing data.” That has made it tough to set up a statewide HIE, she said.
Another issue is that the majority of large integrated health systems all use the Epic EHR and share data that way. “They feel they have what they need,” Sias said, but in terms of sharing with other smaller providers, it has caused problems and has led to there being haves and have-nots. “They can share alerts with each other, but providers in other clinics or on other EHRs have not been able to receive those," she said. "There have been several attempts at HIEs that have failed across the years.”
Once the State of Minnesota created Medicaid ACOs, however, there became a need for more data sharing. The state shared claims data with providers, but providers said it was still difficult to do transitional care management without real-time alerts. In response, the state Medicaid agency set up a statewide alerting service for Medicaid. “We decided to keep it simple and not call it a state HIE,” Sias explained. “We wanted to stay focused. We were just solving a problem. We didn’t want to scare people off. That was successful. We wanted to crawl, walk, then run, and that is what happened."
They started with Medicaid only, and just for admission, discharge, and transfer (ADT) notifications from hospitals and emergency departments. "We were really focused on those Medicaid ACOs," she said. "We got a great response from the Twin Cities area, which has about half the population of Minnesota, but we were struggling to get adoption outside that area. What pushed us over edge in March 2020 was COVID happening and we had the CMS interoperability final rule drop, which requires ADTs to be sent. With that combination, we have almost the entire state onboarded. The holdouts have joined. In part, it was the rule, but also the pandemic. We used the pandemic as a way to send the State Department of Health the ADTs so they could use that for COVID surveillance.”
As a payer, DHS also is looking at how it is going to comply with the new CMS rule that requires sharing data with patients. “We are building the technology to do FHIR APIs for patient data sharing,” Sias said. “We have a lot of work to do on that.”
Mississippi’s Medicaid Clinical Data Repository
During the same panel discussion, Chris Smith, clinical data interoperability program manager for the Mississippi Division of Medicaid, said that starting in 2015 his organization began moving away from providing clinicians just claims data and worked to get them access to clinical data. The Medicaid organization covers 750,000 of the state’s 3.2 million residents.
It worked first with the state’s largest provider, the University of Mississippi Medical Center. “They told us they didn’t just want a portal,” Smith said. “They wanted access to the whole clinical record. Having the ability to have a complete clinical summary in a CCDA follow the beneficiary around was important.” They worked to integrate the state’s clinical data repository with UMMC’s EHR. “I believe we were the first clinical network with an Epic EHR bidirectional CCDA exchange,” he said.
Soon after, other large health systems in the state connected as well. “We now have connected five of the top 10 trading partners in the state into the clinical data exchange, and we have added Medicaid managed care organizations, and are sharing clinical summaries with them,” Smith said.
When a provider queries the master patient index about a patient in front of them, it populates the Epic EHR in under 7 seconds, he said. “Then the physician can reconcile medications and allergies,” Smith explained. “Four hours after the encounter, the provider sends a summary back, we parse that and update our clinical data repository. For COVID, we are parsing our clinical data repository looking for labs and parsing our clinical data to better understand what is happening and how many tests are coming back positive, and what the impact is. We are still early in that process.”