Health information exchanges (HIEs) serve a critical function in health data networks to support interoperable access and delivery of clinical information. I recently led a virtual panel with three senior HIE leaders from across the U.S. for the Journal of AHIMA to discuss the current interoperability challenges, new best practices, and the future of HIEs as public health data utilities. The panel included:
• Erica Galvez, CEO of Manifest MedEx (California)
• Martin Lupinetti, President and CEO of HealthShare Exchange (Pennsylvania, New Jersey, Delaware)
• David Kendrick, MD, MPH, FACP, Principal Investigator and CEO of MyHealth Access Network (Oklahoma)
Here’s what these HIE leaders had to say.
Gaps in Participation and Data Blocking Present Challenges
There is a lack of comprehensive interoperability participation among healthcare organizations. Lupinetti shared that according to Healthshare Exchange data, 30% – 40% of patients receiving care at a health system that has Epic implementation are also receiving care at a non-Epic institution. These gaps in participation create an inaccurate representation of a patient’s chart that should be resolved through integrated systems for better care delivery. There is legislation aimed at solving this challenge, but it lacks funding to support the infrastructure needed for widespread interoperability and incentives to encourage healthcare organizations to participate.
Kendrick weighed in on vendor and provider data blocking, which continue to present challenges to interoperability. The 21st Century Cures Act has aided in preventing some of the barriers created by both vendor and provider data blocking, but this hasn’t deterred electronic health record (EHR) vendors from continuing to create difficulties by requiring the purchase of additional licenses to interoperate with clinics using that vendor’s EHR solution, for example. Galvez explained that in California there is legislation that will require all healthcare organizations to share data by 2024; however, that does not mean that they will share quality data needed for interoperability to be meaningful in the state.
New Best Practices Ahead
Emerging from the COVID-19 pandemic are some new best practices that played a critical role during the early days of the pandemic. The panelists explained that some of these new practices included more collaboration with HIEs and public health agencies, better public health reporting, and removing barriers to access HIE services like cost. These best practices continue to provide value in the interoperability space today.
The panelists discussed how they partnered with local public health departments and other healthcare facilities to provide meaningful data to the public during the pandemic. This data provided much-needed insight into COVID hot spots, high-risk patients, and contact tracing to support public health efforts.
The data was also used to create a comprehensive COVID-19 digest for health officials and the public to see the growth or decline of COVID cases in their area. The gathered data aided in the creation of bilingual public service announcements and personal case management outreach for high-risk patients. These efforts also increased vaccination rates amongst the HIEs’ most vulnerable patients.
The MyHealth Board of Directors passed a package that allowed a comprehensive approach to data acquisition, alerting capabilities, and collaboration with official government response efforts. The creation of the Oklahoma Healthcare Recovery Program authorized any organization in Oklahoma to connect to the HIE at no cost.
HIEs as Health Data Utilities
The concept of health data utilities has emerged in recent years and is being applied to HIEs more frequently. Civitas’ has this working definition: “Health Data Utilities (HDUs) are statewide entities that combine, enhance, and exchange electronic health data across care and services settings for treatment, care coordination, quality improvement, and public and community health purposes through specific, defined use cases in accordance with applicable state and federal laws protecting patient privacy.”
The panelists unanimously agreed that HIEs are public health data utilities, but there are still some challenges to successfully enacting this role. As a public utility, HIEs would provide health data as a service to healthcare organizations throughout the state and region and would safeguard sensitive data they maintain and provide for private and public stakeholders.
Galvez shared that HIEs as data utilities must establish governance structures to balance the interests and needs of various organizations and agencies they serve. Strong HIE information governance is necessary for building a foundation of trust, which encourages growth and collaboration among the network. Community-wide trust is difficult to obtain but essential to exchange sensitive data; it must be maintained and appreciated. However, Lupinetti pointed out that this can be challenging to enact in states with multiple HIE providers where there can be duplications and repetition.
The Future of Health Information Exchange
While panelists had different visions for the future of health information exchange, the overall message was that the role of HIE will continue to evolve and become increasingly important. Here are their specific takeaways.
Galvez: HIEs will continue to grow as a key partner to certify that the data required for collaboration is reliable and accurate.
Lupinetti: The next generation of HIE is a closed-loop referral system for community-based organizations that will inform providers that a patient has been referred to a community-based organization and can provide follow-up if needed.
At-home monitoring is an additional future trend that will provide a patient’s healthcare team with real-time awareness of patient encounters.
Kendrick: The role of HIEs will evolve in two central areas including improving the function of public health systems (outbreak surveillance, violence against healthcare workers) and improving the actual health of the public (the utilization of HIE data, safer and timelier care, better policy and public resource use).
Strengthening the Patient’s Care Team through HIE
The COVID-19 pandemic solidified the importance of HIE, and the strides made in this space have set a new standard in terms of usage and performance. Moving forward, the use cases for HIE will only continue to broaden and diversify, strengthening a patient’s health care team.
To learn more about how Audacious Inquiry, A PointClickCare Company, can help your organization’s health information exchange efforts please visit Who We Serve: Health Information Exchanges or contact Audacious Inquiry online.
Rob Horst, MBA is the Senior Vice President of Partner Engagement at Audacious Inquiry, A PointClickCare Company, and leads the ENS and MDM lines of business. Rob is a pragmatic and transparent problem solver and audacious thinker committed to ensuring that Audacious Inquiry customers receive nothing but the best possible experience. Rob has served in key operations, security, and strategic consulting roles in the 10+ years that he has been with the company.
Prior to joining Audacious Inquiry, Rob served as Director of IT for Mercy Medical Center in Baltimore where he led a program to implement and support Mercy’s first EHR for over 200 providers. Rob also taught Medical Informatics at Johns Hopkins Carey Business School. He holds an MBA from the Johns Hopkins Carey Business School and a BS from Elon University. Rob resides in Baltimore, MD, where he lives with his wife and two children.