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A Utah HIE's Path to Accreditation--and Beyond

July 8, 2013
by Mark Hagland
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The Utah Health Information Network’s Jan Root has a lot to say in favor of accreditation processes for HIEs

Recently, HCI Editor-in-Chief Mark Hagland interviewed Lee Barrett, the executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), regarding that Farmington, Conn.-based organization’s having entered into an agreement with the federal government for development of for continued development and implementation of EHNAC’s accreditation program for health information exchange (HIE) organizations. EHNAC is now actively working with several health information exchanges (HIEs) to get those organizations accredited, as accreditation involves a rigorous process of assessment and site visitation in order for HIEs to ensure confidence in their core data-sharing processes.

Among the organizations that EHNAC has worked with is the Utah Health Information Network (UHIN), a Salt Lake City-based HIE that has been in existence in some form for 20 years now, and that has achieved EHNAC accreditation. UHIN, which has 37 staff members, is also the statewide designated HIE for the state of Utah.

Jan Root, Ph.D., is executive director of UHIN. She also believes so strongly in the mission of EHNAC that she is a member of EHNAC’s board of directors. Root spoke recently with HCI’s Hagland about UHIN’s ongoing journey as a data and information organization, and her perspectives on the path forward for UHIN and for HIEs more broadly. Below are excerpts from that interview.

You are a statewide HIE, clearly?

Yes, but we actually run several lines of business. We actually started as a CHIN [community health information network] back in 1993. We are a 501c3 not-for-profit organization, but my board is very business-oriented. And back in the 1990s, CHINs were basically trying to solve the same problems that HIEs are trying to solve today. Until 10 years ago, we focused on the part that had a strong business case, which was the clearinghouse side. So we run a not-for-profit clearinghouse; that was our first line of business. We started our HIE work about 10 years ago; we officially opened our doors as an HIE in 2009. So in that regard, we’re much younger, and more like the new group of HIEs.

But we’re different in that we had an existing governance structure; an existing relationship with the state government; and an existing trusted relationship, as a neutral third party, with all of our members, which are payers, providers, hospitals, and state government. A lot of HIEs that are publicly funded are spending a lot of their time getting to governance; and we already had that. And between 2004 and 2008, we experimented with a number of forms of structure; but we decided on a query-based model, and launched that in 2009.

Jan Root, Ph.D.

Tell me a bit more about your organization’s query-based model?

What we have is an HIE where what we call the data sources—the clinics and the hospitals—put data into a federated, central data repository. It is a centralized database, but the federated part means that everybody has their own bucket of data, so it’s not co-mingled, from an IT perspective. That was one of the board’s requirements. My board consists of competitors. We have the four major hospital systems—Intermountain, University of Utah, HCA, and Iasis—plus Regence, our local Blues plan; plus SelectHealth, the Intermountain payer arm; and DMBA, which is the Mormon Church’s insurance company (an ERISA company, for LDS [Latter-Day Saints] Church employees and missionaries); and the public employees’ health plan, PEHP (Public Employees’ Health Plan). And we have Medicaid; we have EMI Health, which is an educators’ health plan; and then we also have consumer representatives; we have three practicing physicians; we have the Utah Department of Health; we have the insurance commissioner; we have the Utah Department of Technology Services (Utah DTS); the Utah Hospital Association; the Utah Medical Association, and HealthInsight—that’s Utah’s QIO [quality improvement organization] and also the regional extension center.

So what does 'query-based' mean, in this case?

That means that the various data sources put data into our HIE, which is called the CHIE—which means Clinical Health Information Exchange. With regard to that terminology, I started sneaking the “C” out in front of the name, and for better or worse, it stuck. So the data sources put the data into the CHIE, and it’s secured and federated. We have a master person index. Meanwhile, the identity component goes to the master person index, and the person involved has their own record number. And the master person index has a record, where all the data is stored for each individual. So if you do a query, you make sure you’ve got the right John Smith—called co-identity adjudication; and if John has given permission, then you can look at all his data that’s in the CHIE, from the multiple sources.

How many persons’ data do you have?

We have identities on 3.3 million individuals; we have data on about 700,000 of those individuals.

How long have you actually been exchanging clinical data?

For about two years now. But I will tell you that the fly in the ointment is that the board has made the CHIE “opt-in.” We have to collect about 3 million signatures now, and so we’re working on that.

Why did you decide to pursue accreditation through EHNAC?