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Connecticut Takes Another Stab (or Two) at HIEs

July 11, 2017
by David Raths
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Connecticut State Medical Society rolls out CTHealthLink based on technology developed in Kansas
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Connecticut, a state that has struggled to create a statewide health information exchange, may soon have two. CTHealthLink, created by the Connecticut State Medical Society (CSMS), is now live and offers clinicians access to patient data, as well as patient portals, data analytics tools, and population health solutions.

Meanwhile, the state is looking to restart its own efforts. A state health IT official recently told the Hartford Business Journal that an advisory board is considering several potential models, including HIEs in Michigan and Maryland. He said the state could fund the launch with federal funds granted to Connecticut's State Innovation Model program, as well as allocations from the state's capital budget.

An earlier statewide HIE effort, the Connecticut’s Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream.

CSMS President Jeffrey Gordon, M.D., chair of the CTHealthLink advisory committee, said his organization hopes to learn from the state’s past mistakes.

“We are aware of the efforts that have struggled,” he said. “The state of Connecticut has been trying for years to come up with a statewide HIE. We recognize from talking with physicians and hospitals that there is still a need. We did a lot of research looking across the country at what has worked and what hasn’t.”

Rather than building something from scratch, CSMS chose to partner with KaMMCO Health Solutions, which built the HIE in Kansas, the Kansas Health Information Network, and is working on technology solutions for Georgia and South Carolina. Gordon stressed that the “turnkey” HIE for Connecticut will not require any Connecticut taxpayer funding. There are no upfront costs for providers. Their costs are incurred as they begin using CTHealthLink products and services. “We have it broken up by size of physician groups and size of hospitals,” he added, with discounts for joining for more than one year.

Gordon said that in his own experience as a blood and cancer specialist, he has experienced barriers to getting patient information and doing reporting to regulatory groups. “The No. 1 priority is that it will be allow hospitals and physicians to access the real-time patient data needed in the office,” he said. “I don’t know how many times I see a patient and they have gotten care someplace else, and I can’t access that data right away. Now, with this HIE, I am going to be better able to access that data in real time sitting in my office or on the computer in the hospital and do more than I could before.”

“We have been getting interest from the hospitals across Connecticut and are in the process of signing up a number of them,” he said. “The advantage we have is that this is not a state-run system, so we don’t have the huge bureaucracy the state will have. We have a system is proven. The model we are using is already up and running in Kansas, and they have a very successful and sustainable model.” He said the CSMS already has a good working relationship with hospitals. “We are just building on that track record,” he said.

Speaking of the state effort, Gordon said the state is just starting out and is facing a big challenge because Connecticut is experiencing a budget crisis. “Also, the state does not have a good track record in regard to working with hospitals. They don’t tend to get along too well.” The state HIE would be a competitor to CTHealthLink, he said, adding, “Frankly, there is no need for two.”

 


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Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”

 

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The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
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The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”


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Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018
by David Raths, Contributing Editor
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Earlier effort failed because HIE was not self-sustaining

The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

An earlier statewide HIE effort, the Connecticut Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream. (The State of Montana also recently decided to take a second try at creating a statewide HIE.)

The grant, awarded by the Center for Medicare and Medicaid Services (CMS) to the Connecticut Office of Health Strategy (OHS), supports efforts to develop a secure, modern HIE that facilitates the sharing of health data to further patient care, improve proper efficiency, and rein in the high cost of healthcare. The HIE is expected to be operational by early 2019.

The grant follows a $5 million federal investment the state received in 2017 that facilitated HIE planning. To qualify for the additional resources, states outlined how their health technology plan would improve disease management, serve the Medicaid population (over 800,000 Connecticut residents), combat the opioid epidemic, and improve overall healthcare through the use of clinical data.

The new round of funding launches a pilot program for the health information exchange, which was one of the nine recommendations made by the Health Information Technology Advisory Council, a statutory body tasked with a comprehensive examination of Connecticut’s current health technology needs.

“The health information exchange will improve care. Providers will be able to exchange clinical and diagnostic data in real time – efficiencies that will save time and resources for healthcare systems and patients,” said OHS Health Information Technology Officer Allan Hackney, in a prepared statement. “We engaged nearly 300 providers and consumers and 75 organizations across the health sector in Connecticut to help us understand the issues and opportunities for improving care delivery and outcomes. Technology can and should be a great partner in health reform.”

Another goal is for the HIE to enable a platform for measuring clinical quality and more quickly analyzing population health – one of the keys to improving healthcare accessibility and correcting racial, ethnic, and gender health inequities. Currently, analysts most commonly use insurance claims data, which is only a proxy for real-time clinical information. This use of the HIE dovetails with the work of OHS’s State Innovation Model Office and the Health Systems Planning Unit in their efforts to better address gaps in healthcare, improve community health, and evaluate the performance of Connecticut’s healthcare providers.

 

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