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Healthcare Informatics Exclusive: As Harvey Engulfs Houston, Texas HIE Leaders Move in to Help

August 29, 2017
by Mark Hagland
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Texas HIE leaders activate capabilities to support healthcare providers in the wake of Harvey

As the annual conference of SHIEC, the Grand Junction, Colo.-based Strategic Health Information Exchange Collaborative, unfolded this week at the Crowne Plaza Downtown Indianapolis Union Station in Indianapolis, the disaster of Hurricane/Tropical Storm Harvey was unfolding in Houston and southeast Texas. Senior leaders of the SHIEC organization and its affiliates were able to connect Healthcare Informatics Editor-in-Chief Mark Hagland with Texas health information exchange (HIE) leaders, who are right now actively working to support the healthcare providers who are caring for Texans impacted by Harvey.

Hagland spoke with several southeast Texas HIE leaders to find what they’re working on right now. Developments continue to unfold live. Two organizations deeply involved in helping clinicians and patients in southeast Texas this week are Greater Houston Healthconnect (GHHC), the Houston-area HIE; and Healthcare Access San Antonio (HASA), the San Antonio-based HIE whose coverage area encompasses San Antonio and an expanding swath of central Texas, including the Austin and Dallas areas. San Antonio, Austin, and Dallas, are all welcoming residents of Houston and southeast Texas who are fleeing flood-ravaged parts of southeast Texas.

At the moment that Hagland reached Nick Bonvino of GHHC on Tuesday afternoon, he was shuttling between shelters in the Houston area, overseeing the setting up of HIE portals, in order to help clinicians provide care for patients sheltering from the storm. The good news? “Right now, all the electronic health record [EHR] systems at all the hospitals in Houston appear to be in regular working order,” Bonvino reported. “As a result, we’re able, with our laptops and WiFi, to access EHR systems in the normal way.” But, he added, “We’ve just gone live in the Houston convention center, and we’re ready to set up portals in all the shelters in which we’re setting up operations.” Thus, if any of the EHRs of Houston’s area hospitals go down, GHHC leaders will be able to support clinicians in providing care to residents fleeing the storm. At the time that they spoke, Bonvino noted, physicians and nurses were rushing to the George R. Brown Convention Center to care for Houstonians, representing large patient care organizations including the University of Texas Physicians organization, and Baylor Health System, as well as members of the Harris County Medical Society.

Meanwhile, within the HIE realm, one of the most fortuitous things related to the current disaster has been the fact that GHHC and HASA, several years ago, created a durable information exchange connection, so that patient records can be accessed through health information exchange with remote siting (Salt Lake City), thus protecting access to EHRs for patients in need. That came about because of a relationship between the two HIEs, explained Phil Beckett, who is the chief information officer at HASA. Back in the time period of 2011-2012, Becket was the chief technology officer at GHHC, and had developed a relationship with Gijs van Oordt, the CEO of HASA. “Gijs and I created a connection back then, in case anything like this [Hurricane Harvey] ever happened. And the [Austin-based] Texas Health Services Authority”—which helps to oversee and facilitate HIE development and governance across Texas—“had created a statewide hub that technically connected the Texas HIEs to each other. So HASA and GHHEC have been connected since 2015.”

So, Beckett told Healthcare Informatics, “Before Harvey made landfall, we sent out a notification to the hospitals with our phone numbers, to contact us, so we could get records to anyone as easily as possible. So we have all the HIEs connected. And there is a portal. And our data from Houston and San Antonio is stored in Salt Lake City. And that portal already exists. So people who are volunteering may not already have an account with us. So we’ll get them access in a heartbeat or look it up for them and fax it to them, as necessary.”

All of that foundational work has suddenly become highly relevant, Beckett noted, as “We’ve got a lot of evacuees in San Antonio from Houston, and we are taking our information from HASA and coordinating with the GHHC team, to get access to records for individuals from Houston.” In fact, he reported, “So far, we’ve got 17,000 evacuees from Houston, and that number keeps growing. Not all of those patients will have [electronic health] records, and not all will need medical assistance. But you can imagine leaving your house in a crisis like this; you can imagine what will happen when someone comes to rescue you with a boat, and you grab your phone and wallet and go; you don’t have any medications with you or anything. So having a doctor be able to access that to refill your prescriptions, will be critical.”

This is also a situation in which the concept of the patient-centered data home™, which the SHIEC organization is promoting and encouraging, and which has been a topic of discussion at this conference, comes into play, Beckett said. “Just this morning, we were on a call that was sponsored by SHIEC, and were talking about the patient-centered data home, which provides a more accurate, precise way to share data. When we make use of this concept, it means that we’re storing a zip code list of zip codes that each HIE covers, and then if a patient shows up in one of our facilities with that zip code, we will send a notification with the home state of that patient, so that we’re connected across state lines with good demographics, since we don’t have single identifiers. That will help” in situations like this one with Hurricane/Tropical Storm Harvey, he said.

Meanwhile, Beckett said, “It may sound self-interested since I’m part of an HIE, but we’re not-for-profit, and we see ourselves as a community utility. And in normal days, looking at being connected to an HIE, and wondering, should I connect or not? And the reality is, we’re really trying to do this for the community. And in Corpus Christi and Victoria, where they were evacuating babies, it’s critical that those medical records move instantly with them. So my plea to us as a state is, as healthcare professionals, let’s connect everything, even if it costs a little bit of money and there’s not a direct return on investment.”

For his part, van Oordt told Healthcare Informatics, when asked about how all of this is playing out right now in real time in the face of Harvey, “A few thoughts come to mind since visiting shelters yesterday. A lot of the care being delivered right now,” he said, “is actually very acute—people are lined up in the hallways to visit physicians and nurses. These needs stem from physical issues related to evacuation, and also a lot of emotional trauma. And we also understand there will be long-term evacuations planned, where people with chronic conditions will need to be evacuated. And we can play a role in providing more aggregated and historical data at that time. I think we’re still very early on in this process, and a lot of that may unfold over a long time,” he added.

What should the CIOs, CMIOs, and other healthcare IT leaders in hospitals, medical groups, and health systems, be thinking about as they reflect on what’s going on right now in Texas? “A few things,” van Oordt said. “What I saw yesterday in the shelters was reflective of how an emergency can be handled. In one case, I was at a middle school, where 800 evacuees had gone. The technology available at that point and in that place was very minimal. They didn’t have a fax or a PC, so one of the first things that comes to mind is that we need to make access to patient history fit that workflow. Something that comes to mind in that context is a phone-based app, because that’s what most of the nurses already have and make use of. And the thinking is that you have essential information like allergies and medications and recent encounters, available through this phone app, and then later, you could deploy other features in such an app, as needed.

More broadly, van Oordt said, “This situation shows This shows heart and soul where health information comes is critically needed. And this is the first major incident that’s happened in the five years since Phil and I first worked together. My feeling is that patient information should be an available staple for emergency care. This is the ultimate use case for having patient information available. Patients are stressed out and providers are stressed out. This really is a staple of emergency care.”

Meanwhile, Kelly Hoover Thompson, who was named SHIEC’s CEO just over a week ago, told Healthcare Informatics, “This is the ultimate example of HIE’s vital role and value to a community. It is how we support patient care, when a patient is facing some of their most critical and vulnerable life moments. This is why SHIEC exists, to take the greatest minds in HIE across the country, to make it work, and advance it, and educate people.”

 

 

 


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Becoming a Data-Driven Ecosystem: How San Diego County is Moving the Needle

December 11, 2018
by Rajiv Leventhal, Managing Editor
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Collaboration around information sharing and integration is serving as the foundation for a person-centered healthcare environment in San Diego

“Living well" would be an accurate way to describe the experiences of tourists who visit San Diego, often for its miles of white-sand beaches and amazing weather. But behind the scenes, too, city healthcare leaders have been working hard on their own version of living well.

Indeed, a strategic vision known as “Live Well San Diego”—the city’s 10-year plan to focus on building better health, living safely and thriving—has provided a foundational base for how healthcare in San Diego should be imagined. Essentially, the strategy aligns the efforts of individuals, organizations and government to help all 3.3 million San Diego County residents live well, the region’s health officials say.

As Nick Yphantides, M.D., the chief medical officer for San Diego County’s medical care services division, puts it in a recent sit-down interview with Healthcare Informatics, “It’s not just about healthcare delivery, but it’s about the context and environment in which that delivery occurs.” Expanding on that, Yphantides notes that the key components for Live Well San Diego are indeed health, safety, and thriving, and within these larger buckets are critical care considerations such as: economic development, vitality, social economic factors, social determinants of health, preparedness and security, and finally, being proactive in one’s care.

So far, through the Live Well San Diego initiative, the city has created more than 8,000 healthcare jobs over a five-year span and more than 1.2 million square feet of additional hospital space, according to a 2017 report on Southern California’s growing healthcare industry.

From here, the attention has turned to improving the data sharing infrastructure in the city, a significant patient care challenge that is not unique to San Diego, but nonetheless critical to the evolution of any healthcare market that is progressing toward a value-based care future. To this end, toward the end of 2016, ConnectWellSD, a county-wide effort to put Live Well San Diego into action, was launched with the aim to improve access to county health services, serving as a “one-stop-shop” for customer navigation. Officials note that while still in the early stages of development, ConnectWellSD will implement new technologies that will allow users to perform functions such as looking up a customer file, making and managing referrals, or sharing case notes.

Carrie Hoff, ConnectWellSD’s deputy director, says the impetus behind the web portal’s launching was the need to pull disparate data together to have a fuller view of how the individual is being serviced, in compliance with privacy and confidentiality. “Rounding up that picture sets ourselves up to collaborate across disciplines in a more streamlined way,” Hoff says.

Moving forward, with the ultimate goal of “whole-person centricity” in mind, San Diego health officials envision a future in which ConnectWellSD, along with San Diego Health Connect (SDHC)—the metro area’s regional health information exchange (HIE)—and the area’s “2-1-1 agency,” which houses San Diego’s local community information exchange (CIE), all work in cohesion to create a longitudinal record that promotes a proactive, holistic, person-centered system of care.

Yet as it stands today, “From a data ecosystem perspective, San Diego is still a work in progress,” Yphantides acknowledges. “But we’re looking to really be a data-driven, quantified, and outcome-based environment,” he says.

To this end, SDHC is an information-sharing network that’s widely considering one of the most advanced in the country. Once federally funded, SDHC is now sustained by its hospital and other patient care organization participants, and according to a recent newsletter, in total, the HIE has contracted with 19 hospitals, 17 FQHCs (federally qualified health centers), three health plans and two public health agencies.

The regional HIE was shown to prove its value during last year’s tragic hepatitis A outbreak in San Diego County amongst the homeless population that resulted in 592 public health cases and 20 deaths spanning over a period of a little less than one year. In an interview with Healthcare Informatics Editor-in-Chief Mark Hagland late last year, Dan Chavez, executive director of SDHC, noted that the broad reach of his HIE turned out to be quite helpful during this public health crisis.

Drilling down, per Hagland’s report, “Chavez is able to boast that 99 percent of the patients living in San Diego and next-door Imperial Counties have their patient records entered into San Diego Health Connect’s core data repository, which is facilitating 20 million messages a month, encompassing everything from ADT alerts to full C-CDA (consolidated clinical documentation architecture) transfer.”

According to Chavez, “With regard to hep A, we’ve done a wonderful job with public health reporting. I venture to say that in every one of those cases, that information was passed back and forth through the HIE, all automated, with no human intervention. As soon as we had any information through a diagnosis, we registered the case with public health, with no human intervention whatsoever. And people have no idea how important the HIE is, in that. What would that outbreak be, without HIE?”

To this point, Yphantides adds that to him, the hepatitis A crisis was actually not as much about an infectious outbreak as much as it was “inadequate access, the hygienic environment, and not having a roof over your head.” Chavez would certainly agree with Yphantides, as he noted in Hagland’s 2017 article, “We’re going through a hepatitis A outbreak, and we’re coming together to solve that. We have the fourth-largest homeless population in the U.S.—about 10,000 people—and this [crisis] is largely a result of that. We’re working hard on homelessness, and this involves the entire community.”

Indeed, while administering tens of thousands of hepatitis A vaccines—which are 90 percent effective at preventing infection—turned out to be a crucial factor in stopping the outbreak, there were plenty of other steps taken by public health officials related to the challenges described above. Per a February report in the San Diego Union-Tribune, some of these actions included “installing hand-washing stations and portable toilets in locations where the homeless congregate and regularly washing city sidewalks with a bleach solution to help make conditions more sanitary for those living on the streets.” What’s more, Family Health Centers of San Diego employees “often accompanied other workers out into the field and even used gift cards, at one point, to persuade people to get vaccinated,” according to the Union-Tribune report.

Yphantides notes that the crisis required coordinated efforts between the state, the city, and various other municipalities, crediting San Diego County for its innovative outreach efforts which he calls the “Uberization of public health,” where instead of expecting people to come to healthcare facilities, “we would come to them.” He adds that “hep A is so easily transmissible, and it would have been convenient to say that it’s a homeless issue, but based on how easily it is transmitted, it could have become a broader general population factor for us.”

Other Regional Considerations

Beyond the problem of homelessness in San Diego, which Jennifer Tuteur, M.D., the county’s deputy chief medical officer, medical care services division, attributes to an array of factors, some unique to the region, and others not: from the warm year-round weather; to the many different people who live in vastly different areas, ranging from tents to canyons to beaches and elsewhere; and to the urbanization of downtown and the building of new stadiums; there are plenty of other market challenges that healthcare leaders must find innovative solutions to.

For instance, says Yphantides, relative to some parts of the U.S., although California has made great strides in expanding insurance coverage, due to the Affordable Care Act—which lowered the state’s uninsured rate to between 5 and 7 percent—there are still core challenges in regard to access. “We’re still dealing with a fragmented system; like many parts of the U.S, we are siloed and not an optimally coordinated system, especially when it comes to ongoing challenges related to behavioral health,” he says, specifically noting issues around data sharing, the disparity of platforms, a lack of clarity from a policy perspective, and guidance on patient consent.

To this end, San Diego County leaders are looking to bridge the gap between those siloes while also looking to bridge the gap between the healthcare delivery system, having realized how important the broader ecosystem is, Yphantides adds. “But what does that look like in terms of integrating the social determinants of health? Who will be financing it, and who will be responsible for it? You have a tremendous number of payers who all have a slice of the pie,” he says.

Speaking more to the behavioral health challenges in the region, Yphantides says there are “real issues related to both psychiatric and substance abuse.” And perhaps somewhat unique to California, due to the cost of living, “we have tremendous challenges in relation to the workforce. So being able to find adequate behavioral health specialists at all levels—not just psychiatrists—is a big issue.”

What’s more, while Yphantides acknowledges that every state probably has a similar gripe, when looking at state reimbursement rates for MediCal, the state’s Medicaid program, California ranks somewhere between 48th and 50th in terms of compensation for Medicaid care. Put all together, given the challenges related to Medicaid compensation, policy, data sharing, workforce and cost of living issues, “it all adds up with access challenges that are less than ideal,” he attests.

In the end, those interviewed for this story all attest that one of the unique regional characteristics that separates San Diego from many other regions is the constant desire to collaborate, both at an individual level and an inter-organization level. Tuteur offers that San Diego residents will often change jobs or positions, but are not very likely to leave the city outright. “That means that a lot of us have worked together, and as new people come in, that’s another thing that builds our collaboration. I may have worn [a few different] hats, but that commitment to serving the community no matter what hat we wear couldn’t be stated enough in San Diego.”

And that level of collaboration extends to the patient care organization level as well, with initiatives such as Accountable Communities for Health and Be There San Diego serving as examples of how providers on the ground—despite sometimes being in fierce competition with one another—are working to better the health of their community. “Coopetition—a hybrid being cooperation and competition—describes our environment eloquently,” says Yphantides.

Learn more about San Diego healthcare at the Southern California Health IT Summit, presented by Healthcare Informatics, slated for April 23-24, 2019 at the InterContinental San Diego.

 

 

 


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Hawaii’s HIE Leveraging Technology to Improve Patient Identification

November 8, 2018
by Heather Landi, Associate Editor
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Hawaii Health Information Exchange (HHIE), Hawaii’s state-designated HIE, is taking action to improve patient identification and the accuracy of provider data for enhanced care coordination across the state.

HHIE is working with Pasadena, Calif.-based NextGate to implement an enterprise cloud-based master patient index and provider registry software to create a sustainable statewide system of accurate patient and provider data by resolving duplicate and incomplete records.

HHIE was established in 2006 to improve statewide healthcare delivery through seamless, safe and effective health information exchange. The HIE covers more than 1.2 million patients and has more than 450 participants including Castle Medical Center, Hawaii Pacific Health, The Queen's Medical Center, and the state’s largest insurance provider, HMSA.

“Accurate, comprehensive data that flows freely across boundaries is a catalyst for informed, life-saving decision making, effective care management, and a seamless patient and provider experience,” Francis Chan, CEO of HHIE, said in a statement.

Chan adds that the technology updates will help to ensure providers have “timely and reliable access to data to deliver the high-quality level of care every patient deserves.” “We are building a scalable, trusted information network that will positively influence the health and well-being of our communities,” Chan said.

“The partnership will enable HHIE to develop internal support tools to create accurate, efficient patient identity and provider relationships to those patients to support focused coordinated care,” Ben Tutor, information technology manager of HHIE, said in a statement.

Cross-system interoperability is critical to the success of HHIE’s Health eNet Community Health Record (CHR), which has more than 1,200 users and 470 participating physician practices, pharmacies, payers and large healthcare providers that contribute to over 20 million health records statewide. Deployment of the EMPI’s Patient Matching as a Service (PMaaS) solution will support HHIE’s vision of a fully integrated, coordinated delivery network by establishing positive patient identification at every point across the continuum for a complete picture of one’s health, according to HHIE leaders.

By ensuring that each individual has only one record, participants of HHIE will be able to map a patient’s entire care journey for informed decision-making and population health management, HHIE leader say.

The provider registry will synchronize and reconcile provider data across clinical, financial and credentialing systems to enable an accurate directory and referral network of providers. Using a single provider ID, the registry aggregates and maintains up-to-date information about individual providers and provider groups, such as specialties, locations, insurance options, hospital privileges, spoken languages, and practice hours. Providers can also easily identify who else is on their patient’s care team as well as what other clinicians should receive test results, lab reports and other treatment summaries.


 

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HIE 2.0: CORHIO’s Leaders Map a Pathway to Advanced Data-Sharing Success in Colorado

November 7, 2018
by Mark Hagland, Editor-in-Chief
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CORHIO’s leaders have been involved in intensive work to improve data quality, while expanding data-sharing more broadly

The leader of CORHIO, one of the most progressive health information exchange (HIE) organizations in the country, continue to innovate forward across a broad range of areas. The Denver-based CORHIO already connects 65 hospitals across Colorado—virtually all of the inpatient community and academic facilities in the state—and connects around 5,000 physicians statewide as well.

As the organization’s website notes, “CORHIO empowers people, providers and communities by providing the information they need to improve health. Our advanced health information exchange (HIE) technology, data analytics tools and expert consulting help healthcare providers access information that saves lives, streamlines care coordination, reduces costs, and improves clinical outcomes for millions of people.”

Recently, CORHIO’s leaders, including Morgan Honea, the HIE’s president and CEO, and Mark Carlson, its director of product management, have been pushing ahead to connect providers across the state both more broadly and more deeply—extending out into the behavioral health sphere as well as facilitating the sharing of more granular data across Colorado, through data normalization work. Honea and Carlson spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding their current initiatives. Below are excerpts from that interview.

You’ve been expanding some of your core data-sharing capabilities of late, correct?

Mark Carlson: Yes; we certainly do have some activity and infrastructure that we’ve been building out. I’ll focus in on clinical and population health first. One area we had identified a couple of years ago in terms of being able to generate information for population health, at the state level, or in partnership with ACOs, came about as the state pushed forward an initiative called “regional care collaboratives” with ACOs. As part of that initiative, we did work on packaging and bundling notifications around ED visits and hospitalizations and discharges, for providers, as well as helping smaller physician practices in that area. And we’ve been looking at expanding out that concept around clinical indicators, initially focusing on labs.

We have 65 hospitals sending data into CORHIO, and we had 30-plus representations as to how a hemoglobin a1c might be represented, in terms of vocabulary and coding. So we used NLP [natural language processing] to help us with that, to help move forward in disease management in areas like diabetes. We’ve also focused on another use case with our Department of Health in Colorado, around an influenza use case, where we’re able to flag a positive influenza use test and track for an inpatient admit that occurs within 48 hours, to map the cost of care as well as the ability to access supporting resources that hopefully would avert an inpatient admission.

That’s what we’re working on—normalization across general labs and clinical metrics; and as we expand our data types, we’re expanding towards social determinants, as well as labs that extend beyond the general labs.

Morgan Honea: I agree with everything that Mark said. I would just add that this is, really, in my opinion, kind of a second evolution around the interoperability question. We’ve got a tremendous HIE with tremendous participation here in Colorado. The important fact is that, after laying the infrastructure for a statewide HIE, it next becomes imperative move into normalization across data sources, so that you’re not changing vocabularies or nomenclature.

That sounds like “HIE 2.0,” in terms of the advanced work, doesn’t it?

Carlson: That’ll work.

What’s next or top priority now for providers?

Honea: Our top priority is to continue to expand the type of data available in the HIE. In that context, we’re facing up to the incredible challenge of continuing to integrate behavioral data into the system. We’re also working with state agencies, to make sure that folks are getting the best care coordination for the best outcomes possible. And probably the highest demand from our clients is fewer queries and more push notifications and types of functionality, greater integration into EHRs [electronic health records] and other population health-type tools, with really clean, neatly packaged data, which is where this conversation becomes more important, because as Mark said, with hemoglobin a1c, things get very messy as the volume of the data grows, if you’re constantly having to clean up the data. So providing the data in interoperable, easily usable ways, is a top priority.

Carlson: And you have to follow the money in terms of reimbursable events and other value-based areas. So as we improve our inbound CCDA-type activities, we want to improve the quality of submission at the level of formatting as well as presence of charted measures, as being able to format and report those out, from practices, including around broader performance measures.

With regard to the capture and sharing of data, are you making any use of artificial intelligence? And where is that going?

Carlson: One of our core initiatives is, how do we become more situationally aware? I’ve looked at FHIR as a path forward, in that context Whereas the CCDA is a blunt-force instrument, FHIR provides the opportunity to be a lot more precise in packaging and bundling data. For example, we’ve been working on a use case for an anesthesiology group. They want to see problems, meds, last treatments, discharge summary, they don’t want to see everything. FHIR helps us to bundle and package data, and then via an API connection, they can receive more precise information that meets their needs, rather than via all-encompassing data. More targeted, based on clinical needs.

Honea: The ability to get down the discrete data level, understand the data points and bundle and share them, is where I think things are going. A CCDA is a big, narrative summary of an encounter, and doesn’t get down to that level of granularity.

Carlson: In the media right now, there’s been a lot of discussion around where the next steps of IBM Watson should be. And we’ve had this discussion with a lot of vendors in the past, where we’ve been introduced to some very compelling functionality; but then some wonderfully designed tools absolutely choke on some of the variability of the nomenclature in the data. And that prevents us from getting to advancing the Quadruple Aim. Those learnings and market information that we’ve gathered over time, indicated our absolute need to partner with organizations that have a foundation for creating mappings that are clinically valid and reliable and backed with the expertise behind it. That can help us get to the population health insights that you’re referencing when you mention AI.

Do you think you’ll be able to incorporate some social determinants of health data into what you’re sharing?

Honea: That’s an area where I’m spending some of my time now. I have no doubt that we’ll run into the same challenges with local code sets and varying terminologies with that type of data that we’ve had with clinical data. I don’t see that that process is strictly limited to hospital and clinic data; I think it will go across all sorts of systems; and when we share from one program to another and one type of data system to another, we’ll face the same types of challenges and requirements for data standardization. So we’ll probably rinse and repeat every time we go out and get another data point.

Carlson: We are working with United Way 211, understanding how their community resources and curated content and partnerships are working, and getting insights from diabetic prevention programs and food banks—the data quality is as variable as some of the source organizations involved. I think this opens up a whole new opportunity for whole-person care, but it will pose some of the types of data normalization and use challenges as clinical data.

How do you see the next few years evolving forward at CORHIO?

Carlson: We’ve touched on a lot of priorities—ECQM work… our learnings in various areas. It’s a big lift to ingest the CCDA documents and get consistency at the data level. Our partner organizations continue to work with us and with Wolters Kluwer, to work on various types of data together. When we spoke at the HIMSS Conference earlier this year, Morgan and I talked a lot about data normalization work and about data visualization, and about being able to visualize risk across counties and the state, to identify pockets of need. And in that context, the social determinants data will help us understand where the food deserts are, and where high levels of chronic diabetics live. We have a number of mountain and rural communities that are fairly isolated, so our opportunities to impact that, are large, but so are the needs, and thus, we need to address data quality issues.

Honea: I agree with everything that Mark said. We’ve got this never-ending effort to include programmatic elements, site-specific elements, into the HIE, every kind of element—that work will never end. But I’m also continually focused on the question of how we as a state, with only 5 million people, can identify ways to leverage the infrastructure built with significant investment at the federal, state, and local levels, to advance our overall HIE efforts as a state, and minimize the risk of continually building new silos of data that will just require new efforts in the same fashion? How do we improve coordination when folks are moving across different geographies or service areas, without rebuilding existing infrastructure? How do we partner with communities to get the biggest bang for our buck? That requires a lot of planning and coordination and collaboration.

Carlson: For HIEs to provide value, Morgan and I often say, it’s data versus documents. Document exchange has a very valuable place in the broader landscape, but where the HIEs are differentiating themselves is at local-level attention and relationships and meeting community needs, and where we can operate at the data level to provide the insights to drive patient care quality forward.

 

 

 


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