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Inland Empire Health Plan’s Clear-Eyed HIE Strategy

January 13, 2017
by Mark Hagland
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Inland Empire Health Plan CEO Bradley Gilbert, M.D. shares why he and his organization are so committed to health information exchange

Inland Empire Health Plan, based in Rancho Cucamonga, is a not-for-profit health insurer that covers 1.25 million members in Southern California, primarily in Riverside and San Bernardino Counties, in the eastern part of the vast Los Angeles Basin metroplex, and with additional members in Palm Springs, the high desert, and other areas.

The health plan’s membership includes 1.2 million MediCal members—MediCal is California’s uniquely named Medicaid program—and 23,000 dual-eligibles—that is, individuals who are eligible both for the Medicare program and the MediCal (Medicaid) program.

A lot is happening at Inland Empire Health Plan these days, and much activity is being led by its CEO, Bradley Gilbert, M.D. Dr. Gilbert, who practiced as a board-certified general preventive medicine and public health specialist before joining the health plan 20 years ago, joined the organization as medical director and CMO, and was promoted to CEO nine years ago. Gilbert has led numerous advances at the health plan, including in the context of the health plan’s support for health information exchange (HIE). It is in that context that Gilbert serves as chairman of the board of the San Bernardino-based Inland Empire HIE (IEHIE).

And it is in that context that Gilbert was one of the leaders participating in the January 10 announcement of the planned merger of IEHIE and the San Francisco-based California Integrated Data Exchange (Cal INDEX). Gilbert and others spoke at a press conference held simultaneously at the Sir Francis Drake Hotel in downtown San Francisco, and via telephone. The merger, once approved by federal authorities, is expected to create one of the nation’s most comprehensive not-for-profit HIEs.

It was announced that Claudia Williams, former White House technology senior advisor, will lead the new organization as CEO, effective February 1, 2017. The merger, subject to regulatory approvals, is expected to be completed in the first quarter of 2017 and will operate as a tax-exempt public benefit corporation under a new name.

And, according to a press release published at the same time as the press conference was taking place, “The new HIE will combine the 11.7 million claims records from Cal INDEX founding members Blue Shield of California and Anthem Blue Cross with the 5 million clinical patient records of IEHIE and its 150 participating partners. HIEs help improve the quality of the patient experience, support collaboration and coordination and improve efficiencies by making it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the healthcare system.”

And the press release quoted Dr. Gilbert as stating that “The creation of this new statewide health information exchange by IEHIE and Cal INDEX is an important milestone in transforming California’s healthcare system into a coordinated system that delivers higher quality and more efficient care to all Californians.”

Two days after the press conference, Dr. Gilbert spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding all these developments. Below are excerpts from that interview.

Based on your experiences, what do you believe are the biggest challenges in evolving HIEs forward these days, and in sustaining them in the current operating environment—one in which many HIEs have been failing?

I believe that the biggest single challenge is getting the participants involved in HIEs. At Inland Empire Health Plan, we already have good access to pharmacy data and claims data—but the claims data is older data. In that regard, the key is getting the hospitals and medical groups involved; they have clinical data that is more timely. The IEHIE has been pretty successful—we have every single hospital in the Inland Empire either actively participating in the HIE, or contracted to participate. We’ve got multiple medical groups participating as well. So the key is getting the data, and the second is the financial model that makes it self-sustaining; we’ve doing both.

Bradley Gilbert, M.D.

It’s not just the medical elements, it’s the social determinants of health and other factors that have to be considered, in order to engage in effective care management, correct?

Yes, it’s not just the medical elements at all. It’s the behavioral elements, too; and also housing, food, transportation, everything. Having done this for 20 years, and having spent my medical career caring for this population—if we can take care of dual-eligible and disabled MediCal members, we can take care of everyone.

And getting a handle on all of those factors is especially important for the Medicaid/MediCal population, especially the disabled Medicaid/MediCal population, and the dual-eligible population, correct?

Yes, I agree, it’s even more important to make sure that we can get current, up-to-date data on members of certain populations, because many of our members really are very transient and are moving around a lot. It is a more transient and fragmented population. That’s why we’re so engaged—why I’m the chairman of the board of IEHIE, why we support it financially, because it holds so much potential for our population.

What are the key practical challenges facing HIE leaders in this context?

There are a couple of challenges; the barrier getting just to the medical data alone is tough. And the behavioral health system data is very fragmented, so that can be a challenge. Now, Inland Empire Health Plan does cover behavioral, so we do have some data. Substance abuse is a carve-out under federal law, and that’s a challenge. And then you get to housing and other challenges. So we very tightly connect to the housing services in the two counties and other social services, but the actual movement of the data is a challenge, a big challenge. And ultimately, if we can get the medical and behavioral data integrated, that would be a big step.

Let’s talk about a typical member of Inland Empire Health Plan, and what that member’s challenges might be. That member is probably older and fragile, with social-determinant challenges, correct?

Yes, that’s right; our typical member is a relatively complicated patient. They probably have diabetes and CHF [congestive heart failure] possibly CAD [coronary artery disease] and COPD [chronic obstructive pulmonary disease]. But certainly, our typical member has coronary vascular disease and diabetes. They may have transportation issues, so we have to provide transport for them. They may be so sick that they need ADL [activities of daily living] help, with cooking and cleaning, things like that. So the care manager has to be sensitive not only to their diabetes, but also to their depression; we’ve got to get them transported to their various appointments, including specialty appointments; and IHSS—in-home supportive services—MediCal will pay for a personal care aide. It’s a person the member chooses, often a family member who’s paid a very modest wage to do shopping, cleaning, transportation. We pay for it, but it’s administered by the counties.

 And that’s an example of the continuum of services that have to be coordinated for that kind of person. Our care manager has to be connected to all those services, including IHSS, transportation services, and referrals to specialty appointments. That’s our typical “MediMedi dual” or MediCal member. And I didn’t add substance abuse to that, and I could have. So it’s not one thing, it’s five to ten things that our typical member is faced with.

Care management for many of these MediCal and dual eligible plan members is very complex stuff, obviously then, correct? And can require broader solutions—even such actions as paying to install handrails in members’ houses, that kind of thing.

Yes, exactly. Take the extreme example of if they’re homeless; until we manage they’re housing, they won’t be able to manage their medications or get to their appointments, etc. So the care manager has to look at the plan member across the entire continuum of their lives. And home modification is not covered by MediCal, but, for example, in one recent situation, we bought a washer and dryer for one of our members, because she had such bad COPD that having to go out to the laundromat was terrible for her and worsened her condition, so it made sense to do that. And your example of the hand railings in the house made sense, because a hip fracture is devastating for everyone. And that goes back to the data. You have to figure out that a member is being hospitalized often for COPD, and she tells us that she goes out of her house and gets sick. And this is taking it well beyond what we’re required to do; but we do these kinds of things to improve the health status of our members.

And even among the disadvantaged population, Americans travel and move around a great deal and obtain their care in many locations, correct?

Yes, that’s right; we definitely have members traveling a lot. So for me, next year, what’s really key is to integrate the two different entities with their different strengths. Claudia [Williams, the new CEO of the new merged HIE, who will join the organization formally next month] got to integrate the staffs, the different activities, goals. And we’re both on Orion, but on different platforms, so that has to be integrated. And what is our value proposition for the providers? You’ve got five big health plans [involved in the new merged HIE], and so we have a really good story to share with potential participants. Particularly in this age around alternative payment mechanisms and bundling; people need data.

What kinds of alerts are live already at Inland Empire HIE?

We alert the doctors when there’s an inpatient admission; we also are reporting ED visits, in report format. Now one thing is that there’s alert fatigue. So it’s talking to the doctors and medical groups and asking them, how best do you want to consume data? And sometimes, it’s analysis of which of their patients were in the ER. So working out whether it’s an alert, a report, an electronic notification, we have to figure that out.

Do the physicians in your area understand what you’re trying to accomplish on behalf of your members who are their patients, as we move into the emerging arena of population health?

Yes and no, we have to show them the value, that it helps them take better care of their members, versus it being a burden. And being a doctor and working with many doctors, I think people are getting it, they’re understanding the concept of population health versus just focusing on the patient ahead of them. It’s to some extent a generational change.

Population health is a game-changer, but hard to actually execute on, right?

Exactly. And we’ve got to deliver the data to them that is usable and actionable—hey, I’ve got all these diabetics who have uncontrolled blood sugars. Hey, I’ve got to have Mrs. Smith come in and see me. And if we don’t deliver the data to them, they won’t know, until that member shows up and is in their presence. A lot of docs and medical groups and ACOs [accountable care organizations] are doing these things. But in the inland Empire, we’ve got some work to do, in a good way.

This offers the potential to keep them at a higher level of health status, yes?

We cover a quarter of the population of the Inland Empire. Yes, there’s been a good drop in unemployment, but a lot of those jobs are low-income jobs without health insurance, so they’re getting IEHP through MediCal. There are a lot of individuals who are at risk because of their low income level are at IEHP. So it’s not just the diabetes, it’s everything, all the factors. So that’s exactly our mission, to organize the care and bring people to …

What would you say to the CIOs and CMIOs and patient care organizations whose organizations might be partnering with you, about this HIE development work?

I think they need to become participants, and start actively sharing data through interfaces. And then they’ve got to consume the information. It’s got to be bidirectional, with the HIE. Classic situation: patient arrives in the ED, doesn’t recall all their medications. You want that ED doc to have that list immediately. And he says, here’s the list I see, and are you taking those? And by the way, I’m not going to prescribe this one medication, because you’ve got this other one. Some complex patients will bring lists with them, others don’t.

And they might not even remember all the medications they’re on.

Yes, that’s right. My mom is a classic example of that; she’s on a ton of medications, and can never get it straight. And there are two doctors in the family, and that helps. But her situation illustrates the typical kinds of situations facing ED doctors when patients come into the ED for care. Having data at hand and available in situations like ED visits is extremely important.



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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.




More From Healthcare Informatics


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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