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LIVE From HIMSS17: HIE Leaders Discuss Sustainability and Emerging Services to Deliver Value

February 21, 2017
by Heather Landi
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Healthcare providers increasingly want and need access to their patients’ data for the purposes of care coordination and care management, and, to meet this need, regional healthcare information exchange (HIE) organizations are pushing into advanced analytics and developing new services to bring actionable data to providers at the point of care.

During a session titled, “Emerging Services among Health Information Exchange Networks: Towards Sustainability,” during a pre-conference sessions at HIMSS17 on Sunday, executive leaders at three HIE organizations were joined by John Rancourt, deputy director, office of care transformation (OCT), from the Office of the National Coordinator for Health IT (ONC), to address the issue of HIE sustainability and to discuss several emerging services that HIE organizations are offering to support individual care delivery as well as population health.

However, before the discussion began, John Kansky, president and CEO, Indiana Health Information Exchange, said he took issue with the idea that HIE sustainability is a challenge.

“It’s hard work. I feel like any business that can generate value and has the opportunity to create new value shouldn’t have any problems sustaining itself as a business. With the healthcare system as fragmented as it is, there is no shortage of things that HIEs can do to add value,” he said.

With that being said, the panelists shared what is driving innovation at their HIE organizations and where they are focusing their investments to deliver more value to providers and payers and support interoperability of health data among providers, payers, and other health care organizations.

Brandon Neiswender, vice president and COO, Chesapeake Regional Information System for our Patients – CRISP, a regional HIE serving Maryland the District of Columbia, said, “One of the new things driving innovation at CRISP and what are we investing in is, we believe a lot of the access to C-CDA (Consolidated-Clinical Document. Architecture) clinical data is going to get easier. We see we’re making progress with large national efforts, such as The Sequoia Project and Carequality, moving data a little bit easier upon query,” he said.

However, Neiswender noted, “Connectivity is not interoperability. We have a lot of connectivity, but interoperability is still a challenge for us. FOR CRISP, our stakeholder community is driving us to build care coordination solutions,” he said.

He said CRISP is investing in delivering actionable data at the point of care, “so want to glean relevant information out of C-CDAs and make them snippets of information available at the point of care and building out the C-CDA so other EHR vendor can ingest that directly into the EHRs.” And, CRISP is focusing on connecting the care team, behavioral health use cases and Big Data concepts applied to claims and clinical data.

“We’re also taking a preliminary look at patient-generated data from value-based payment perspective, with a focus on getting that PGD to providers so they can prevent an acute admission,” he said.

Charles Scaglione, CEO and executive director, Bronx RHIO, described his organization as a regional health information organization servicing greater NYC area, specifically the borough of the Bronx, with a population of 1.4 million people. Stakeholders represent appropriately 100 organization from small specialty community-based organizations to integrated delivery systems. Collectively, these providers deliver more than 95 percent of the borough’s annual hospital discharges, more than 600,000 annual emergency department visits and 4.5 million annual ambulatory care visits. Bronx RHIO participates in the Statewide Health Information Network for New York (SHIN-NY).

Currently, key drivers for Bronx RHIO, Scaglione said, health indicators for the Bronx population. “The Bronx historically is poor performing in health outcomes; it’s ranked lowest in New York State, despite the great work being done. It’s a unique population, it’s young, there’s a lot of poverty and challenging health, social and economic indicators, so it’s challenging.”

Health reform initiatives, such as Medicaid redesign and the Delivery System Reform Incentive Payment Program (DSRIP) had a big impact on the organization, he said. “We were the beneficiary of a CMS  [Centers for Medicare & Medicaid) innovation grant four years ago and we have used that to push into analytics and working to introduce analytics into the point of care,” he said.

Further, Scaglione says the organization is being driven by providers moving into value-based care models, such as accountable care organizations (ACOs) and patient-centered medical homes.

Scaglione said Bronx RHIO is specifically focusing on data quality assessment and improvement initiatives. “About four years ago, we were starting out on analytics and we realized we didn’t know enough about our data. So, we’re really focusing on data knowledge, data intelligence and we have a board-level priority to focus on this and we’re working with our stakeholders on data quality initiatives.”

The organization also is focused on advanced analytics targeting interventions and improved outcomes, data aggregation and routing to improve care transitions and coordination, patient and population health safety as well as education and research partnerships.

Providing the ONC/ONT perspective, Rancourt said one of the underpinnings of the MACRA legislation is providing a strong incentive to drive providers from payments based on volume to payments based on value. “That requires quality improvement by providers, including a range of interoperable, health information exchange capabilities,” he said. Rancourt said his office actively engages with state leaders and industry stakeholders to focus on the health IT functionalities that providers need and how industry stakeholders can play a role in the healthcare system.

“An area to watch—qualified clinical data registries,” he said. The qualified clinical data registry (QCDR) reporting mechanism was introduced for the Physician Quality Reporting System (PQRS) beginning in 2014. According to the Centers for Medicare & Medicaid Services (CMS, a QCDR will complete the collection and submission of PQRS quality measures data on behalf of individual eligible professionals and PQRS group practices. For 2016, a QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients.

“Another key area to watch is the Comprehensive Primary Care Plus model, which is an advanced alternative payment model under MACRA legislation. This model includes very specific health IT requirements that can be satisfied by a number of different entities, the EHRs within the practice, or through an HIE, or another entity. That’s another area that we’re focusing on with states and HIEs as an area to driving improved interoperability in the space.”

Rancourt asked the panelists to highlight emerging and innovative services at each of their regional HIE organizations.

“Analytics been a cool service in terms of getting to another level of detail and focusing on their business needs,” Scaglione with Bronx RHIO said. However, on a more basic level, he said, the functionalities having the greatest impact on HIE usage are single sign on and data availability alerts.

“A challenge we face on a daily basis is getting end users to use the HIE services. One of the areas where we’ve seen a dramatic impact is single sign-on from within the EMR into the HIE, as opposed to forcing providers to access data in a different way,” he said.

“The other one is data availability flag, where we are embedding the flag into the local system, the ED system, so that the end user or the provider knows when there is data available in the community outside of what’s in their EMR,” he said, and added, “Part of the reason that it that there are specific use cases when need HIE services. Some organizations in the Bronx, about 50 to 60 and even up to 70 percent of patients are accessing care outside their system. For other providers, it’s only 20 percent, so 80 percent of the case, for that provider, they are not finding data outside the system so they routinely access the HIE and 80 percent of the time, they are not getting a hit. The data availability flag allows them to go in when they need to go in.”

“The value of single sign on," Scaglione said, "is recognizing that where the providers are going to live in the future is their EHRS. Any value proposition where you are pulling eyeballs out of EHRs, you need to think about that.”

Scaglione also highlighted Bronx RHIO’s participation in SHIN-NY which enables a statewide patient lookup. “Implementing a statewide interoperability has been a big challenge. You need a very collaborative effort to do that. You need to start in small chunks, as with the statewide patient lookup. We’re moving onto a statewide alerting system that crossing boundaries so the providers can be alerted if there is activity outside of their region. We are moving to other functionality, but it’s incremental.”

Neiswender highlighted CRISP’s care alerts registry, “a by-product of our work on notification services,” he said. “We need a small, lightweight platform to store things to notify people to take action, such as ‘Is the patient in a care management program? Who is the care manager and what is their phone number? Has the patient had a discharge from hospital in past 30 days? These can be small little flags embedded in the patient care overview and available in the query portal, and also available in an API platform.”

He continues, “It’s about small, little use cases. So, I’m an ED registrar and when I see that patient, I call the care manager at that time and avoid some utilization and it’s a completely scalable platform. The care alerts registry tells you who the care manager is, who the PCP is, is this patient taking prescription opioids? A provider can type a two sentence note and say, ‘this is a patient of mine, I know he frequents the ED often, give me a call.’ Things like that. We don’t need to do the heavy lift of C-CDAs, we can extract the data until the standards catch up. In some cases, we’re utilizing the standards,” he said.

In an ongoing effort to provide value and meet the needs of the market, Neiswender said the strategy is more about incrementalism as opposed to long-scale HIE solutions. “I think what has worked for us has been going back to an agile mentality. We ask, ‘who is the user? What is the user story? What am I building a service for? How do we get something small done to show value?”

“We talk a lot about home runs and base hits,” Kansky said. “In our 10-plus year history, we are figuring out what our market wants and needs and will pay for. We need to get away from just wanting to hit home runs. Something that’s talked about in the tech start-up world, and less in the HIE world, is “fail fast,”— if you try to hit a home run and you bet so much resources and two years of development on this huge thing and screw that up, that’s an existential threat. If you do incrementalism, add small value, and figure out which pieces work and not work quickly. And, it needs to be okay to fail. With more things coming into the marketplace to add value, it’s okay to have some failures.”

 

 


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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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