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In a Muddy HIE Landscape, CORHIO Delivers the Goods

April 2, 2018
by Rajiv Leventhal
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The HIE’s CEO believes its success has always been driven by the collaborative nature of how Colorado healthcare leaders work

In states such as Vermont and Connecticut, recent stories have highlighted the struggles that those regions have experienced in being able to sustain health information exchange (HIE) success. But in certain other pockets of the country, data exchange efforts are progressing much better. In Colorado, for one, the Denver-based Colorado Regional Health Information Organization (CORHIO) has been able to attain levels of HIE achievement that are mostly unparalleled throughout the U.S.

Indeed, the CORHIO HIE is a network for information exchange comprised of 74 hospitals and more than 11,000 healthcare participants including physicians, hospitals, behavioral health, emergency medical services, public health, long-term care, laboratories, imaging centers, health plans and other community organizations. As the HIE’s CEO, Morgan Honea, details, there are nearly 12,000 users on CORHIO’s community health record portal, which is the tool that providers or their staff can log in and query patients within the HIE. What’s more, approximately 125,000 patient result messages are sent to electronic health records (EHRs) each week, and in all, there are nearly 1 million queries per week for 5.4 million unique patients.

Just recently, CORHIO announced the launch of Community Interchange, a product from the Salt Lake City, Utah-based Medicity, which officials say enables the transformation of disparate data into a single, de-duplicated, comprehensive continuity of care document (CCD). As a result, without investing any significant effort, busy healthcare providers can now have a single view of all clinical information available for a patient, according to Medicity executives.

Speaking to the impetus behind the implementation of Community Interchange, Honea says that the primary issues CORHIO has been trying to solve are around workflow and ease-of-use of the HIE, and the organization of the data within it. “The driving factor was that we have gotten to the point with the volume and variety of data with the HIE, and with the different formats and types of data that come from our various senders, that it became critical to enhance the user experience in order for providers to look at the HIE and have the ability to consolidate the data in a way that makes much more sense in terms of clinical workflow rather than looking at libraries of data,” he says. Now, Honea contends, the HIE can display data in a “much more consolidated fashion”—from ambulatory settings, hospital settings, and ancillary settings.

Morgan Honea

Expanding into New Horizons

Beyond the Community Interchange deployment, plenty of other new developments are taking place with CORHIO. Honea notes that the HIE is now serving hospitals and clinics in three different states—western Kansas and Wyoming, in addition to Colorado—and that is largely contributed to hospital consolidation and growth in those areas. In terms of organizational growth, he says there isn’t a whole lot of work left to do in terms of onboarding hospital systems, as most of those not on the CORHIO network are rural critical access hospitals and are “strapped for resources or may have vendor challenges with connecting to an HIE. But we are slowly working through those [issues] as well,” he says.  

The largest focus for CORHIO right now is on behavioral health and substance use data integration, Honea says. “We are working with our stakeholders to address integration of care and we are working rapidly on incorporating social determinants and environmental [care factors] into that longitudinal record so we can take a big leap forward into population health,” he adds.

This type of integration, of course, is challenging as providers are not traditionally accustomed to thinking about these data points. “One of our staff members describes HIE challenges in two paths: documents and data,” says Honea. “In the provider workflow, it is focused around documents—so the clinical encounter that happened at the primary care practice, or the discharge that came from the hospital. This is very much a document-based exchange. And then as you think about population health, environments of care and public health use cases, it’s much more about data. Crossing those chasms and making them interweave and mesh together, and using the healthcare standards and the things we leverage to make that magic happen, is challenging. But in Colorado we are fortunate to have smart folks in different segments doing great work,” Honea attests.

Indeed, in this sense, Honea says CORHIO is not starting from scratch and building these capabilities themselves, but rather they are partnering with others to leverage the work that already has been done, and then scaling those efforts by building on top of the heavy infrastructure that CORHIO was capitalized with from HITECH funding. And that infrastructure, he continues, is mostly about data management, data usage agreements policies, data governance, and patient identification. So now the goal, Honea states, is to “include a no-sequel environment so we can get beyond those relational database structures, leverage all of the interactions we have with the healthcare ecosystem, and build on the great relationships and work that has been done in other segments like research and population health, and human services.”

Collaboration is the “Secret Sauce”

Honea believes that CORHIO’s success has always been driven by the collaborative nature of how Colorado healthcare leaders work. “We have some incredible thought leadership from hospital CIOs in different communities. There is a strong recognition that healthcare is local, but policy can be regional and federalized, and it’s the collaboration that is the secret sauce,” he says. When CORHIO was stood up, Honea says that “great visionaries came together and said they wouldn’t compete on technology.” And as he points out, Colorado hospitals are almost universally on Epic at this point, so that vision has come true. To this point, Honea says that just because a provider is using Epic’s data exchange product, Care Everywhere, doesn’t mean that it also can’t participate in an HIE. “They are complementary processes—not and/ors,” he says.

Instead, local leaders agreed to continue to compete on quality and experience. Honea asserts that this has provided CORHIO with the legs to become an “unbiased, trusted partner that is here to improve the quality of care.” He adds, “We have a fantastic relationship with our local legislation and state government partners. And we have a great relationship with the federal level as well. Sen. [Michael] Bennet [D-CO] sits on the Senate HELP [Health, Education, Labor, and Pensions] committee and represents us well. And we have great relationships with ONC [the Office of the National Coordinator for Health IT] and CMS [the Centers for Medicare & Medicaid Services], too.”

Nonetheless, it’s not as if CORHIO doesn’t face many of the same challenges as other HIEs. Honea points to the “uncertainly of the federal landscape” as one challenge that needs to be managed. “We wish there was a clearer path forward on where we are headed in that regard,” he says. “There also continues to be challenges with data quality and standardization coming out of the various EHRs. We see firsthand that data content, quality and structure can change, not only by vendor, but by version and instance, too. So that requires a lot of ‘mid-stream’ interaction on the data in order to make sure that it’s useful downstream. And if there were more money in the world we can do this job better and faster, so we are always looking for ways to capitalize and resource our efforts better.”

TEFCA Thoughts

Earlier this year, ONC released its draft Trusted Exchange Framework and Common Agreement (TEFCA)—a plan to jolt the sluggish pace of progress on interoperability between providers. But some experts have pointed out that TEFCA, which is voluntary and introduces a new concept of the Qualified Health Information Network (QHIN), would force regional HIEs to switch their focus from just moving data between providers to offering value-added services or risk being put out of business.

For example, ONC’s Genevieve Morris, principal deputy national coordinator for health information technology, said in a recent webinar that regional HIEs struggle to connect ambulatory facilities; in her experience, Morris said, it takes up to nine months to connect just a single practice. She noted in that webinar, “We would never get to nationwide interoperability within 100 years that way. While we have a number of regional HIEs that are doing very well, the amount of white space that has no coverage from a regional HIE is quite significant.”

When asked about TEFCA, Honea says that for areas where interoperability continues to elude providers, TEFCA has the potential to make great strides. But conversely, for regions such as Colorado, in which CORHIO is a supportive member of the national HIE group SHIEC (the Strategic Health Information Exchange Collaborative) and works closely with its peers across the U.S., there is “great work going on that doesn’t get enough credit.”

As such, in these regions, Honea believes that “TEFCA has the potential of undermining the progress and investments that have already been made. In Colorado, we have developed a thoughtful statewide strategy where we have a path designed for how we will improve and expand interoperability, and TEFCA could undermine that strategy, potentiality,” he says.

Honea points to other states such as Utah, Arizona, San Diego, Michigan, Maine, and Ohio where interoperability has similarly been approached very strategically, and where HIE leaders are working on downstream opportunities now that some level of health information exchange has been accomplished. This is why Honea—who firmly believes that TEFCA will be a benefit in those areas that don’t have a strong HIE footprint—hopes that the feds “take into account those of us who have worked hard to make interoperability less of a challenge rather than undermine those of us who have worked really hard to figure it out.”


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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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Seven HIEs Now Connected to Military Health System

November 1, 2018
by Heather Landi, Associate Editor
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Seven physician-led health information exchanges (HIEs) are now connected to the Military Health System (MHS), enabling MHS providers to have access to patients’ electronic health records to support clinical decision making at the point of care.

The Kansas Health Information Network (KHIN), the eHealth Exchange, and KAMMCO, a provider of insurance and health care technology services for physicians and other health care professionals, assisted in facilitating the connection.

With this new development, medical records can be shared across the world as military personnel and their families transition between multiple locations, stateside or overseas. Military hospitals and clinics now can quickly and securely access patients' personal health information 24/7 and have access from the physician-led HIEs in Kansas, Connecticut, New Jersey, South Carolina, Georgia, Missouri and Louisiana.

“This represents the growing capabilities of HIEs to share records in all locations from which a patient has received care,” Laura McCrary, executive director of KHIN, said in a statement.

“MHS cares for 9.4 million beneficiaries, delivering care globally in military hospitals and clinics and providing coordinated, integrated care through civilian networks," Kimberly Heermann-Do, Health Information Exchange Office Lead in the EHR Modernization Program Management Office, said. Heermann-Do added, “Through HIEs, records are available securely from the private sector if the HIE is onboarded to the MHS. Having access to records for patients across the KAMMCO network will assist MHS providers with clinical decisions.”

“The Medical Society of New Jersey (MSNJ) has a long history of supporting the healthcare needs of our active duty military in New Jersey. Sharing clinical information from our physician practices with MHS through OneHealth New Jersey furthers our support in this important area,” Larry Downs, MSNJ CEO, said in a statement. “With a large joint base located in New Jersey our physician members provide care to many active duty military and their families.” MSNJ is one of seven medical societies who partner with KAMMCO in the delivery of a physician-led health information exchange platform.

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