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.
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”