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”
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.”
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.”