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SHIEC’s New CEO Discusses Vision and Finding HIEs’ Next Level of Value

August 22, 2017
by Heather Landi
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Hoover Thompson, an attorney by background, discusses how to find the next level of value in HIEs as well as issues related to sustainability
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The Strategic Health Information Exchange Collaborative (SHIEC), a national trade association representing health information exchanges (HIEs), last week announced that it has named Kelly Hoover Thompson as its new CEO. The new leadership at the Grand Junction, Colo.-based national HIE association comes at a time of accelerating change in the healthcare industry and at a time when health information exchange, as an area of healthcare, has seen its share of barriers and challenges. At the same time, effective health data exchange is vital to many of the ongoing developments to improve the quality of patient care delivery.

As SHIEC CEO, Hoover Thompson, an attorney by background, will lead the 54-member organization and is charged with working collaboratively with the SHIEC board of directors to develop and actively advance an organizational strategy that ensures success of SHIEC and its members.

 Hoover Thompson brings a decade of HIE experience, including leading development of Pennsylvania’s statewide health information exchange, called the eHealth Partnership. In that role, the HIE achieved statewide connectivity in every county by last year, and developed a patient care alert system. Prior to her work on behalf of the state of Pennsylvania, Hoover Thompson was a senior advocate of policy and regulatory matters for The Hospital & Healthsystem Association of Pennsylvania. She serves nationally and locally as a health policy and privacy advisor.

Healthcare Informatics Associate Editor Heather Landi recently spoke with Hoover Thompson about her vision for the three-year-old HIE national association, the role of HIEs in the healthcare industry and the opportunities, and challenges, facing HIE leaders in the evolving national healthcare landscape. Below are excerpts of that discussion.

What drew to you to this new leadership role at SHIEC?

Fortunately, I’ve been able to work on health information exchange for about the last decade; it’s an interest of mine. I’m a healthcare attorney, a privacy attorney, by background, and I’ve always worked in healthcare, except for the first couple years of my career. It’s something that I’m interested in and SHIEC is an up-and-coming organization and it seemed like a good opportunity for me to be able to give back on the issue, and for folks to provide me with new insight as well.

What do you see as the role of HIEs in the evolving healthcare industry?

Health information exchange, I think, is a piece of the puzzle that when you look at where healthcare is moving toward—it is looking at breaking down silos, looking at working across the continuum, looking at things like ACOs [accountable care organizations] and supporting patients and residents as they travel, and each of the pieces of the care setting across that continuum. Health information exchange is that one cornerstone piece of the puzzle that supports the ability to look at the whole community approach for that individual patient to support things like precision medicine.

What do you see as your core focus for SHIEC moving forward?

SHIEC is only a few years old, actually, this fall, just three years old. So, one of the things that I’ve envisioned for SHIEC is really to step up and become the trusted resource for health information exchange in the country; to be the trusted voice that lawmakers and policymakers look to whenever they are making decisions. One of the best places you can be in this whole process, whether it’s legislative, regulatory or just looking at general process, that impacts an issue is that those decision makers will call you, will touch base with you, before they make any key decisions. I think SHIEC is so well positioned and is only on the cusp of just scratching the surface of all of the value that they can provide.

SHIEC has outlined one of its goals as “elevating the awareness, stature and perception of HIEs on the national healthcare landscape.” As CEO, how do you plan to do that?

One of the things that is pretty core to association management, approach and advocacy is that people don’t know all the good stuff you do, unless you tell them. So, one of the things that we’re going to have to talk through is how to capture the stories, how to capture all the good stuff that these HIEs are doing within their communities. So, talk about patient stories. One of the impacts I know about is that one of our HIEs was supportive in a ransomware attack; these are things that are very practical and valuable to show the role of HIEs and to really elevate them.

The vision of anybody that has been working on HIE, boots on the ground to make this work, is they really are in it for the right things, to support the patients. And, so, I would imagine the vision is the same, that it has been, and that it has only been stepped up in terms of the need and the interest. The fact that the board has hired a CEO and has invested in that, to move the organization forward, is a significant sign to show where HIE is headed.

It has been pointed out that technology is an important piece of HIE work, but the work that HIEs do also address issues around people and process. How do you think your background will help to address all these issues?

My background is pretty broad, which makes it interesting for this position. I do feel that with SHIEC, because I’m an attorney by background and I spent so many years trying to implement HIEs, so I’ve drafted legislation, I’ve drafted regulation, I’ve gone through the process. I’ve worked with association management, I’ve worked with stakeholders, I have had people disagree with me on approach, I’ve taken a lot of voices and built consensus around issues, but I’ve also, from an operational standpoint, had the opportunity to figure out once we get agreements drafted, and get a legal framework in place, and get all the regional, state and local exchanges connected, what that really means. And what practically has to happen to get people to pay attention, and really realize the value of what HIE has to offer.

I think each of those pieces of my background is going to be helpful for the organization. I think it’s going to draw very much on my broad background. I am not an IT person by training; I know enough to be dangerous. The reality is that I’ve done a pretty good job of educating myself and knowing where my strengths and weaknesses are, and I think often in the HIE environment, there are a lot of IT people who know a lot of about IT, but HIE is not just IT. There are all the policy implications, and legal, and again, drafting agreements and figuring out how to identify a team and put a team together that can go out into the community and establish trust and be able to interact with the community, with folks at all levels of the healthcare continuum that are responsible, at the end of the day, with creating a better healthcare system. In terms of people and process, I think one of the things that I’m probably strongest at is in the personal skills and relationship building and being able to put together a team that can advance things and deliver. I actually think people and process is going to be one of my strongest successes, as we move forward, with a very team-based approach, as I know that I will not do it on my own.

What are the some of the biggest challenges facing HIE leaders now?

I think one of the biggest challenges is that now that we have those agreements in place, the framework in place, we’ve gotten people’s attention that they need to understand what HIE is and how it fits; it’s up to us to find the next level of value in the HIEs. We often talk about interoperability, and throw that term around, like it’s something easy to accomplish, but anyone who works in HIE knows that it’s really not. I would say that the privacy of the information is going to be one challenge. You see some of the work that SAMHSA [Substance Abuse and Mental Health Services Administration] is doing, with 42 CFR, about what types of information should be shared or not. And there are folks on both sides of that issue. One of the challenges, first and foremost, is going to be, now that we have this framework in place, how can we expand it, how can we take the information and use it to really support the patient through the continuum? And how can we take the information and look at things like predictive analytics and supporting the social determinants or the social aspect, because there is such a link between the social piece for an individual and the healthcare outcomes that we all hope are the best as they possibly can be.

I also think, operationally, there are just some practical pieces. There are still sustainability issues for folks. Just keeping the lights on and figuring out how to work all these pieces, and quite frankly, as a soon-to-be-former regulator, looking at laws that were written years ago that didn’t anticipate health information exchange today. I think that’s a lot of what SAMHSA tries to do, and even ONC [the Office of the National Coordinator for Health IT], in some of their work, they are trying to modernize healthcare in this century. That’s a couple of the issues that I think are going to be facing us we move forward. I don’t think those are surprises to anyone.

On the issue of sustainability, many HIEs are sustainable and are growing, but many HIEs have closed. Is there reason for concern?

I think any business, especially new ones, any start-up business, it’s often part of the conversation that you are faced with sustainability, but I don’t think that it is at a place where we are panicking. What I think we are looking at, at least in my experience and in my state, is identifying sources that might be out there that we just haven’t identified. Again, with starting up an exchange, there’s so much focus that goes into getting the framework in place to even be able to share the information or get people interested. So, one of the things that we have done is identify federal grant dollars that we were able to pass through us out into the communities across the state to support providers as they are connecting; to support them in leveraging and getting all their Meaningful Use incentives.  I think, moving forward, sustainability will likely be a part of the conversation for many exchanges, but I also don’t think that it’s going to be the defining moment for them. I think there is so more than that, but that is a reality of doing business.

Looking at the ongoing transition to value-based care and payment models and even looking at the cybersecurity landscape, do you think there are certain uses and benefits of HIEs that haven’t been explored yet or should be explored?

Absolutely. There are absolutely benefits that we haven’t even discovered yet with HIE because we’re just on the cusp of making HIE even more so of a cornerstone of healthcare. For example, one of the things that we’ve discussed here, just in my state, is how can we provide, again, looking at that social services piece, looking at whether there are pieces within health information exchange that look at things like end of life care. I know there are some exchanges that do that, such as looking at things like organ donation. There could be opportunities for HIEs to do predictive analytics and many of them, I think, already are. At the very least, if you think about patient care alert, some exchanges are not to the point where they are alerting admission, discharge and transfer (ADT) notification. Some of those ADTs are patient care alerts that are so vital for a provider to be able to treat a patient. And think about the timing of the information that is shared and near real-time sharing of information. We have some reporting and collection of information that might be delayed, otherwise, in the old way of doing things. But HIE offers the opportunity to provide near real-time data sharing, information sharing when patients are in their most critical, vulnerable moments, and need that information to be available for providers to give them the best care that they can.

The other thing that I should mention, too, is that many states are talking about Medicaid; we’ve talked a lot about Medicaid expansion and medical assistance. In order to really identify, I think, where you are going to find some of that value-based purchasing, and the cost containment opportunities and efficiencies, that is, I think, another opportunity. I think that’s one of the reasons you see CMS [the Centers for Medicare & Medicaid] providing a significant amount of grant dollars through Implementation Advanced Planning Documents (IAPDs) and pushing it out to the states to be able to support advancement and improvement in those areas. I think that cost piece of it is a whole other area that we haven’t even really completely scratched the surface yet.


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Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”


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The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
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The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”

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Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018
by David Raths, Contributing Editor
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Earlier effort failed because HIE was not self-sustaining

The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

An earlier statewide HIE effort, the Connecticut Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream. (The State of Montana also recently decided to take a second try at creating a statewide HIE.)

The grant, awarded by the Center for Medicare and Medicaid Services (CMS) to the Connecticut Office of Health Strategy (OHS), supports efforts to develop a secure, modern HIE that facilitates the sharing of health data to further patient care, improve proper efficiency, and rein in the high cost of healthcare. The HIE is expected to be operational by early 2019.

The grant follows a $5 million federal investment the state received in 2017 that facilitated HIE planning. To qualify for the additional resources, states outlined how their health technology plan would improve disease management, serve the Medicaid population (over 800,000 Connecticut residents), combat the opioid epidemic, and improve overall healthcare through the use of clinical data.

The new round of funding launches a pilot program for the health information exchange, which was one of the nine recommendations made by the Health Information Technology Advisory Council, a statutory body tasked with a comprehensive examination of Connecticut’s current health technology needs.

“The health information exchange will improve care. Providers will be able to exchange clinical and diagnostic data in real time – efficiencies that will save time and resources for healthcare systems and patients,” said OHS Health Information Technology Officer Allan Hackney, in a prepared statement. “We engaged nearly 300 providers and consumers and 75 organizations across the health sector in Connecticut to help us understand the issues and opportunities for improving care delivery and outcomes. Technology can and should be a great partner in health reform.”

Another goal is for the HIE to enable a platform for measuring clinical quality and more quickly analyzing population health – one of the keys to improving healthcare accessibility and correcting racial, ethnic, and gender health inequities. Currently, analysts most commonly use insurance claims data, which is only a proxy for real-time clinical information. This use of the HIE dovetails with the work of OHS’s State Innovation Model Office and the Health Systems Planning Unit in their efforts to better address gaps in healthcare, improve community health, and evaluate the performance of Connecticut’s healthcare providers.


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