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.