Activity in the world of health information exchange (HIE) is accelerating rapidly now in many quarters, as the shift towards value-based healthcare delivery and payment is bringing the payers, purchasers, and providers of care, as well as public health agencies and state governments, and groups representing consumers, together, to share key data and information, in order to improve care. Of course, some HIE organizations have been working steadily on advances for years now.
One HIE that has years of experience under its collective belt is the Utah Health Information Network (UHIN). Incorporated back in 1993, UHIN has been innovating for some time. And, as of this moment, 100 percent of the hospitals in the four largest health systems operating in the state of Utah (HCA, IASIS, Intermountain, and the University of Utah health systems), totaling 90 percent of the state’s 50 hospitals, are actively participating in data exchange within the HIE. What’s more, UHIN is sending out 2,000 ADT notifications per day, a very large number, considering the state’s total population of approximately 3 million.
As the organization notes on its website, “UHIN positively impacts healthcare through reduced costs, improved quality, and better results by fostering data-driven decisions. A nonprofit founded in 1993, we offer affordable tools that allow providers, payers, and patients to safely exchange clinical information, claims and reports electronically.” The website statement adds that “As a full-service clearinghouse, we exchange all HIPAA transactions, including claims, remittance advice, acknowledgement reports, detailed claim status reports, eligibility, and enrollment requests. We also operate the Clinical Health Information Exchange (cHIE), allowing doctors and patients to work together for safer, better-coordinated care by making crucial information available to doctors at the point of care. UHIN is a Standards Development Organization actively participating with national electronic transaction committees. We share the knowledge we gain throughout the healthcare community through events and education sessions.”
UHIN adds, on its website, “We have also joined forces with our HIE colleagues in Arizona and western Colorado to form a Patient-Centered Data Home. This PCDH enables providers using any one of the three HIEs to receive electronic notifications and patient summaries when their patients have an encounter across state lines at a hospital in one of the other HIEs’ network.”
UHIN’s leaders are moving forward across a broad range of areas of activity, among them, fulfilling the terms of a grant from the federal Office of the National Coordinator for Health Information Technology (ONC). That grant, in the amount of $3,132,029, involves eight different projects, with 52 strategic goals—of which UHIN has already met 50. It also involves the data of over 1 million patients, and 28 hospitals and over 300 eligible providers, and five community partners: the Utah Department of Health, the University of Utah Department of Bioinformatics, the University of Utah Department of Nursing, Intermountain Healthcare, and Health Insight. Among the several key areas focused on: providing for the electronic exchange of behavioral health referrals and information with those of physical health referrals; creating an effective patient care summary for transitions from hospital to long-term care; providing patient access to the HIE to allow patients to see an aggregated view of community data, and for patients to deliver standard clinical care summaries to their providers; a program to increase ADT notifications across entire communities; a program to create a statewide provider directory resource for payers, providers, and patients; and a rural community initiative to expand HIE across a particularly underserved rural area within the state.
In the week prior to the September 26 UHIN Annual HIT Conference, UHIN’s president and CEO, Teresa Rivera, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the organization’s direction and current initiatives. Below are excerpts from that interview.
How long have you been with the organization?
I’ve been with UHIN for ten years now.
And the organization goes back to 1993, making it one of the longest-lived successful HIEs created back then. That really was very early in the current history of health information exchange.
Yes, it was very early. And we are fortunate, the community runs us and makes up our board, we have all the major hospitals and clinics, the Utah Medical Association, the Utah Hospital Association, and a consumer as well. And as you heard from Dr. Rucker at the SHIEC Conference [National Coordinator for Health IT Donald Rucker, M.D., was the opening keynote speaker at the SHIEC Conference, held in Indianapolis in August, and sponsored by the Grand Junction, Colorado-based SHIEC—the Strategic Health Information Exchange Collaborative], communities and consumer representatives are an important stakeholder in HIE. And Alan Orensby is from AARP, representing consumers. And it is because of that consumer perspective that we did things such as providing a view into the HIE, and a patient can sign up and see their aggregated data, just as a provider would. They are also able to direct their records, as needed, already.
Do you have statistics on the volume of data flowing, and on participant organizations?
We send over 2,000 ADTs [admission, discharge and transfer notices] every day. We have over 45 million records in the Clinical Health Information record, which we call the cHIE. We have the majority of hospitals connected, in the 90-plus percentile; there are just four or five small independent hospitals left in the state that are not yet connected. Altogether, we have over 500 data sources contributing into the cHIE.
How would you say UHIN is doing, in the broader national context?
I believe that HIE works best at the local community level, because you move as fast as the trust is established in your local community. On a national basis, we’ve connected with the surrounding states—Colorado, Arizona, Nevada, Idaho, and Nebraska, and hospitals in Wyoming connected. And we know patients in the southeastern corner of the state, Moab, go to Grand Junction, Colorado, for care. So we are a very big proponent of the Patient-Centered Data Home.
And we have patients who are so-called “snow birds,” who seek care in Arizona, for example. At the same time, Salt Lake City is a medical hub. We have the primary children’s hospital in the state, the burn center, the Huntsman Cancer Center. And since April 2016, with the first cross-border ADT message, we’ve had nearly 50,000 ADT messages go across borders [state lines].
What are the biggest challenges facing you as an organization right now, overall?
I would say, the amount of work we still have left to do. As I said, we’ve gotten most of the hospitals and the large clinics in the state connected, but now we’re entering into a project we’re bringing on the specialists, and the physical, occupational, and speech therapists, so that that data is flowing. I just got out of a meeting where we were talking about having a shared care plan that follows the patient as well. We have not yet connected to entities like criminal justice, yet we know that they have medical needs. We have a homeless population that we want to be able to serve, and a refugee population. We need to connect and let data flow, not only to the medical provider, but to other areas of the community that will serve them, with transportation and community services. We have the behavioral health nut to crack, where we want the data to flow and follow the patient, and still respect the consent that’s required. That will be important for criminal justice. So we do have a lot work.
And you believe that you have a sustainable model at UHIN, correct? That has become so important in the current funding and operating environment.
We do. We are self-sustaining. We’re fortunate in that members pay to use the services, and they value the services.
That includes physicians paying to connect?
Yes, that’s correct, they do. One of the other projects we’re looking at is the Physician Order for Life-Sustaining Treatment program, which would be a great value for our community.
What will be the difference between HIEs that falter and those that proper, in the next few years?
I would say that the HIEs that prosper will be those that can deliver services that go beyond just exchange. You heard Dr. Rucker say that data needs to flow with little effort from the provider. We need to look at the data that’s presented, and make sure it’s presented in useful ways. For example, our state is working on a fall prevention effort. And the HIE can assist the provider, by identifying cues that would compel the physician to reach out to the patient who is vulnerable. And it’s difficult to recover from injuries like falls. So, providing meaningful, actionable reports to providers, in their own systems, that’s what’s needed, right? Clinicians don’t want to have to leave their own systems in order to access that data. What’s more, they don’t need too much data—they need just the right data—at the right time. The reality is that, it’s not too difficult if all we’re looking to do is to “hook up pipes”; vendors do that already today. That’s not where HIEs can really serve.
What will the HIE landscape look like five years from now, do you think?
I believe we’ll all be connected, even before five years from now. We’ll be delivering important information beyond the C-CDA [consolidated clinical document architecture]; it will be important data that needs to be shared for things like end-of-life. And it will include not just the hospitals and big health systems, but long-term care and home health and EMS, and it will be so automatic that when the patient is presented to any venue of care, their data will be presented at the same time. I think, in five years, we will be taking this for granted, just as patients today assume that all their information, and their medical information is being coordinated right now, it actually will.
I believe that we can all work together and get this going. it is not easy. And I know that we've taken criticism, all of us, because Congress and all those not in the industry, assumed it would be as easy as an ATM [automated teller machine] connection. But I think we have the most brilliant minds at the table, and if we work together, it can happen.
It seems that we’re at an inflection point right now, in terms of the potential for health information exchange and other phenomena to move forward, given the right conditions and collaborations.
Yes, I agree. I think we are at this inflection point. and we just can't stop; we've got to push forward, with the development of more and more innovation. you see it with the standards folks developing new standards, and pushing on standards, including transfer standards, such as FHIR [the Fast Healthcare Interoperability Resources standard]. We just have to keep this going.