The Commonwealth of Pennsylvania is ramping up a Public Health Gateway (PHG) that was created as a single point of entry for healthcare information organizations (HIOs) submitting data for provider organizations to dozens of applications in the Department of Health and Department of Human Services. The transition has been slow and difficult, but providers are starting to sign up and see benefits.
A panel of executives from the Keystone State spoke about the creation of the PHG at the 9th Annual State Healthcare IT Connect Summit in Baltimore last week. Pat Keating, CIO of the Department of Health, said that several years ago his department did an analysis and realized it had 100 applications collecting data. “We could see how one point of entry would make it easier for end users to submit data. As we recognized that, we also realized we didn’t have the infrastructure or talent to do it. It was a good idea, but not something we could do initially.”
But the advent of health information exchange and the Affordable Care Act brought the idea back to the table. “We decided to get rid of point-to-point connections and have a central hub, which then sends data on to agencies.” Providers send data to their regional HIO, which sends it on to the Public Health Gateway. From there it goes on to the registries in Health or Human Services. Applications include the immunization registry, cancer registry, syndromic surveillance and electronic lab reporting. (The Commonwealth also will add the prescription drug monitoring program (PDMP) to the gateway. In addition to four existing HIOs, two more are in the process of connecting.
“What we are trying to do is standardize onboarding providers for data collection, instead of having so many applications that are point to point with different points of contact,” Keating said. “We believe that by streamlining that process, it will help us to get more consistent data.”
Many states have one agency for both health and human services, Keating noted. “Having them separate makes it somewhat challenging. We are a midsize agency. Human Services is gigantic,” he said. “They receive more money from the federal government than we do. We were able to leverage their infrastructure and expertise for the Public Health Gateway.”
One of the promising uses of the PGH is for submitting electronic clinical quality measures for Medicaid managed care organizations. David Kelley, chief medical officer of the Pennsylvania Medicaid program, said his organization is moving away from manual chart reviews to more effectively gather eCQMs.
“From our standpoint it is an opportunity to get out of chart review and sharing of electronic eCQMs,” Kelley said. “Not only can these be used for quality improvement and NCQA reporting, they allow us and managed care organizations to see what is happening with patients in terms of diabetes or blood pressure control in a timely manner. It is vitally important that we are moving away from paper.”
The Commonwealth took advantage of CMS 90/10 funding to create incentives for HIOs to create connections and lower barriers for individual member organizations to connect to registries, said Martin Ciccocioppo, director of the Pennsylvania eHealth Partnership. In 2017, it successfully got several organizations connected to the electronic lab reporting registry. But getting providers connected didn’t go as quickly as the Commonwealth and HIOs wanted, he admitted. “We have not been able to respond to demand as effectively as we wanted,” he added. “We wanted to have more connections up and offer more grants. There was a little frustration on the part of HIOs. We have been talking about this for four to five years, with the promise of a single point of connection.
Part of the pace of adoption problem was a capacity issue on the registry owners’ side. “They can’t handle as much onboarding as the member organizations would like. We had to limit awards based on capacity issues,” Ciccocioppo said. “But at this point we have reached a tipping point where we have successful connections, and are expanding the number.”
Ciccocioppo was asked about governance of the PHG. He said getting Commonwealth agencies to work together on sharing heath data has been a challenge for years. He recalled several years ago attending a monthly meeting of stakeholders on interoperability hosted by the Pennsylvania Medical Society.
“The thing that perplexed me was that for representatives from agencies and registries from the state, the only time they were meeting was during those meetings,” he said. “There were huge silos, and they didn’t talk even within the same agency. That monthly meeting was beneficial for them. Now we have an active governance structure involving key stakeholders from both agencies, both at the management and program level.”
Kelley gave examples of other programs that could take advantage of the gateway, including the Department of Aging, the Department of Military and Veteran Affairs, and the Department of Corrections. “An office in our agency is Children and Youth Services. We have programs pulling Medicaid data and manually pushing it out to 50 counties about children in foster care on antipsychotic drugs,” Kelley said. “We could automate accessing that data. We can be more efficient.”