On the heels of this year’s Civitas Networks for Health 2022 Annual Conference, a collaboration with the DirectTrust Summit, executives from two health information exchanges have shared with Healthcare IT News perspectives on their organizations’ roles as public health utilities, interoperability challenges, successes achieved during the pandemic and trends shaping the future for HIEs.
Our conversation features commentary from Erica Galvez, CEO of Manifest MedEx, the largest HIE in California, and Kyle Russell, CEO of Virginia Health Information, the non-profit organization that operates the commonwealth’s HIE, emergency care coordination program, all-payer claims database and other data collection systems.
Q. How can health information exchanges serve as public health utilities?
RUSSELL: To truly live out the words “data utility,” HIEs must be structured with strong public accountability mechanisms. They must serve the entire community, not just select groups.
The concept of a health data utility really formalizes the wide scope of functions many HIEs already deliver. Services like complex data linking, developing standards for data exchange and patient risk profiling have been key components of HIEs for years, and translate well to the concept of an HDU.
Galvez: Health data networks provide valuable public health data infrastructure by connecting, matching, aggregating, de-duplicating and sharing health information across a broad ecosystem of organizations in a timely manner.
In some cases, HIEs provide infrastructure for tracking reportable lab results, immunizations and syndromic surveillance. In other cases, HIEs provide more complete and timely information for critical public health functions like case management and contact tracing to prevent transmission of communicable diseases.
Q. What data and interoperability challenges do HIEs face today?
RUSSELL: Strong advocates for increased interoperability for healthcare data exchange have made great strides over the past several years, but there are still challenges that HIEs must continue to address.
A major issue nationwide is concerns over sharing substance use disorder treatment data consistent with 42 CFR Part 2 regulations. Overly conservative interpretations of these rules can limit interoperability and hamper data sharing that would ultimately result in much better care coordination for the patient.
“There is increasing recognition that provider data sharing incentives can improve the quality of data shared in states where participation in HIEs is not mandated.”
Erica Galvez, Manifest MedEx
Addressing a lack of exchange standards for social determinants of health data is also something we expect to change significantly over the next several years.
Galvez, There’s a lot of interesting exploration around SDOH data right now, such as housing, food, education and environmental risk factors. Here at Manifest MedEx, we are specifically interested in closing the gaps around demographic information through our partnership with PointClickCare’s HIE Encounter Notification Service (ENS) from Audacious Inquiry, a PointClickCare company.
Knowing the basics such as a patient’s age, race, ethnicity and what language they speak at home is very powerful to enable trustworthy care. and advance health equity.
Q. What have been some of the successes achieved during COVID-19 in expanding the role of HIEs?
RUSSELL: HIEs are built to thrive in environments where quick action is needed. At the onset of the COVID-19 pandemic, HIEs engaged very quickly in enabling real-time notifications of COVID-19 positive, pending and negative laboratory results.
These notifications were critical to reduce duplicative laboratory tests, enhance the ability for healthcare organizations to protect their workforce from COVID-19 transmission, and have informed conversations with their patients.
Once this process was up and running for COVID-19, HIEs were able to replicate it for additional laboratory results, such as multidrug resistant organisms (MDROs). The timeliness in which HIEs were able to respond, in some cases for no additional cost to users, confirmed how effectively HIEs support their communities through their platforms.
For VHI, this capability is provided through our partnership with PointClickCare’s care collaboration network from Collective Medical, a PointClickCare company.
Galvez: COVID quickly exposed the most fundamental gaps in healthcare’s data infrastructure, particularly for public health systems, vulnerable communities and underserved populations. It reinvigorated conversations about the work HIEs had been leading over the past decade to connect and share health information across providers, health plans and state agencies.
Data exchange and aggregation supported by HIEs helps us better understand and manage pandemics in real time, proactively reach the people most at risk, track interventions such as vaccines, and measure outcomes. This is an essential utility for public health now and for the future.
Q. What are some trends you see going forward for HIEs?
RUSSELL: At the forefront is integration of SDOH data. HIEs are actively supporting connections to SDOH data sources and technology platforms to give healthcare providers information in real time, and within a clinical workflow that allows them to provide a more holistic approach to patient care.
This type of HIE and SDOH partnership also allows for community-based organizations to leverage technology and legal frameworks that are already established.
An HIE’s trusted data exchange shares information much faster than a manual process, and that facilitates their ability to help their clients’ providers much faster. There has also been a significant increase in multi-state and regional HIE collaboratives that exchange data and share common technology solutions. This trend should continue to accelerate in the future.
Galvez: Manifest MedEx and other HIEs are rapidly improving on capabilities that go beyond exchanging raw data. For example, we’re providing greater value to network participants by reducing the burden of HEDIS reporting with NCQA-validated data. We are also simplifying risk adjustment for health plans by extracting and sharing clinical chart notes.
Finally, there is increasing recognition that provider data sharing incentives can improve the quality of data shared in states where participation in HIEs is not mandated. These incentives play a critical role in helping HIEs expand their network to support many of the Medicaid initiatives that advance health equity and whole person care.
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