- Health information exchange (HIE) collectives and networks-of-networks including eHealth Exchange, CommonWell, and Surescripts help promote secure health data exchange across healthcare facilities nationwide.
The Strategic Health Information Exchange Collaborative (SHIEC) is one such organization. Established in 2014, the Colorado-based collaborative comprises over 55 HIE organizations including Reliance eHealth, the Colorado Regional Health Information Organization (CORHIO), HealthlinkNY, the Utah Health Information Network (UHIN), and others.
At its annual user conference, SHIEC revealed its HIE membership has grown 67 percent since 2016.
Since its inception three years ago, the consortium has grown 175 percent and now serves nearly 75 percent of the US patient population.
“SHIEC continues to grow, even during a time when there are fewer HIEs on the market, because SHIEC plays a unique role in the market,” said SHIEC CEO Kelly Hoover Thompson. “Like every new industry, the HIE market has undergone consolidation.”
“Because we provide a highly collaborative environment where HIEs learn from each other and counsel each other, we’ve been able to elevate the state of the entire HIE market by propagating the use of best practices nationwide,” she added.
The continued growth of SHIEC and like-organizations is emblematic of the healthcare industry’s use of HIE associations and networks to solve problems with health data exchange stand-alone HIEs may not be able to tackle on their own.
With interoperability at the forefront of the nation’s list of healthcare industry priorities, HIE networks and associations will be integral to proliferating standardization and the use of new technologies across the industry.
Standardization across HIE Organizations
At a press conference earlier this summer, ONC officials appointed by the Trump Administration named interoperability as one of its top priorities in 2017.
The federal agency intends to adopt a four-pronged approach to overcoming barriers to seamless exchange between different EHR systems.
“The way that we’re thinking about interoperability right now is basically as four targets: technical, trust, financial, and workforce,” said ONC’s Genevieve Morris.
“We are going to be building strategies around those four targets, but making sure that we’re pulling in from the roadmap the items that haven’t been accomplished yet but still need to be accomplished in order to move us forward,” she continued.
To achieve standardization in the technical and trust areas of interoperability, ONC is currently gathering information from a variety of stakeholders on ways to develop a trusted health data exchange framework and common agreement per provisions in the 21st Century Cures Act.
The first of three stakeholder meetings was held on July 24, 2017, and closed for public comment on August 25.
In response to the meeting, AHA submitted comments to ONC National Coordinator Don Rucker advising the federal agency follow the example of existing networks-of-networks such as CommonWell and Surescripts and build off their successes in promoting interoperability.
“Some of the networks are already working to connect,” wrote AHA. “And, importantly, there are also initiatives that have working frameworks in place to connect across networks, of which Carequality is the most mature and widely adopted example.”
AHA agreed encouraging all HIEs to adhere to the standards of a nationwide trusted exchange framework would advance interoperability beyond what existing networks are capable of. However, the association stated the groundwork these networks have laid out should be incorporated into the framework rather than discarded.
“Therefore, as ONC contemplates the parameters of a trusted exchange framework and common agreement, we recommend that the agency avoid disrupting existing, working exchanges and focus on creating a more seamless network-of-networks approach,” wrote the association. “Specifically, ONC should work with the private sector to accelerate nascent attempts while promoting mature efforts with demonstrated success for existing networks to connect across platforms.”
Specifically, many networks-of-networks have been successful in promoting standardization through the use of the Carequality technical and legal framework.
In 2016, CommonWell signed an agreement with Carequality to implement the Carequality Interoperability Framework to further promote interoperability.
As part of the agreement, CommonWell and The Sequoia Project agreed to carry out the interoperability and health data exchange activities necessary to create a Carequality-compliant CommonWell alliance.
Additionally, the two networks agreed to collaborate in the future.
“Collaboration and inclusion are the keys to success in health data sharing and interoperability,” said Carequality Director Dave Cassel.
Building off existing technical and legal frameworks and extending these frameworks across the industry through HIE networks encourages standardization on a large scale.
Widespread use of new technologies
HIE collaboratives can also be effective in quickly disseminating new technologies through large-scale initiatives.
This year, SHIEC’s Heartland Project expanded its Patient Centered Data Home to several HIE organizations in the Midwest and Western parts of the country.
PCDH is designed primarily to encourage HIEs to adopt admit, discharge, and transfer (ADT) notifications to assist participating healthcare organizations in coordinating care and improving patient health outcomes.
Earlier this year, Great Lakes Health Connect (GLHC) in Michigan connected to six other HIEs to develop and test the project. GLHC matched ADT messages with specific patients to enable providers to receive alerts as patients moved to different healthcare facilities and across the continuum of care.
The Utah Information Network (UHIN) also participated in the project and connected to HIEs including the Idaho Health Data Exchange (IHDE) and the Nebraska Health Information Initiative (NeHII).
Through its initiative, SHIEC can quickly spread the use of ADT notifications to its participating HIEs, allowing a great number of healthcare facilities to benefit from the new technology.
UHIN leadership in particular sees opportunities to leverage this new technology to reduce hospital readmissions.
“This level of care coordination quite literally saves both lives and money,” said UHIN President and CEO Teresa Rivera. “However, for it to be successful, all of Utah’s hospital systems must be willing to securely share their admission and discharge transactions with the appropriate health care community responsible for the patient’s care — including those outside their own system.”
Using the broad reach of HIE associations to spread new technologies could assist in lessening the potential for some organizations to lag behind others in adopting new health IT developments.