HIE UPDATE
most successful when they are really community-level integrators — when they incorporate social determinants of health. In Nebraska, for instance, they are incorporating PDMP [prescription drug monitoring program]. They can incorporate lots of different services and really serve as that hub in their communities.
I wrote something recently about a presentation at the SHIEC conference by David Horrocks of Maryland’s CRISP HIE and John Kansky of the Indiana Health Information Exchange in which they argued that every state should have a state-designated and regulated health data util- ity with a monopoly akin to an electric company. Do you agree
with them? Bari: The public data utility model of HIE is one approach that people are talking about. In addition to Horrocks and Kansky, Claudia Williams of Manifest Medex in California also recently published a piece about the public data utility model. Personally and from a SHIEC perspective, we definitely think that is a great idea. It doesn’t solve all problems and may not be appropriate in every single cir- cumstance, but it is a good idea. I will say that if you are going to be a utility, there is a whole new level of regula- tion that goes with that. For example, I live in Baltimore, and Baltimore Gas & Electric has to provide connections to everybody in a certain geographic region. If you are a utility you are sub- ject to different rules around pricing and coverage, so there are two sides to it. From a public health perspective, it is an interesting idea.
Some states already have something akin to that, such as
Maryland. Bari: Yes, it is written into the state’s global budgeting and the agreement they have with CMS.
But some states have really strug- gled due to cultural, political and other reasons. Even a state like Minnesota, which has done a lot of good things in terms of health IT, doesn’t yet have a statewide HIE. And one reason they have had trouble getting large health system participation is that the hospital systems are all on Epic and so they can easily share infor- mation with each other privately
and don’t feel a strong need to contribute to building a broader public infrastructure. Unfortu- nately, that leaves a lot of provid- ers, especially small ones, out of the loop. How can states like that get from where they are to where
Maryland and Indiana are? Bari: It is so tied to the state government and what it prioritizes. One vendor is not going to solve health information exchange. Let’s say that all the hos- pitals in the region have one vendor, which I would argue might be a prob- lem, you are still missing long-term care, post-acute care, social services, prisons, foster care. You are missing so much that is part of the healthcare landscape. That is the promise of these nonprofit, vendor-neutral community integrators that are part of the HIE landscape.
“One vendor is not going to solve health information exchange. Let’s say that all the hospitals in the region have one vendor, which I would argue might be a problem, you are still missing long-term care, post-acute care, social services, prisons, and foster care. You are missing so much that is part of the healthcare landscape.”
David Horrocks and John Kansky also argued that there needs to be more consolidation of HIEs both within states and across state lines to get greater purchas- ing power and more scale. Soon after they made their presenta- tion we saw the HIEs in Colorado and Arizona announce plans to come together. Is there a role for SHIEC to help in sharing best practices for bringing organiza-
tions together? Bari: Across healthcare broadly we see a lot of consolidation happening. That
may also happen in the HIE world. I think what SHIEC can do is work to bring HIEs together to have a bigger voice as one entity, essentially, and also help SHIEC members work on stan- dard transactions and quality initia- tives and to align advocacy issues like patient matching or to align on issues around funding through HITECH, which is sunsetting soon, or Medicaid technology funding – just making those connections stronger. We are already doing that. I don’t think we want to have a role in either slowing down or speeding up any part of consolidation.
It is interesting that we are see- ing two strong statewide HIEs in adjoining states come together. We haven’t seen that happen
before. Bari: Health Current and CORHIO are really great community integrators that have forward-thinking CEOs and boards, who are excited to see what can happen if they can be stronger together. CRISP is becoming regional, with Maryland, D.C., and part of Northern Virginia and West Virginia. We may see more of that. At the same time, some communities are really tied to the HIEs as they are today and they don’t have any intention to grow, but maybe they will partner more.
The pandemic has demonstrated the importance of data sharing, particularly with public health. What are some other ways that SHIEC can help advocate for investment in improving infra- structure that can last beyond the
current emergency? Bari: We just got done meeting with key congressional committees, and one of the asks we made was for a GAO report to be put in legislation to look at the historical investment in HIEs and the different methods of funding. It is eso- teric and complex. Even though there are all these things available to states and HIEs, it is often such an asymmetry of information between what is techni- cally allowed, what states understand, and what the guidance is. States and the federal government have invested a lot of money in HIEs for this technology build-out. It is really important to get their money’s worth and keep those investments going where it makes sense and figure out how to get the most out of it. We just saw the CDC saying here is a paper card to track vaccinations. My goodness, why? Build on the infrastruc- ture you have already started building. Don’t re-invent that wheel. HI
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