FEATURE · INTEROPERABILTIY & HIE I


n August 2020, David Horrocks, who was then president and CEO of the Maryland-based Chesapeake Regional


Information System for our Patients (CRISP), and John Kansky, president and CEO of the Indiana Health Information Exchange (IHIE), proposed the idea that every state should have a state-designated and regulated health data utility with a monopoly akin to an electric company. They noted that during the pandemic, states that already have such state-level organizations in place were able to lever- age them for crucial public health needs. Three years later, the health data util-


ity (HDU) concept that Horrocks and Kansky envisioned is becoming a reality in many states. Last year, the State of Maryland signed


into law requirements that designate CRISP as the state’s health data utility. Effective Oct. 1, 2022, state law required CRISP to provide data in real-time to individuals and organizations involved in the treatment and care coordination of patients and to public health agen- cies. The legislation also required the Maryland Department of Health, nursing homes, electronic health networks, and prescription drug dispensers to provide data to the state-designated HIE. Similar efforts are underway in Missouri and Michigan, while California is working on its own version of a requisite data- sharing framework. In March 2023, Civitas Networks for


Health, a membership organization for HIEs, published a Health Data Utility Framework that intends to guide states, regions, HIEs, and community partners through the evolution from HIE to a health data utility. Civitas CEO Lisa Bari, M.B.A., M.P.H.,


says that the health data utility model emphasizes local, regional and statewide connections. “It talks about how we can use health data in those regions and states as critical infrastructure for meeting various needs, from clini- cal care to social care, public health, and more. It’s really acknowledging the progress that has


Lisa Bari, M.B.A., M.P.H.


been made by those state and regional entities and also framing them as critical infrastructure resources for those states and regions,” she explains. “I think you'll see the vast majority of the really effective


organizations move toward the health data utility model because they see the need and because they are increasingly receiving funding and engagement from different entities such as Medicaid and public health, beyond just basic clinical data exchange.” By the HDU Framework’s defi nition,


“HDUs are models with cooperative leadership, designated authority, and advanced technical capabilities to com- bine, enhance, and exchange electronic health data across care and service set- tings for treatment, care coordination, quality improvement, and community and public health purposes.” The term health data utility helps sig-


nify that HIEs are going beyond just data exchange, says Jolie Ritzo, M.P.H., senior director, network engagement at Civitas. “They have value-added services and analytics. They're working in a way where it's not suffi cient to just move the data; they also have to understand the community need and create governance structures that support them. There were initial use cases for health information exchange that were specifi c to moving clinical data, but we need much more robust social determinants of health data and public health data. This is not HIE 2.0, but rather, a much more evolved model, and it's continuing to evolve quickly.”


An example from Maryland CRISP Shared Services (CSS), the nonprofi t arm of Maryland’s health information exchange that provides services to other HIEs across the nation, recently named Marc Rabner, M.D., M.P.H., as its fi rst- ever chief medical off icer.


Rabner


Marc Rabner, M.D., M.P.H


agrees that while the tradit ional model of the HIE is clinical stakehold- ers sending data to each other, the HDU expands that


concept beyond the walls of the typical healthcare delivery sites and payers to include public health and other nonclini- cal stakeholders. “For instance, we have a use case


around asthma,” he says. “There's a prior- ity in Maryland for decreased emergency department utilization among children with asthma, and better controlling their asthma so they're not showing up in the emergency department.”


“Healthcare providers and payers have been involved in HIE for a long time. We have to say to community- based organizations: What problems do you have that could be solved by a high- trust network where the participants are involved in designing the product, and there’s governance that involves all of them?” — Richard Gibson, M.D., Ph.D., M.B.A., medical director of Comagine Health


Rabner says that in Maryland, they


can identify children who present to the emergency department with asthma, and the HIE automatically sends that information to a Medicaid-supported program that's run by the local health departments. The local health depart- ments can reach out to those families and ask them if they're interested in environmental controls that they offer. They can go into the house and provide HEPA fi lters, get rid of vermin, and offer environmental controls to help prevent that patient from going to the hospital. “What's really great about the HIE is


we're able to do that in near real-time, so that we can ask about their interest in those services when it's relevant,” Rabner says. “What we see is that a lot in patients for the week or two after their ED visit or hospitalization are very interested in not letting it happen again. But then as time goes on, their interest in enrolling for these kinds of services wanes, so being able to provide services when it's most relevant to the family and patient is very valuable.”


First steps in Oregon Richard Gibson, M.D., Ph.D., M.B.A., medical director of Comagine Health, a Portland-based nonprofi t consulting fi rm, is part of a group coming together to envision a community health data util- ity in Oregon. He describes four major data sources they are talking about bringing together: the Reliance eHealth Collaborative HIE data, a community


JULY/AUGUST 2023 | hcinnovationgroup.com 11


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