FEATURE · INTEROPERABILTIY & HIE
information exchange involving a number of community-based organizations, public health, and an all-payer claims database. “With those four data sources, how
can we meet the needs of providers, community-based organizations, and public health? Those last two that have been left out of the conversation largely so far,” Gibson says. “Healthcare pro- viders 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?” A health data utility potentially could
also help with reducing the quality mea- sure reporting burden for clinicians, he adds. Today, the providers work with six to eight payers, and each has its own quality measures. Each one wants their own reports, and each one has their own monthly meeting. “Here is an opportunity for a community health utility to do that function — one set of clinicals quality measures to react to,” Gibson says. Sarah Hallvik, Comagine’s vice presi-
dent of data solutions, adds that the data governance issues are separate from the technical challenge of bringing all these different data sources together. “We want to make sure that we have
the data governance in place that meets the needs of all of the parties who would be asked to contribute data and/or pull data out of a health data utility,” Hallvik adds. “It helps to have those use cases defined in advance and have the com- munity benefit organizations at the table with everybody else. We're hoping that sets the community health data utility up for success. Everybody who contributes data should be able to pull out enriched, more meaningful data, that ultimately helps them provide better service to the same shared patients and clients that we're all working with across the state. The data governance — who makes the decision on how the data are used and if it's legal and ethical, and who pays — is an equal counterpoint to the technical question of how the health data utility functions and what technology platform is used to facilitate that.” Erick Maddox, executive director
of Medford, Oregon-based Reliance eHealth Collaborative, says that in some communities across the country the HIE is set to function as both community
“Just like we need the same type of power resources across urban and rural, we need the same data to be available across sectors and across urban and rural environments. The alignment made a lot of sense, especially from a policy perspective.” — Jaime Bland, D.N.P., R.N., president and CEO of Nebraska-based CyncHealth
information exchange (CIE) and HIE in the health data utility equation. “At Reliance in Oregon, we don't see our- selves playing that role. We will help with the interoperability and the data- sharing work. We have our governance structure for healthcare,” he says. “But at the center of all this needs to be a governance structure that sets the rules of the road between four key groups: HIE, CIE, all-payer claims database, and public health. How do we set up this gov- ernance function, so that the healthcare side — through the HIE — knows how to share and move data appropriately with social services through the CIE or with payers and public health, and how does all that data move across? That's really where our focus is.”
The utility concept resonates in Nebraska Jaime Bland, D.N.P., R.N., is president and CEO of CyncHealth, which provides interoperability services in Nebraska and Iowa. Her organization has started using the health data utility phrase to explain its services. She says that because Nebraska is one of the only states using a public/pri- vate partnership for electrical services, “we really started to make parallels when talking to leg- islators about the concept of a public/ private partnership utility. Just like we need the same type of power resources
Jaime Bland
across urban and rural, we need the same data to be available across sectors and across urban and rural environments. The alignment made a lot of sense, especially from a policy perspective.” CyncHealth tries to understand what
the health utility service needs are at the point of consumption, Bland says. From a provider's perspective, the data needs change, whether it’s for a payer, a primary care provider, ED physician or a nurse
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practitioner out in rural Nebraska. For instance, event notifications are needed by all of those different stakeholders, but the form and delivery mechanism may be different. “With event notifications, we will deliver
anything from workflow integration via APIs to a flat file or Excel document so they can manage their population,” Bland says. “I think it's the scale and right-sizing of the interoperability that has contributed to our growth, and this concept of utility has really been something tangible for people to understand better than the HIE because it's really not an exchange of information, right? You share your data, and we take all the other shares and package it back to you in a way that is consumable for you. So that's where the utility concept really took off for us.”
An HDU takes shape in Missouri While Maryland was the first state to enact enabling legislation with the term health data utility in it, Missouri was the first to enact enabling appropriation for a health data utility to the tune of $50 million a year annually, says Angie Bass, executive vice president and chief strategy officer for Velatura, a nonprofit arm of the Michigan Health Information Network Shared Services (MiHIN) that offers HIE services in several other states, including Missouri. There are four HIEs that serve provid-
ers and payers in the State of Missouri, and they are all data-sharing partners, Bass adds. “We all worked to advocate for the health data utility model. We at Velatura brought the model to the group, and then we worked to solidify commitment with them to bring it to the state to say ‘Hey, this sounds like a great avenue to bring interoperability together in Missouri and work with the state as a partner to really drive that digital health- care ecosystem.’” The group is using the state funding
to do some coordinating activities and stakeholder engagement interviews to get consensus on how they want to structure
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