FEATURE · INTEROPERABILTIY & HIE


the health data utility, in terms of gover- nance, operational and technically. “A final report that will be out by the end of the year, and then we'll go into implementa- tion phase on each of those pieces.” Bass says the term health data utility


does a much better job of describing what Velatura does than HIE. “First, it speaks to the evolution of HIE as becoming a new vessel for expanded interoperability, a wider net to cast for the digital healthcare ecosystem to be participatory by utiliz- ing a shared utility. Health data utility also implies a digital health ecosystem implemented and utilized as a public util- ity. The term public utility implies lots of things. Everyone gets to use it. Everyone gets value out of it, and they pay for those value-added services. There's a layer of regulation that is absolutely needed and also a new layer of sustainability.”


COVID changed everything TIm Pletcher, MiHIN’s executive director, says that the conversations he has with legislators in Michigan have changed dramatically over the last few years and there is a greater openness to the importance of a health data utility model. “I think COVID made certain things easier,” he says. “COVID was basically a 9/11 equivalent for social services and equity and a lot of what we do in public health. There was a lack of infrastructure


and a lack of coordination. The folks who were not used to working with their HIE duplicated resources and wasted a lot of time. I think that the health data utility is very much going to be a model for economies of scale.” He says that looking across siloed


legacy systems, most state and county social services programs can’t tell you if they are dealing with the same person. “We HIEs have been struggling with patient matching for years and we've gotten pretty good at it. Some of us have even progressed to doing consent and other hard problems. It's going to take you a decade to do that if you don't build on this infrastructure. We want to build on these core utility type services to do more and more.” Once you start to look at things like


SNAP, children's services, and doing a better job preventing people from get- ting sick, that's much broader than just the social determinants of health, Pletcher says. “It's full cross-sector infrastructure. Suddenly, we realize we need a utility.” Pletcher says transparency is a key issue


as health data utilities reach out to stake- holders beyond traditional health system partners. “As we expand to these other cross-sector areas, it can't be dominated by the health plans or the big hospitals. The governance, particularly the opera- tional governance of things, has to evolve.


I think that's going to come with more public-sector funding. The trick will be to do that in a way where the politics don't screw up the ability to execute.”


A chance for some states to start over There are some states where the develop- ment of a state-level health information exchange has failed, despite repeated attempts, perhaps because incentives were misaligned. Could the Civitas framework help those states develop a path to success? Bari thinks so. “We are trying to show which types of stakeholders need to be involved to make this successful in dif- ferent contexts,” she says. “We think that the framework could help regions and states that have been underserved figure out how to expand their efforts or create new efforts.” Illinois is an example of a state that has


tried and failed. But there are lots of inter- ested parties in Illinois, Bari notes. “They are certainly served piecemeal by differ- ent technology companies, but they don't have a full nonprofit neutral convener. The folks who we work with in Illinois ask how they can make this happen. And honestly, something like the HDU Framework can help them make a case over time, and help them figure out who needs to be at the table to create this type of thing for their region or their state.” HI


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