Health Information Exchanges Jump to Front of Health IT Line This Year

Vaccination registries, social determinants of health, and patient matching advance the HIE mission.

2021 will continue one positive trend begun in 2020: maturing and increasingly cloud-based health information exchange, driven by the COVID-19 pandemic, but yielding benefits across the continuum of care.

So predicts Lisa Bari, interim CEO for the Strategic Health Information Exchange Collaboration (SHIEC), whose Health Information Exchange (HIE) members cover 95% of the U.S. population.

"If you're waiting for the burning platform, people need information critically right now to deliver care in COVID," Bari says. "In some cases, we see we're still dealing with paper bridges or digital silos as well, but at the very minimum, the importance of sharing health information has jumped to the front of the line."

Complicating that imperative was the White House directive that hospital reporting of COVID-19 data go directly to the U.S. Department of Health and Human Services (HHS) and the White House, Bari says. "A lot of hospitals, HIEs, and states had a lot of concern with that, and they still do," she says.

"The future solution will probably be a mix of the new system that was set up, and expanding the previous reporting system, whereby hospitals send their information to the Centers for Disease Control [and Prevention] (CDC)," she says.

The Role of HIEs in Sharing COVID-19 Vaccination Data

SHIEC supported many of the provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, passed by Congress and signed into law on March 27, 2020. SHIEC also supported many of the provisions of the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, though that legislation was blocked by the U.S. Senate and replaced by different continuing resolution legislation last month.

The new year tilts health information exchange in an additional direction, as providers now begin to share registries of those who have been vaccinated from COVID-19.

"It varies by HIE, but some HIEs already have connections to immunization registries," Bari says. Until recently, these registries have been focused on children, and according to Bari, HIEs are part of the conversation of getting adult immunization registries rolling.

As an umbrella organization for HIEs, SHIEC plays a role. At its annual conference in August 2020, Phil Beckett, PhD, CEO of Healthcare Access San Antonio moderated a session titled, "The Power of Public HIEs to Deliver Optimized Adult Vaccinations to Safety," and presenters from the University of Texas at Austin described an operational adult vaccination registry for Texas.   "presenters from the University of Texas at Austin described ImmTrac2, an operational adult vaccination registry for Texas."

The federal government should play a role by increasing funding for HIEs' efforts in this area, and optimizing funding already budgeted for HIEs, Bari says.

"The federal government and the CDC should be funding broad public health use cases for HIE across the country," she says. "HIEs are probably best positioned to deliver it in a way that aggregates across states, regions, and communities, and there's a real need for that."

With such a reporting system in place, public health officials could much more easily see where COVID-19 hot spots may arise next, Bari says.

Expanding Into Social Determinants of Health

Another front-burner priority for SHIEC participation in 2021 is the Gravity Project, an effort by HL7 to expand social determinants of health (SDOH) core data for standard, interoperable use in electronic health records.

HL7 is hosting the Gravity Project FHIR accelerator, developing SDOH use cases, common data elements, recommendations on how best to capture and share data, and create an HL7 FHIR Implementation Guide for software developers.

Additionally, companies such as Unite Us, who are building SDOH software, are working to build connections between communities and providers, as well as tracking referrals and obtaining feedback on them, Bari says.

"The first thing that we and HIE members can do is be part of these standards development organizations and start to build that into our work," she says.

Already, the Nebraska Health Information Initiative (NEHII) partnered with Unite Us to build Unite Nebraska, a community information exchange of health and social care providers that could serve as a model SDOH community information exchange for other states, Bari says.

In October 2020, Unite Us and NEHII announced they were expanding their partnership to six additional states, including Iowa, Missouri, South Dakota, North Dakota, Kansas, and Minnesota.

Bari says healthcare will see final versions of SDOH interoperability standards this year. "They've made some great progress," she says.

Patient Matching Benefits From New ONC Project Built on USPS Addresses

One other technology accelerated by the pandemic is patient matching, Bari says.

"Lots of labs stood up really quickly—the ones who hadn't been doing reporting on public health before," she says. "It showed that HIEs are important for patient matching, and that we still have huge gaps.

"The great news is ONC [Office of the National Coordinator for Health Information Technology] just announced a new project to build an address standard, basically using the person-matching capabilities of the U.S. Postal Service."

Still, Congress needs to act to remove bans on HHS studying and working on patient identifiers and patient matching, Bari says.

"We need to stop being scared of this idea of a patient ID or patching matching," she says. "We need Congress to come to the table and commit to getting this done at the national level, whatever the solution is."

Editor's Note: This story has been changed to correct acronymns.