State prepares to launch health info exchange
This fall, after more than a decade of false starts, shifting plans and millions of dollars spent, Connecticut will launch its statewide health information exchange, a single repository of medical data that can be accessed by any provider involved in a patient’s care.
The long-anticipated system is arriving at a critical time: the need for up-to-the-minute, robust patient information has become more pressing as COVID-19 continues its grisly march through the state. The exchange is designed to reduce duplicative services, prevent medical errors and improve care.
But even as the move is regarded as an important step forward, leaders of the most recent push to form the network have been frustrated with the pace of progress. Three previous attempts collapsed in failure, leaving Connecticut without an all-inclusive data sharing system when the pandemic hit last winter.
Meanwhile, other states have used their information exchanges, known as HIEs, to trace outbreaks in nursing homes, to identify COVID-19 hotspots in communities, to analyze data on race and ethnicity and to help agencies, like public health departments and regional health districts, access more extensive patient information in the midst of an emergency.
“I just wonder how many people could have been saved, had we had this up and running,” said Allan Hackney, Connecticut’s health information technology officer, who is in charge of the latest effort to create an HIE here. “How many health care workers could have avoided burnout if we had this data? I get very frustrated.”
During a medical seminar over the summer, Hackney watched as his counterparts in Rhode Island and Maine dazzled with demonstrations of real-time COVID-19 data.
“They were showing live graphs of information on what’s happening with COVID in counties and towns, by zip code, by age,” he recalled. “Then we get to Connecticut – and yes, we have some reporting we’re pretty happy with – but the data is coming in whenever it comes in, and the robustness of it is not even in the ballpark of what I saw from Maine and Rhode Island. They’ve had HIEs for a long, long time.”
The exchange will allow health practitioners to get fuller patient medical histories. If a woman receives a coronavirus test at a physician’s office in New Haven and walks into an emergency room in Putnam a week later, the hospital doctors could view her results, along with any underlying conditions she may have. The system gathers data from physician practices, laboratories, hospitals, radiology offices and community organizations, giving providers a comprehensive look at a patient’s background.
Information about immunizations and advanced directives, which have taken on fresh significance during the pandemic, are also expected to be included in Connecticut’s HIE.
“We’ve had to piece together public data, private data, data from the Connecticut Hospital Association, and other information to understand what’s going on,” said Max Reiss, a spokesman for Gov. Ned Lamont. “Tools like this prevent that time from being wasted. It would have been easier … to have something like this in place seven months ago.”
Since coronavirus took hold in the state, Hackney has pondered how things might have been different if officials had managed to get the system online sooner. More than 4,500 people have died of COVID-19 here.
The network is expected to launch in November.
“Connecticut would have been in a lot better place if we had an operating HIE,” Hackney said. “It kills me that we’re in this situation.”
‘We were made for a time like this’
Connecticut is one of the last states in the nation to launch a broad health information exchange.
Some states have a single network that serves all residents. Others, like Texas and California, have several regional HIEs that cover different pockets of the state. And a handful have started the networks but run into problems, forcing them to dissolve the systems and start over.
With the ability to aggregate data, HIEs have played a key role in disaster response efforts during floods, fires and hurricanes. Since COVID-19 moved into the country, the systems are being used to support contact tracing, track trends and direct resources.
“There’s one example in Oklahoma, where by looking at zip code data, they were able to identify a particular nursing home where there was an outbreak. And by working with the nursing home, they identified the person who brought COVID-19 into the home,” said Tom Reavis, a spokesman for the Strategic Health Information Exchange Collaborative, a trade association representing about 80 HIEs nationwide. “They gave valuable information for public health.”
At least three information exchanges – in Nebraska, Pennsylvania and Oklahoma – created dashboards during the pandemic that corral COVID-19 data from across the state into one place.
“A Pennsylvania HIE, KeyHIE, has a dashboard where you literally can see, county by county, hour by hour, what the situation is looking like there,” Reavis said.
Indiana’s HIE worked with the state and Indiana University to form a new initiative that shares information on social determinants of health, such as food access and housing stability, with researchers and health care providers who are dealing with COVID-19.
An HIE in Tallahassee, Fla., developed a system allowing practitioners to view medical records from health plans, hospitals, urgent clinics, public health departments and other entities across the state.
In Delaware, which launched the country’s first statewide health information exchange in 2007, HIE officials are working with state agencies to fill in gaps in patient data.
“When somebody has gone to, let’s say, one of these pop-up testing sites at a Walgreens or some other location, they don’t always fill out their information clearly,” said Randall Farmer, chief operating officer of the Delaware Health Information Network. “They don’t always include all the information that would be helpful from a public health standpoint. So our governor’s office came to us and asked: Can you guys help enrich some of this missing information?”