Prepared and Ready: America’s HIEs and the Response to COVID-19

When COVID-19 hit, America’s health information exchanges (HIEs) were already ready.

The state HIE in Maryland, Chesapeake Regional Information System for Patients (CRISP), was geared up to aggregate the surge of COVID-19 test results, even as mobile sites were set up. They were not only able to provide real-time alerts to providers on test results, they provided a daily public dashboard that tracked the progress. They were—and are—the state’s valued resource for COVID-19 data.

The recently retired deputy secretary for public health services of the Maryland Department of Health, Francis B. Phillips, RN, MHA, believes that the success was the result of years of good, close relations. “Fortunately, we had been long-time partners in all kinds of activity and surveillance, so it was a natural alliance when we needed really good, accurate, and fast data to make sense of our interventions around the pandemic,” she says.

The Keystone Health Information Exchange (KeyHIE) in Pennsylvania was set up to aggregate COVID-19 test results by county and by ZIP code. This enabled them to create a digital dashboard that provided real-time results on the geography and demographics of the pandemic. This dashboard allowed public health officials, hospitals, and state government to track COVID-19 results and even hospital bed capacity in real-time, according to Kim Chaundy, senior director, HIE and interoperability for KeyHIE. “We were tracking and posting results every two hours, and this allowed hospitals and executive leaders to see the path of the pandemic and be prepared,” Chaundy says.

In Nebraska, the state benefitted from the long-time relationship with the state-designated HIE, the Nebraska Health Information Initiative (NeHII). NeHII manages the state prescription drug monitoring program (PDMP), which monitors not only opioid prescriptions but all prescriptions. This means that the HIE allows clinicians to see patients’ medication histories as well as their longitudinal patient records—an invaluable data source for clinicians during the pandemic. NeHII set up several real-time dashboards that provided rich data to clinicians and the state, according to Jaime Bland, CEO, NeHII.

“The data that our HIE in Nebraska provided through various dashboards demonstrated the power of HIE and helped Nebraska fare pretty well. We were able to partner with our public health and Medicaid clinicians and professionals to provide an informed and coordinated response,” Bland said.

Essential Services Already in Place

HIEs were ready for COVID-19 not because they rapidly developed new services, but because they already were delivering essential services to their communities. Across the country, HIEs connect not only hospitals, labs, and clinicians, but also to first responders, correctional facilities, state and local government, post-acute care facilities, and the community-based organizations (CBOs) that serve communities across the country. In each community, HIEs are the neutral, unbiased data trustee that provides critical patient record and health data services, and this placed HIEs in the position of being the community and state resource for COVID-19 data. Many of these HIEs are the state-designated “health data utility” for their state or region, providing these essential services:

• Data aggregation: HIEs are connected to labs and hospitals and receive electronic data feeds on critical patient data such as test results and care episodes such as hospital admissions, discharges, and transfers (ADTs).
• Alerts and notifications: In each state or region, HIE participants can “subscribe” to alerts on their patients so that they can receive real-time notifications on test results or ADTs.
• Patient or data portal: HIEs aggregate patient data across disparate hospitals, health systems, and labs and make this data available for providers to view or download for new patient visits or more complete longitudinal patient histories.
• Population health and data analysis: As the state or regional data aggregator, HIEs are also able to analyze data to study the health of populations or the progress of disease. This data analysis provides valuable information for providers and communities to help improve health outcomes.
• Community engagement and reporting: HIEs aggregate and analyze critical patient and community health data, and this allows HIEs to provide reports to health departments and others on syndromic surveillance and patient data.

Applying Services to COVID-19

America’s HIEs were able to respond swiftly to the COVID-19 pandemic because they already had a national network or infrastructure in place. More importantly, HIEs and their state and local public health partners are demonstrating innovative use cases for using the existing health data infrastructure to address COVID-19:

• Data aggregation: HIEs were already connected to hospitals and labs, and this allowed HIEs such as Healthix in New York to receive results from a temporary COVID-19 hospital or from new mobile testing sites—as the Maryland HIE, CRISP, and others did to meet the demand for increased testing. It also allowed HIEs like the Pennsylvania-based KeyHIE and the Nebraska-based NeHII to track hospital bed availability and essential personal protective equipment (PPE) that helped healthcare communities to respond.
• Alerts and notifications: HIEs were geared up already for real-time electronic reporting on test results, so moving from thousands of tests to tens of thousands of tests was not difficult. New York hospitals, for example, relied heavily on real-time test results from HIEs when COVID-19 first spiked there. In other communities such as in Oklahoma, first responders quickly realized that they could get quicker results from their HIE, MyHealth Access, than they could from public health departments. Many HIEs such as Maryland’s CRISP expanded their alerting to include text messaging to patients testing positive to encourage self-isolation.
• Patient or data portal: Early on in the COVID-19 pandemic, clinicians began to realize that a patient’s history and comorbidities had an enormous influence on the course of the disease and treatment. New York HIEs were an invaluable data source for clinicians treating COVID-19 patients. Nebraska’s NeHII already administered the state prescription drug program, so access to medication history was and continues to be valuable. Across the country, access to more complete patient information through one centralized portal has proven to be a huge benefit.
• Population health and data analysis: COVID-19 has flooded the healthcare system with data, but HIEs from Manifest MedEx in California to CRISP in Maryland to Healthix in New York City have provided health departments and state governments valuable insights into the pandemic, identifying geographic areas and patient types that are more seriously affected by COVID-19. Much of the COVID-19 data and analysis is highlighting vulnerable populations and patients, and HIEs like Health Current in Arizona are using this data to improve outreach and service to Medicaid providers and beneficiaries.
• Community engagement and reporting: HIEs across the country have worked with health departments and state government to provide reports and dashboards tracking the progress of COVID-19 and its treatment. In Nebraska, for example, the NeHII dashboard provides not only real-time reporting on COVID-19 test results, but also current information on bed capacity, PPE, forecasting, and even trending by health districts in the state. This reporting has fostered greater collaboration among health departments, state government, and HIEs. In Arizona, for example, a representative from the state health department sits on the Health Current Board, and collaboration among health department professionals, state Medicaid, and the HIE are commonplace. One very positive outcome of work on the pandemic is a much stronger and growing bond between the state or regional HIE and the public health and Medicaid communities.

A National Health Data Infrastructure

The response of HIEs in the United States to the COVID-19 pandemic has demonstrated the value of HIEs to communities and the nation and helped to chart a path to a better national health data infrastructure.

The HITECH investment in US HIEs has paid off. The country’s HIEs already had the services and functions in place to respond to the COVID-19 pandemic. Through community support and participation along with valuable federal funding, HIEs have become a critical part of the national health data infrastructure. Every day, HIEs better inform care coordination and improve clinical outcomes.

There is a clear need for better national health data infrastructure. HIEs have played and are playing an integral role in providing data and analysis to better inform a COVID-19 response from state health departments to state Medicaid agencies to the Centers for Disease Control and Prevention. COVID-19 has demonstrated the need for a better, more coordinated national health data system, and HIEs deliver more complete data to clinicians and government, improving outcomes and even saving lives.

There is value for communities and the nation in extended HITECH funding. A better national health data infrastructure does not require new programs or investment. Instead, building on the investment already made to America’s HIEs will pay dividends for a COVID-19 response today and for our nation’s future.

Tom Reavis is a communications consultant with the Strategic Health Information Exchange Collaborative (SHIEC).