A panel of health policy experts discussed the need to improve Utah’s health data interoperability at the 2023 Utah State of Reform Health Policy Conference, which took place late last month in Salt Lake City.
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Federal law requires health systems to maintain and share electronic health information (EHI) in most instances and prevents information blocking, aimed at giving patients greater control over their personal health data and making it easier to share patient records.
Rep. Raymond Ward (R – Bountiful), a private practice primary physician, shared his personal experience and those of his constituents and colleagues about the challenges in accessing EHI in Utah.
“When a patient comes in, and there’s something important that is in their medical history, it happens every day that we don’t have access [to data] in a timely fashion to do what we need,” Ward said. “The drawbacks of that on just a day-to-day basis are that care is delayed every day. I see 25 patients in a day.
[For] four or five of them, there will be some piece of information that we want or need that we can’t get at the time of the visit. On any given day, there might be one or two, where care has to be duplicated.”
Ward outlined the dangers of not having crucial patient information such as allergies and conditions that could lead to complications during standard procedures.
The situation prompted Ward to sponsor a bill in this year’s general assembly proposing the creation of a centralized health information exchange where patients and providers would have protected access to medical records across the state’s hospital systems. The measure failed to pass because several community groups opposed it due to suspicions over government databases, according to Ward.
He said part of the problem is that state policy focuses too much on interoperability’s benefit for public health when the conversation should be focused more on the patient.
“We would get a better outcome if we stopped doing that and started saying the reason we even have that data is not for a public health project, it is for that patient—that patient is the one who paid $2,000 for that MRI,” Ward said. “And it’s not right if we build a system where after they have paid that money, or gone through a test that might even add risk to them, then their own information is not available to them the next time [when] they need it. We just need to focus on the patient’s right to have their information where they need it.”
The One Utah Health Collaborative is working with state partners and stakeholders on improving patient outcomes and reducing costs, which includes improving EHI access and interoperability. There are five key areas of digital focus that the collaborative is targeting, starting with establishing a common agreement to help with the data exchange, according to Navina Forsythe, PhD, chief data officer for the Utah Health Information Network.
“The other four [areas are around] a single sign-on [portal]—so being able to access this information through a single login that some entities like [University of Utah Health] can already do—that they sign in to their electronic health record (EHR), and it’s got the interfaces and provides information,” Forsythe said.
“But not all entities in the healthcare ecosystem have that so enabling that the more modern architecture like [Fast Healthcare Interoperability Resources (FHIR)] having a digital address book, so we have the FHIR endpoints in a place that it can be referenced and [providers] know how to connect [application programming interfaces] across the different systems.”
The Office of the National Coordinator for Health Information Technology proposed new rules last month to advance interoperability, improve transparency, and support the access, exchange, and use of EHI.
David Lee, senior director at Leavitt Partners, a Health Management Associates Company, said the federal government is moving forward with imposing and enforcing significant financial penalties for information blocking, which should incentivize actors to improve the flow of data.
“We’ve made a lot of progress in [the interoperability] space, but Congress isn’t done—the government’s not done,” Lee said. “I think folks will potentially be aware of the CMS interoperability and patient access rule. This came out three years ago, and it looped in CMS-regulated plans—Medicare Advantage, Medicaid managed care, qualified health plans, and state Medicaid. Now we’re going to be required to enable FHIR servers to share data to their enrollees and their beneficiaries.
They’re going to be required moving forward because of the interoperability and prior authorization rule, which just went through comment period—required to share data with other providers and provide and share information with payers, and payers are going to be required to share data with [other] payers about their enrollees at the direction of the individual.”
Lee said eventually the level of information sharing will be standardized and required across the entire US core data for interoperability.
Interoperability has proven challenging because of the complexity in which EHRs and the systems to access them have been formatted. The University of Utah Health (U of U Health) and Intermountain Healthcare, two of the largest hospital systems in the state, utilize different EHR systems, Epic and Cerner, respectively.
Donna Roach, U of U Health’s chief information officer, spoke to the progress made in recent years toward interoperability in Utah.
“Intermountain Healthcare is now available through the CommonWell exchange, and that opens up a lot more exchange opportunities,” Roach said. “Take it to the present, total all-time exchange metrics for us: about 20.5 million records sent to outside organizations, 25.4 million records received—so those are the ones that we receive and use within our system. And then 1.7 million of [U of U Health] patients with records sent or received over time.
Now, I’ve [thrown] a lot of numbers at you … The point I’m trying to make is, we started making very baby steps. We have made progress. Are we there? Are we at the pinnacle of where we need to be? Absolutely not. The team works very closely in trying to achieve this, but they’re also working in terms of maintaining and implementing systems and making sure the systems are viable for our organization, our clinicians, and our care delivery systems.”
Forsythe said administrators remain concerned with the quality and timeliness of health data due to the need to sort through duplicate, incomplete, and inaccurate records. The state’s common agreement should establish minimum requirements for quality and for what core data would be exchanged, so that systems know it is the most useful data that patients and providers need.
“This is not one organization—this is the entire ecosystem saying it is important to have this information available,” Forsythe said. “As an administrator, there are a lot of uses for this data beyond [patient care]. We need information to know where the needs are—where do we devote our resources [and] what is working? There are lots of analytics that are available. And I agree we do not want to detract from the mission.
For providers, I think that we can take steps to meet all of those needs without one pulling resources from another. So you’ll hear things about health data, utilities and information for population health, things like that [where] we can take the same steps to fulfill those leads. So it’s exciting the collaboration that’s coming together, the digital workgroup saying, ‘How can we ease the burden [and] make better data more accessible, more timely, and easier to use?’”