The Austin, Texas-based Connxus well being info trade is eyeing growth — each geographically and by way of companies supplied. The HIE not too long ago joined the Affected person-Centered Information House (PCDH) effort, enabling seamless knowledge switch throughout the U.S. Initially shaped by an alliance of native security web suppliers in 1997, Connxus now has partnerships throughout eight Central Texas counties. The HIE’s CEO, Eliel Oliveira, M.S., M.B.A., not too long ago spoke with Healthcare Innovation concerning the state of interoperability in Texas and nationwide.
Oliveira has a prolonged and spectacular resume within the interoperability sphere. Previous to becoming a member of Connxus, he was a senior director on the Harvard Pilgrim Well being Care Institute (HPHCI) within the Division of Inhabitants Medication on the Harvard Medical Faculty. Earlier, he led the division of Well being Informatics within the Division of Inhabitants Well being on the Dell Medical Faculty on the College of Texas at Austin and likewise served because the CIO on the Louisiana Public Well being Institute (LPHI) in New Orleans, the place he led the design and implementation of the Analysis Motion for Well being Community (REACHnet) as a Medical Information Analysis Community node within the nationwide Affected person-Centered Outcomes Analysis Community (PCORnet).
HCI: Are you able to speak about a number of the development Connxus is seeing?
Oliveira: Now we have expanded to cowl eight counties in Central Texas. Now I believe there’s a nice alternative to increase to different areas of the state. Texas has launched a program known as ATLIS (Aligning Expertise by Linking Interoperable Programs) that gives incentive funds to hospitals and managed care organizations for partnering with HIEs to attain and construct on sure data-sharing milestones.
HCI: Your group began with a deal with the protection web inhabitants. Has that guided a number of the work that you just do by way of inhabitants well being or whole-person care? Or connecting community-based organizations?
Oliveira: Sure, it has guided us, and we spend fairly a little bit of effort on coordinating with social organizations. Now we have been fastidiously shifting our branding from a well being info trade to a well being knowledge utility. I do know there are different definitions on the market throughout the nation, however our definition is that we imagine that so as to enhance well being, it’s a must to have greater than scientific knowledge. The non-medical drivers of well being are all the time crucial. We collaborated with the Michael & Susan Dell Basis on the Accountable Well being Group, and the outcomes are fairly spectacular. It is all about neighborhood well being staff serving to people navigate for social care. Now we have the social staff on workers, which isn’t quite common for organizations like ours.
HCI: Staying with the well being knowledge utility idea, do you might have sturdy connections with regional or state public well being businesses, and is that a part of your conception of what a well being knowledge utility needs to be concerned in?
Oliveira: I assume one of many benefit of being in Austin is we have now each Austin Public Well being and state public well being proper right here. After which we have now our hospital district, which is known as Central Well being in Austin. Inhabitants well being is one other key layer of that well being knowledge utility mindset that we have now. However we predict otherwise than different HDUs throughout the nation. Within the case of Texas, given its measurement, it is laborious to have one supply of information. From right here in Austin, I’ve to drive 9 hours to get to El Paso, and it’s a special story there. So the regional knowledge in Texas creates complexities. I believe that is one of many causes we have now 5 HIEs within the state.
HCI: Are there elements of the state that that do not have HIE protection or the place there’s not a robust HIE presence?
Oliveira: There are. We will see a white house between central and west Texas — between us and El Paso, as a result of there’s not numerous inhabitants there, to be trustworthy. It is rather dry, with very lengthy distances to journey to something. After which there is not an HIE in North Texas. Dallas can also be very restricted. It looks like Dallas determined some time again to have the hospitals use Epic’s community. However you are lacking the FQHCs. You are lacking the behavioral well being knowledge. All of them use completely different techniques, proper? So that you’re getting the image from hospitals, however that is very restricted. Really I simply met with the director of public well being in Dallas, and that is precisely the purpose I used to be making to him — that we may assist the Dallas area. In order that’s a part of the growth that we take into account goes up I-35 by means of Waco and Fort Value.
HCI: For some time, we had been seeing mergers and consolidations amongst HIEs, similar to between those in Arizona and Colorado. Do you assume we’ll see extra of that?
Oliveira: We used to have 12 HIEs in Texas, and now we have now 5 left, so consolidation has occurred right here, too. Possibly we have now gotten to a steady state in some methods, the place whoever was critical about it has stayed.
Contexture is a special case. I by no means imagined that Arizona and Colorado would turn out to be one, however the mannequin that I’ve seen that appears to be catching on is HIEs promoting or partnering with their options, versus a takeover. I could not see how somebody in New York, as an illustration, goes to know what the legislators in Texas are doing and be capable of handle two completely different authorized frameworks from completely different states. What we have now accomplished is partnered with Oklahoma and we’re using their tech stack, as a result of it is FHIR-ready, however we preserve our independence, and assist one another to be impartial as a result of we imagine in native governance.
HCI: You might be collaborating within the Affected person-Centered Information House effort from Civitas Networks for Well being. Are you able to speak about what’s concerned in collaborating in that and the advantages for sufferers and clinicians in your space?
Oliveira: It is a utterly free service. From a technical standpoint, it’s only a matter of placing agreements in place and connecting to one of many 5 nodes within the nation. We will mainly get any ADT [admission, discharge and transfer] from throughout the nation for people receiving care elsewhere who’re from our area. That message will get routed to Connxus, after which we ship that in lower than a minute to the first care suppliers. So far as I do know, that is the one push community within the nation as a substitute of the info being pulled, proper?
HCI: I learn that you just’re additionally co-chairing a studying well being techniques workgroup at Civitas and main the event of a nationwide HIE-based analysis knowledge community. Are you able to speak about what a number of the targets are?
Oliveira: The explanation that I jumped on that’s as a result of I’ve a little bit of expertise in analysis, from serving to construct PCORnet after which the FDA Sentinel community at Harvard Pilgrim. It is unusual for HIEs to become involved in analysis loads. One of many issues we’re doing is getting all of the HIEs to mix particulars about the place the inhabitants will get care, so we will have a way of how a lot fragmentation we have now nationally. We’re that as nicely from the attitude of fragmentation throughout EHRs, as a result of after we have a look at our knowledge and in different HIEs individually, what we see is that lower than 4% of people have their knowledge in just one EHR. The common is between 4 to seven EHRs. The fragmentation is the important thing factor that we’re engaged on — first to simply present how fragmented the system is, throughout distributors, throughout organizations, and throughout the nation. After that, the objective is to place collectively a primary question infrastructure in order that we will really do primary examine feasibility queries throughout HIEs. We have to begin slowly, however that is the following step. From there, we may have a look at how we may assist a pharmaceutical firm or NIH researcher to pick the areas the place they will collaborate on the bottom.
HCI: I noticed that you just had been a member of the ONC Well being Info Expertise Advisory Committee (HITAC) and a member of its Annual Report Working Group. What is the standing of HITAC now? Is it on hiatus?
Oliveira: I do not know something. There was no formal communication come what may. That’s a part of the Cures Act and was outlined by regulation. So until someone adjustments the regulation, technically it nonetheless exists. However we’ve not met since December, and everyone’s simply on maintain ready to see what’s the course. I believe we could hear within the subsequent couple of months what the following steps are.
HCI: What’s your tackle TEFCA? Will Connxus hook up with it by way of a QHIN or are you in a wait-and-see mode about that?
Oliveira: We’re in a wait-and-see mode, as a result of we did some analysis with our well being techniques and organizations, and there have been just a few issues that they had been fairly involved with. Should you have a look at the bulletins from CMS and the White Home, there was no point out of TEFCA in any respect.
HCI: You place out an announcement pledging to be part of the Trump effort at CMS on interoperability. What does turning into a “CMS aligned community” imply to your group? How may it impression how sufferers work together with their very own well being knowledge?
Oliveira: I really feel that we have now bought some nice alignment with what the White Home was saying in that announcement, and what we have now all the time believed could be the pathway ahead. The Cures Act in 2016 mainly instructed us that sufferers ought to have entry to their knowledge with out particular effort, proper? We bought funding from ONC in 2019 to pilot that. We constructed a platform that did simply that: the particular person would signal on one time, in a single place, and get all of their knowledge from our area — all utilizing FHIR.
We additionally collaborated with one other HIE in California on capturing psychological healthcare consent within the scientific settings after which visualizing that in a distributed style by means of the HIE to scientific suppliers utilizing FHIR. And that labored very well.
My level is, we have now examined all of the items that I believe the White Home is speaking about. I am engaged on convincing management right here in Travis County that we should always deploy a system locally right here the place people have one place to go to entry all the info. We will handle consent in a central place, and we will present companies in a coordinated style.