The Austin, Texas-based Connxus well being data change is eyeing growth — each geographically and when it comes to companies provided. The HIE lately joined the Affected person-Centered Knowledge House (PCDH) effort, enabling seamless information switch throughout the U.S. Initially fashioned 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., lately 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 Scientific Knowledge 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: We’ve got expanded to cowl eight counties in Central Texas. Now I believe there’s a nice alternative to broaden 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 concentrate on the protection web inhabitants. Has that guided a number of the work that you simply do when it comes to 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. We’ve got been rigorously transferring our branding from a well being data change to a well being information 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, you must have greater than scientific information. The non-medical drivers of well being are all the time important. We collaborated with the Michael & Susan Dell Basis on the Accountable Well being Neighborhood, and the outcomes are fairly spectacular. It is all about group well being staff serving to people navigate for social care. We’ve got the social staff on workers, which isn’t quite common for organizations like ours.
HCI: Staying with the well being information utility idea, do you could have sturdy connections with regional or state public well being businesses, and is that a part of your conception of what a well being information utility must be concerned in?
Oliveira: I assume one of many benefit of being in Austin is we now have each Austin Public Well being and state public well being proper right here. After which we now have our hospital district, which is known as Central Well being in Austin. Inhabitants well being is one other key layer of that well being information utility mindset that we now have. However we expect in another way than different HDUs throughout the nation. Within the case of Texas, given its dimension, it is arduous to have one supply of knowledge. From right here in Austin, I’ve to drive 9 hours to get to El Paso, and it’s a unique story there. So the regional knowledge in Texas creates complexities. I believe that is one of many causes we now have 5 HIEs within the state.
HCI: Are there components 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 area between central and west Texas — between us and El Paso, as a result of there’s not lots of inhabitants there, to be sincere. It is extremely 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 as if 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 information. All of them use completely different programs, 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 might assist the Dallas area. In order that’s a part of the growth that we keep in mind goes up I-35 by way of Waco and Fort Value.
HCI: For some time, we have been seeing mergers and consolidations amongst HIEs, akin to between those in Arizona and Colorado. Do you suppose we’ll see extra of that?
Oliveira: We used to have 12 HIEs in Texas, and now we now have 5 left, so consolidation has occurred right here, too. Perhaps we now have gotten to a steady state in some methods, the place whoever was severe about it has stayed.
Contexture is a unique case. I by no means imagined that Arizona and Colorado would develop into 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 to handle two completely different authorized frameworks from completely different states. What we now have accomplished is partnered with Oklahoma and we’re using their tech stack, as a result of it is FHIR-ready, however we hold our independence, and assist one another to be unbiased as a result of we imagine in native governance.
HCI: You might be collaborating within the Affected person-Centered Knowledge 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 principally 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 information being pulled, proper?
HCI: I learn that you simply’re additionally co-chairing a studying well being programs workgroup at Civitas and main the event of a nationwide HIE-based analysis information community. Are you able to speak about what a number of the objectives 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 get entangled in analysis lots. 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 are able to have a way of how a lot fragmentation we now have nationally. We’re that as properly from the angle of fragmentation throughout EHRs, as a result of once we have a look at our information and in different HIEs individually, what we see is that lower than 4% of people have their information in just one EHR. The typical is between 4 to seven EHRs. The fragmentation is the important thing factor that we’re engaged on — first to only 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 are able to really do primary research feasibility queries throughout HIEs. We have to begin slowly, however that is the subsequent step. From there, we might have a look at how we might assist a pharmaceutical firm or NIH researcher to pick out the places the place they will collaborate on the bottom.
HCI: I noticed that you simply have 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 legislation. So except anyone modifications the legislation, technically it nonetheless exists. However we’ve not met since December, and all people’s simply on maintain ready to see what’s the route. I believe we could hear within the subsequent couple of months what the subsequent 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 programs and organizations, and there have been a couple of issues that they have been fairly involved with. For those who 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 a press release 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 might it affect how sufferers work together with their very own well being information?
Oliveira: I really feel that we now have received some nice alignment with what the White Home was saying in that announcement, and what we now have all the time believed could be the pathway ahead. The Cures Act in 2016 principally instructed us that sufferers ought to have entry to their information with out particular effort, proper? We received 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 information 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 trend by way of the HIE to scientific suppliers utilizing FHIR. And that labored rather well.
My level is, we now have 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 must always deploy a system in the neighborhood right here the place people have one place to go to entry all the information. We will handle consent in a central place, and we are able to present companies in a coordinated trend.
