Blog from April, 2021

Christopher Jason

Pew Charitable Trusts recommended three items for ONC to improve patient data exchange and public health.

The Office of the National Coordinator for Health Information Technology (ONC) should expand the data required in the United States Core Data for Interoperability (USCDI) to improve public health efforts and patient data exchange, according to Pew Charitable Trusts.

ONC defined USCDI as “a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange.”

The agency adopted the first version of USCDI as a standard in the ONC Final Rule. It set a foundation for increased patient data sharing to boost patient care

In January 2021, ONC released USCDI Version 2 to enhance interoperability and patient data exchange between patients, providers, and other users.

“We recognize that these criteria may change each year based on trends within the submissions received, high priority target areas, and other factors,” wrote ONC in January. “We aim to provide relevant details on a given year’s priorities in order to provide greater transparency into the process and ensure continued alignment of USCDI submissions to high priority target areas for health IT and health care.”

However, Kathy Talkington, director of Health Programs at Pew, said USCDI Version 2 is missing valuable information to help combat public health crises, such as COVID-19.

“When finalizing the proposed version, ONC should ensure the USCDI includes data needed for public health and health equity, which can help public health agencies fight the current pandemic—and be better prepared for future crises,” Talkington wrote in a letter to ONC.

According to Pew, over 40 percent of lab results are missing important patient data.

To strengthen USCDI, Pew recommended ONC:

  • Require the use of US Postal Service (USPS) standard to boost patient matching
  • Include key data elements, such as travel history, employment, and death date
  • Accelerate social determinants of health (SDOH) data integration

“Given these existing gaps, ONC should ensure the USCDI includes data needed for public health and health equity, which can help public health agencies fight the current pandemic—and be better prepared for future crises,” Talkington added.

Standardizing data elements, such as phone numbers and addresses, is crucial to patient matching. Talkington said patient matching could improve with the help of USPS formatting. USPS address formatting can increase matching by up to 3 percent, according to a 2019 study published in the Journal of the American Medical Informatics Association.

“Using additional data elements to verify individuals’ identities can help do that,” Talkington explained.  

“ONC rightly added more demographic data to the USCDI in version 1, including current and previous addresses; phone number (as well as the type of number, such as a cellphone or home landline); and email address,” she continued.

Pew recommended ONC integrate additional demographic data, such as health plan ID or Medicare Beneficiary ID to provide a standardized way to improve patient matching and link patient records across systems.

However, ONC said integrating this standard would result in provider burden.

“Instead, ONC created Project US@, a multi-stakeholder initiative to create a health care-specific format for address, building off of and removing existing variation in the USPS standard,” Talkington said. “However, this process will take time to develop a more specific standard, and ONC should not delay adoption of the USPS standard in the interim. Even with the variation allowed in the USPS standard, adoption would lead to fewer discrepancies and differences in address depiction than exists today.”

Next, Pew suggested ONC integrate specific public health data elements to boost patient data exchange during a public health situation, such as COVID-19.

Pew said ONC should include an existing “problems” data class, a “specimen” data class, a “travel history” data class, a “work information” data class, an “observations” data class, and also include a “death date” data class.

“Including data needed for public health as part of the USCDI will ensure that all EHRs are able to document and exchange this information in a standard manner, including with public health agencies,” wrote Talkington.

Research shows that identifying and implementing individual SDOH data into the EHR is crucial to finding answers to significant health issues. Studies show this data accounts for 80 to 90 percent of individuals’ health.

Once identified, SDOH data can create opportunities to offer social services and interventions for high-risk individuals.

“The COVID pandemic has also highlighted the importance of using data to improve equity of care, and how missing data can make it harder to target resources, distribute vaccines appropriately, and assess the risks to different communities,” Talkington explained.

“Yet, USCDI fails to include many important SDOH data elements. We encourage ONC to accelerate their inclusion of SDOH in USCDI version 2”

Talkington said providers and patients should engage in conversations about the importance of SDOH data, which could ultimately allow individuals to give providers access to collect and share SDOH data.

“USCDI version 2 is an opportunity to ensure data needed for patient care and public health activities are included within standards for exchange,” concluded Talkington.

“The COVID-19 pandemic has highlighted the existing gaps in current mechanisms for data exchange, both between health care facilities and with public health agencies. A comprehensive USCDI could help close these gaps and ensure complete, standardized data can be seamlessly shared with those who need it.”

Christopher Jason

HHS awarded New York eHealth Collaborative (NYeC) and a United Way of New York State subsidiary for their social determinants of health (SDOH) data initiative.

The New York eHealth Collaborative (NYeC) and 2-1-1 New York, Inc. (2-1-1 NY), an affiliate of United Way of New York State, will work to promote patient data exchange through social determinants of health (SDOH) data.

This work comes as a part of the organizations’ Social Care Referrals Challenge award granted by the Department of Health & Human Services (HHS).

“We are thrilled to be partnering in this important work that is sure to benefit so many New Yorkers and further the mission of both 2-1-1 and United Way,” said Mary Shaheen, vice president of United Way of New York State (UWNYS) and president of 2-1-1 New York.

The two organizations plan to establish a framework that supports patient data exchange and collaboration between existing networks and users. NYeC and 2-1-1 NY said the framework would create a statewide resource repository of local organizations and services to help exchange SDOH data and improve referrals.

“Vulnerable New Yorkers rely on resources and services delivered by community-based organizations, but those needs often go unmet due to the fragmented structure that exists between the healthcare and social services systems,” said Valerie Grey, NYeC CEO.

NYeC runs the Statewide Health Information Network for New York (SHIN-NY), the New York statewide HIE.

One hundred percent of hospitals in New York and over 100,000 healthcare professionals connect to SHIN-NY. The HIE facilitates secure and confidential electronic sharing of patient data across the healthcare system. It connects regional networks, or qualified entities, that allow participating healthcare professionals, with patient consent, to quickly access and share health information and medical records.

2-1-1 NY provides individuals with a repository of health and human resources based on specific needs and locations. The organization said individuals could access these community resources online or by phone.

“Community-based organizations must be supported to assist healthcare providers with resources to improve overall health, reduce disparities, and increase wellbeing of patients and communities,” Grey continued. “While several systems have emerged in recent years to address these types of needs, they are disparate and not interoperable. These are gaps we can fill so stakeholders can continue to innovate within this space for the betterment of our broader community.”

This adds to the investments HHS has been making in health data exchange and interoperability.

Earlier this month, the agency awarded funding to two regional NY HIEs, Bronx RHIO, and HEALTHeLINK, to improve patient data exchange between the HIEs and immunization information systems.

Through this program, HHS plans to help public health agencies track and identify patients who need a second Moderna or Pfizer vaccination and also identify high-risk individuals who need to begin a vaccine regimen.

Bronx RHIO will use the funding to support public health agencies identify and track individuals who need vaccinations in high-risk communities, the HIE explained. The funding will also help the HIE improve COVID-19 vaccination administration, monitor long-term vaccine-related health effects across populations, and measure vaccination patterns based on social determinants of health.  

With the funding, HEALTHeLINK intends to develop COVID-19 technologies to assess immunization statuses for individuals in Buffalo and several other western New York counties, the HIE said. The HIE will also deliver patient monitoring to vaccinated individuals and provide clinicians with COVID-19 EHR alert notifications for patient immunization statuses, hospital admissions, and COVID-19 test statuses.

HHS and ONC will distribute roughly $20 million in funds from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Among other things, the CARES Act aims to support the country’s COVID-19 vaccination efforts.