Blog from April, 2021

Christopher Jason

CTHealthLink added Connecticut Children’s and the Connecticut Children’s Care Network to its expanding list of provider connections.

CTHealthLink (CTHL), a physician-led health information exchange (HIE) established in partnership with the Connecticut State Medical Society (CSMS), added its first integrated delivery system to its network, Connecticut Children’s and the Connecticut Children’s Care Network (Care Network).

“We are pleased that Connecticut Children’s and its Care Network are dedicated and committed to a more comprehensive way of sharing patient information,” Richelle deMayo, chief medical information officer at Connecticut Children’s, said in a statement.

The three-year-old HIE enables clinicians, hospitals, and other healthcare providers in the HIE network to exchange patient health records, utilize data analytics tools to improve patient outcomes, and streamline clinical processes. It also grants patients access to their respective health records, CTHL said.

“Being part of CT HealthLink and having access to this type of patient data will allow us to save lives by preventing suicide which is the second leading cause of death in children and young adults starting at 10 years old,” said Steve Rogers, MD, medical director of Emergency Behavioral Health Services.

“Children receiving care in our network often have complex medical needs that require them to see a number of different providers. CTHealthLink will help us to connect information across different providers and EMR systems to improve the care we deliver to our patients,” Rogers continued.  

Connecticut Children’s leaders explained that Connecticut’s current mental health crisis was a critical reason to connect to the HIE.

The health system has one of the state’s lone behavioral health units. However, Connecticut Children’s clinicians and patients currently experience difficulty with patient data access and exchange.

“Patients at risk of suicide are seeing their healthcare providers, but their risk is often unrecognized due to the fragmentation of health information throughout the system,” said Rob Aseltine PhD, CTHealthLink Board Chair.  “We see access to the integrated data and analytics provided by systems like CTHealthLink as a critical tool in helping pediatricians identify and intervene with children at risk of suicide.”

Connecticut Children’s and Care Network join Yale-New Haven Health, UConn Health, CVS Health and Minute Clinics, the Veterans Administration (VA), DaVita Health, the Department of Defense (DoD), Fresenius Medical Care, and Premise Health on CTHealthLink’s list of connections.

This connection also allows the healthcare organizations to have full access to the state’s public health registries.

These additions, plus Connecticut’s 26 independent pediatrician practices, aim to improve patient data exchange and interoperability across the state, triggering a more effective response to certain health emergencies, including the COVID-19 pandemic.

Clinicians in the Care Network can leverage the HIE to ensure that children with special healthcare needs will receive the COVID-19 vaccine. Connecticut’s immunization registry tracks all COVID-19 vaccinations.

“Children with complex medical conditions are especially at risk for coronavirus infection,” said David Krol, MD, medical director of CT Children’s Care Network.

Additionally, the HIE is connected to the Carequality interoperability network and is a KONZA National Network member, enabling patient data exchange from across the country.

“Health information exchanges have untapped potential and broad reaching benefit for healthcare.  In partnership with CTHealthLink, we have an opportunity to further the quadruple aim in enhancing the patient experience, improving population health outcomes, reduce costs, and enhance the clinician experience across Connecticut, supporting our trajectory towards value-based care,” said Jung Park, Chief Information Officer for Connecticut Children’s. 

“Implementing this critical infrastructure begins a virtuous cycle, helping to enable future care innovation and accelerating research aims. I’m excited by the prospects and synergies that CTHealthLink will enable,” Park concluded.

Christopher Jason

Scientifically tracking EHR use measures could improve clinician well-being and ultimately mitigate clinician burden.

To effectively boost EHR optimization and reduce clinician burnout, healthcare stakeholders must develop EHR use measures that are actionable, usable, transparent, and trustworthy, according to a JAMA Network op-ed from American Medical Association and Yale School of Medicine leaders.

Scientific-based methods could effectively track EHR use and performance, op-ed authors Christine Sinsky from the AMA, and Harlan Krumholz and Edward Melnick, both from Yale, wrote.

Extended EHR use, documentation, excessive EHR inbox messages and notifications, and other EHR usability issues can result in clinician burnout. According to a recent study published in the Journal of the American Medical Informatics Association (JAMIA), ambulatory physicians spend more than five hours on the EHR for every eight hours of scheduled patient time.

This EHR use study, plus many more, revealed EHR performance measures and variations that led health IT professionals and developers to increase focus on patient care and clinician burnout.

“Without the capacity to identify targets and evaluate interventions, quality was mired in an era of implicit review without systemic approaches to improvement,” wrote the op-ed authors. “Measures are not sufficient for improvement, but good measures, in the proper context, have a central role in supporting and incentivizing better performance.”

EHR use metrics are vital to measuring EHR design, implementation, and regulation, along with gauging improvement in clinical workflow and teamwork, according to Melnick, Sinski, and Krumholz.

“For a measure to be scientifically sound, its results must be precise, reliable, valid, and adequately risk adjusted,” the authors explained. “Such measures can be used to compare vendors and instances of the same product, identify variation and best practices among clinicians, support training of students and residents, and spark efforts to improve.”

For example, researchers, health systems, and health IT developers could leverage EHR use measures to determine:

  • Total EHR time
  • Work outside of work
  • EHR documentation time
  • Prescription orders
  • Inbox usage time
  • Teamwork for orders
  • Undivided attention

EHR audit logs are a common and current way to gauge EHR use measurements. Audit logs automatically capture observational data, such as number of workflows, keystrokes, and mouse clicks.

“EHR audit logs are an appealing data source for measurement,” explained Melnick, Sinski, and Krumholz. “Yet the validity and reliability of their data remain in question due to their unwieldy and subsequent inaccessible nature and lack of standard data definitions. Standard definitions of time-out lengths and work performed outside of scheduled clinical hours across vendor products and better integration of clinician schedules with EHR audit logs could begin to address many of these issues.”

Although audit logs do not always tell the complete story, they can offer critical data and implications. For example, the previously noted JAMIA study authors leveraged audit logs to reveal female physicians spend more time on the EHR than their male counterparts.

Researchers and health systems can utilize this information to conduct further studies or optimize their respective EHR systems. Furthermore, this data could emphasize EHR user experience to add visibility and transparency to the specific problem at hand.

To prove the importance of EHR use data, the authors suggested the Office of the National Coordinator of Health IT (ONC) to require regular vendor EHR use measure reporting to maintain certification. Thus, ONC would place the measurement burden on the developers and not the clinicians.

Reporting EHR use data could also result in accurate, meaningful, and current EHR use measurements, which could trigger policy, regulatory, or workflow changes, Melnick, Sinski, and Krumholz wrote.

EHR use measures should have evidence that links it to a particular outcome, must target a poor performance area, and must produce actionable and usable results that are relevant to healthcare stakeholders, the trio recommended.

“The EHR has the potential for benefit, harm, and burden,” concluded Melnick, Sinski, and Krumholz. “To optimize EHR design, implementation, and regulation, EHR use measures must be developed that are trustworthy, clinically important, scientifically sound, transparent, and feasible for implementation. These measures are needed now.”

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.