In Times of Crisis, HIEs are Front and Center

The response to the COVID-19 pandemic has shown the even greater importance of ensuring the right information is accessible to those who need it. Health information exchange (HIE) organizations play an essential role in aggregating and disseminating data to give local hospitals, public health officials and providers a better understanding of the virus’ spread and the patients being tested and treated. Several national exchange efforts are contributing to the response, but as the U.S. deals with a pandemic that impacts each region differently, these regional HIE organizations play a vital role and can have a direct impact on a community’s preparedness and response to COVID-19.

The Role of HIEs: A Reliable Partner in a Crisis

Historically, HIE organizations have successfully responded to all kinds of crises — both natural and man-made disasters. During recent hurricanes, wildfires and mass shootings, these entities have played critical roles and are viewed as a reliable source of truth when exchanging information for the many people displaced from their normal care settings.

As the United States braces for the apex of the COVID-19 pandemic, HIEs play the extremely important role of exchanging data, facilitating the ability for frontline staff to save lives every day, everywhere. The following are real-world examples of how HIEs have prioritized in their response efforts:

• Test Results Aggregation and Alerting: HIEs are coordinating directly with public health officials, providers and labs to increase awareness of cases and community transmission, and to better prepare providers for interventions with infected patients. For example, Healthshare Exchange, a HIE serving the Delaware Valley region, has leveraged their Encounter Notification Service tool to specifically track COVID-19 admission and discharge codes to assist in the monitoring and follow-up with infected patients. Indiana HIE (IHIE) runs the Notifiable Condition Detector that supports detection and reporting of communicable disease cases to the state health department. This tool has been expanded to include coronavirus testing in its case reporting.
   
• Population Health Surveillance and Analytics: Because of their role as data aggregators, many HIEs are implementing tools to assess trends and inform decision making around regional responses. IHIE is working on a dashboard to track admissions, test rates and diagnostic data to inform state efforts. Similar tools were leveraged in 2009 during the H1N1 outbreak.
   
• Broader Coordination across Communities: Many HIEs partner with clinical and social organizations within a community and leverage their existing infrastructures to offer broader support and expanded access to non-HIE participants. Arizona’s Health Current has accelerated implementation for COVID-19 related access, while HIE Networks in Florida is expanding the sources of data that can be exchanged through their portal.

Roadblocks to Effective Exchange

Even with the incredibly positive role these entities play in connecting essential data points, there are persistent organizational and technical barriers that impede even more robust exchange. These problems aren’t new and are deeply embedded within our healthcare ecosystem, and unfortunately, COVID-19 has merely exposed them even further.

Gaps in the Data Exchange Ecosystem: To date, many regional HIEs have expressed challenges connecting with one of their key stakeholders — the labs processing the COVID-19 test results — to ensure robust virus surveillance and coordination. Further compounding the issue, some HIEs may not have formally established connections with state and local public health departments, so meaningful gaps remain between hospitals and public health entities in terms of the information that should be communicated on an ongoing basis.

Evolving Technical Needs: Organizations have been quick to release new CPT and ICD-10 codes to document COVID-19 cases. However, many healthcare organizations don’t have the technical infrastructure to handle basic exchange needs. As mentioned above, HIE Networks in Florida is allowing new data sources, such as faxes, to be exchanged, but challenges remain around the integration of that data into broader information for the community.

Increased Flexibility and New Mandates for Improved Exchange

The current pandemic has created an extraordinarily dynamic landscape in which policymakers are furiously working to keep up with the evolving needs of our healthcare ecosystem. New state and federal guidance, directives and mandates are being released at an accelerated pace to decrease barriers and encourage faster, more impactful exchange.

For example, in California, state entities are now authorized to share relevant medical conditions, as necessary, to mitigate the COVID-19 outbreak with governmental and nongovernmental partners for the limited purposes of monitoring, investigation and control and treatment and coordination of care.

To mitigate issues with data sharing from labs, some states and jurisdictions are imposing new requirements around the release and access to COVID-19 lab results. For example, Riverside County in Southern California now requires labs now report data through Manifest MedEx, their regional HIE, for exchange and access with departments and facilities in the area.

At the federal level, HHS’s Office of Civil Rights (OCR) announced a number of flexibilities and guidance on what protected health information (PHI) can be shared as it relates to COVID-19. These flexibilities expand the offerings of data that HIEs can make available to their participants. For example, OCR has released HIPAA guidance on when COVID-19-related PHI can be disclosed to law enforcement, first responders and public health employees. They have also relaxed HIPAA non-compliance penalties on business associates sharing PHI with public health authorities in good faith, even if such disclosures are not permitted in their existing business associate agreement. As HIE organizations are and/or work with business associates, this notice can have positive implications on COVID-19 data exchange.

HIMSS encourages states, HIE organizations and partners to consider the following:

1. Leverage HIEs to collect and disseminate data across all sectors, including but not limited to, EHR encounters, emergency management service (EMS) data, laboratories and public health surveillance data. This approach can create targeted interventions and efficient emergency response plans relating to communicable diseases and other non-health data, such as transportation to support health impact assessments, that policymakers can leverage to make informed decisions during all crises.
   
   States have the authority to appoint an HIE organization to collect COVID-19 information and should consider the role HIEs can play to further enable automatic submission of syndromic surveillance information to the state health department and collection of COVID-19 test data from hospitals (including temporary hospitals created in times of emergency), public health labs, EMS systems and community test sites such as churches, drug stores and other retail health locations.
   
   States should also engage HIEs and local and state epidemiologists to create COVID-19 dashboards that leverage aggregated and anonymized location data from social media sources and to support the creation of disease prevention maps.
    
2. HIEs should coordinate with their partners to aggregate and disseminate key demographic information, including, but not limited to, race, ethnicity, sex, employment history, as well as recent travel history, in order to broaden understanding of risk factors and proper interventions. Early data suggest that, due to multiple factors, black Americans face higher rates of COVID-19 infection. Furthermore, a recent study has indicated that exposure to air pollution increases a person’s risk to severe COVID-19 outcomes. Coordinating more robust information sharing of these demographics and other social determinants data can better inform targeted public health responses to combat the spread of the virus.
    
3. Use HIEs to identify where future outbreaks may occur due to their predictive analytics capabilities. These entities have information that could inform public health officials with essential information about where clusters of COVID-19 cases are emerging within a hospital/health system, state or region. Hixny, an HIE organization in New York, is working with their Department of Health (DOH) to better identify populations with underlying conditions; This may help the DOH better forecast how quickly hospitals may become overwhelmed by a cluster of COVID-19 cases.

Learn more about the role HIEs play and the role states play in response to COVID-19.

Healthbox, a HIMSS solution, launched the COVID-19 Digital Think Tank, a valuable resource for you as you lead your facility, team and patients through the crisis. Share what you know, see what’s working for others, and bring lessons back to your community. Engage with the HIT community on solutions.