HIMSS23: Health Data Utilities hold potential to advance interoperability

Lisa Bari, CEO of Civitas Networks for Health, speaks about HDUs and interoperability at the HIMSS23 global conference in Chicago on Monday.

Photo: Jeff Lagasse/Healthcare Finance News

CHICAGO – Federal and state governments have made a number of investments in health information exchange (HIE) and interoperability infrastructure, exemplified by the ONC State HIE Cooperative Agreement and Medicaid HITECH 90/10 Federal Financial Participation. But many states have kept developing and remodeling their data governance and exchange services.

The goal is to support broader community needs, which is where the emerging Health Data Utility (HDU) model comes in. HDUs utilize existing technical and relationship infrastructures across states to bring together personally identifiable health data, as well as population and public health data.

Strengthening interoperability, as usual, is the desired endgame.

The future of HDUs was the focus of the opening keynote to the Interoperability and HIE Forum during the opening day of the HIMSS23 annual conference in Chicago.

Lisa Bari, CEO of Civitas Networks for Health, noted that healthcare has not yet achieved complete and total interoperability throughout the industry. It's not due to a lack of technology and standards – those exist – but rather a lack of implementation and adoption, as well as competitive behavior in healthcare and a lack of adherence to nonprofit missions.

"We're obviously experiencing challenges and barriers," said Bari. "We've also made some progress. For the last 10 years there have been significant advancements."

Most hospitals use regional and state HIEs and national networks, she said. As of 2021, 79% of acute care hospitals are using regional and state HIEs, which is up from 53% in 2019. Sixty-six percent of such hospitals are using national networks, up from 44% over the same period.

But there are gaps, especially outside of hospitals. Bari cited ONC research showing that just 62% of acute care hospitals are sending, receiving, finding and integrating health information. And only 16% of physicians are doing the same. 

"This is a gap," said Bari. "This is showing where we still have a lot of work to do. 

"Competition between healthcare entities, misaligned incentives, poorly enforced requirements and an unwillingness or inability to change workflows are some of the most significant remaining barriers to full data health interoperability," she said. "Technology and standards exist, but changing the culture of interoperability requires trust, and truly aligned incentives. That can only happen in an organized movement to get people to do something differently."

Legislation and regulation over the past couple decades point to nationwide centralization, consolidation and an EHR-centric view of interoperability and data exchange. But community-governed HIE organizations fulfill critical roles that greatly exceed the goals of nationwide interoperability, networks and frameworks, said Bari. 

"Data governance must happen at the community level with stakeholders, in line with state laws and local preferences," she said. "These local organizations can and should exist alongside national networks and frameworks."

That's where the HDUs come in. HDUs are statewide entities that combine and enhance electronic health data across care and service settings for the treatment, care coordination and quality improvement. According to Bary, they enable specific, defined use cases, with extra protections to ensure patient privacy and protection.

Some of the defining characteristics of HDUs include neutrality and flexibility, serving a specific geography, a cooperative style characterized by local leadership, inclusive and transparent governance, sustainable financing through public and private revenue sources, and going beyond the baseline of state and federal laws.

Civitas, with help from the Maryland Health Care Commission, has developed HDU resources to define and provide implementation, said Bari. The company will be involved in the space as it's expected to grow.

"We still have a lot of work to do," said Bari.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com