Anatomy of HIEs, state data management systems

Kentucky and Maine increasingly are harnessing data from various state agencies to improve care delivery and reign in healthcare costs.

“While planning technology for Kentucky’s health benefit exchange (KHBE), we really hadn’t stepped backed and thought how that affects the whole enterprise solution,” said Shari Randle, director of the Division of Systems Management at the Kentucky Office of Administrative and Technology Services, speaking at the 2014 State Healthcare IT Connect Summit on April 2.

But under the guidance of Kentucky CIO Rodney Murphy, the state developed a “house” of quality health information, which is built on a foundation of enterprise tools with pillars representing the Kentucky health information exchange (HIE), Kentucky Medicaid Management Information Systems, KHBE, support programs and public health programs.

“The pillars, or program areas, are separate and data are not exchanged except through interfaces for specific information,” she said. “The roof of the house is a single citizen’s portal, where you can come to a single sign-on and access any data related to you.”

The roadmap ultimately links everyone across the master data management system so data can be aggregated across the enterprise. “There’s purpose for that. We don’t know how well we are serving constituents. It’s about knowing what clinical outcomes we can link to those citizens.”

John Langefeld, CMO for clinical integration, population health and medical informatics for the state of Kentucky, said he is working on a governor priority of identifying high utilizers and reducing inappropriate emergency room (ER) use.

Through their data, Langefeld’s team found that $360,000 was spent on ER use in the past six months, and about half of those patients—about 45,000—were readmits. With the KHIE providing data flow and connectivity both internally to the state and externally to providers, the system now alerts care teams when a super utilizer enters a healthcare setting. “These are fundamental ways we’ve begun to use the technology.”

Some of Maine’s efforts revolve around a common utilizer of ER: patients with mental health conditions. About 79 percent of patients who visit the ER have mental health issues.

Unfortunately, obtaining patient consent to receive behavioral health data brings up thorny legal issues, said Dawn Gallagher, state HIT coordinator for Maine.

To maximize data flow into the state’s HIE, Maine is an opt out state, meaning that it has a state statute that requires an opt out for general care and an opt in for behavioral health. But getting patient consent for some behavioral issues like substance abuse is difficult. “You can’t even share substance abuse even if a patient says you can. It would take an act of Congress to change that,” she said.

To obtain general mental health data, the state obtains consent via a third-party originator or TPO relationship. Now “you can get an informed consent agreement with patients that’s a little less onerous than what was in the past.”

In other comments, she said Maine is changing its definition of a care management team to encompass not only clinicians, but the people who help individuals find housing, improve nutrition, etc. When an ER notification is sent through the HIE, it goes out not only to a provider, but to Medicaid where there are care managers prepared to intervene.

“We are linking medical care management and social care management with the payment system and we can do this by virtue of legal documents through a business association agreement,” she said.