State health IT leaders talk data sharing, priorities

State health IT leaders are looking to data sharing, interoperability and governance strategies to usher in the next phase of the Affordable Care Act.

“It’s time to act, but please don’t overreact,” said Manu Tandon, CIO and health IT coordinator within the Executive Office of Health and Human Services for the Commonwealth of Massachusetts, speaking during a panel session at the State Healthcare IT Connect Summit on April 1. 

It shouldn’t be surprising that healthcare reform and IT adoption have been difficult, complex and remain a work in progress.  But now is the opportunity to handle trouble spots, including the need for better data sharing, procurement strategies and governance, he said.

During the panel, Ron Baldwin, CIO for the state of Montana, said his state did not want to invest millions of dollars on systems that fail to interoperate.

“When first implementing brand new systems in human services, we decided in Montana that we aren’t going to take money to rebuild siloed systems, but that we are using money to lay down enterprise, service-oriented infrastructure so there are tools we can use to share data,” he said.

Montana also focuses heavily on data analytics, harnessing data across state programs and departments, he said. “We’re implementing a statewide data portal solution, we are implementing governance around that, and we are implementing standard agreements around use of the data so departments feel data are used in an appropriate, protected way,” he said.

In Ohio, state officials are working to build models across its agencies, and developing a platform to aggregate data for a patient-centered view, said Rex Plouck, portfolio manager for the governor's Office of Health Transformation. This platform initially will focus on fraud, waste and abuse “where you can get easy wins and make big savings.”

Agency heads from Medicaid, Health and Human Services, the Department of Child & Families and Education in Ohio are working through legal, privacy, security and policy matters. “It’s evolving, we learn every week and adjust,” he said.

One breakthrough was the implementation of operative protocols. As attorneys and legal issues stalled data sharing efforts, the protocol allows sharing as it’s all considered as an initiative sponsored by the governor, which means that no contracts are required. “It’s helped a lot not only with sharing data, but sharing resources. Like everything, people have resisted it, but like everything they learn that resistance is futile.”

Everyone knows data sharing is important, but what data elements you choose to exchange must be thought through. “At the top of the pyramid you have data elements like demographics. Everyone has them and uses them. In the middle tier, you have race and ethnicity. Seventy five to 85 percent use it, but it doesn’t mean the same for everyone. On the bottom tier, you have income and adjusted income. Everyone uses that, but God help us if you stratify that definition,” Tandon said.

As such, “the reality is you want to focus on the top of the pyramid.” He said systems don’t necessary have to contain data, but know where they are, like an index. The importance is how meaningful are the data being generated.

State leaders need to keep their eye on the bigger picture of what they want to know when it comes to data and who they want to be, said Tracy Wareing, executive director at the American Public Human Services Association.

“This isn’t just about coverage and enrollment, it’s about what we know about the social determinants of health, and how to connect providers with social services for prevention and intervention and ultimately to bend the cost curve.” States are still figuring out the baseline of data collection and sharing, and how to transform that data. But once there, real improvements will take off, she said.