How HDUs enable better public health by bridging the data divide

Health data utilities are revolutionizing public health by breaking down data silos, enabling proactive interventions and addressing health disparities.

This article is part of the August/September 2023 COVERstory.

Note: This article is part 3 of a 3-part series that takes a deep dive into HDUs. Click here to return to part 1.

It’s a scenario pediatricians see play out time and again. A child comes into the emergency department with an exacerbation of asthma. It’s the child’s fourth visit to the department in 18 months, and with each visit, she is admitted for an overnight hospital stay. Yet, despite education directed toward the parents from physicians, nurses and respiratory therapists and refills on vital medications, the 7-year-old returns to the department every few months.

The reason: Her health is deeply intertwined with the health of her environment.

Clinicians know that the child’s bedroom is infested with mold because of inadequate maintenance by a landlord that has limited resources for improvements. It’s a problem that could be prevented with simple interventions — and there are public and community programs available to provide them. Yet data streams for public health and clinical health are locked in separate silos. Without a way to proactively get the right data into the hands of public health officials who can intervene and help high-risk patients, families are left to deal with these challenges on their own, with limited success.

Leading states are breaking down these data siloes by funding health data utilities (HDUs) and leveraging them to support the right interventions for better health.

Better public health infrastructure

Much like other state utilities, similar to those that supply electricity and gas to residents, HDUs are neither public nor private. HDUs sit at the intersection of clinical care and public health, collecting data in real time from multiple entities to ensure the right information is available when and where it is needed most.

HDUs are governed by the same privacy and security regulations as healthcare providers’ IT networks, meaning access is only available to those who are authorized to view the data. They provide the technology, data harmonization and agreements to function as a one-stop shop for comprehensive health data. This ensures public health entities and clinicians can access and share critical information securely and in compliance with laws and regulations. Further, HDUs are governed by boards and agencies that are often led by elected officials and key healthcare leaders in the area, providing more local governance over data access and sharing practices.

HDUs aren’t a new concept in public health and healthcare. In fact, states possess more than a decade of experience in using federal funding to create health information exchanges (HIEs). While some HIEs have sputtered because of challenges related to data quality, difficulty exchanging data across platforms and capacity, those that remain have taught the industry a great deal about what it takes to connect clinical and public health data while protecting patient privacy. These HIEs — and now, HDUs in only a few states — also have given us a road map for value, with rich use cases that demonstrate the power of data sharing to bolster outcomes for vulnerable populations.

Consider the following examples:

  • • In West Virginia, efforts to enrich HIE datasets with race and ethnicity information empower state agencies such as the West Virginia Cancer Registry to measure and improve racial and ethnic disparities in cancer care at a population level. This data provides health officials with a better understanding of and solutions to the challenges specific populations face regarding quality of oncology care, access, cost and more.
  • • In Maryland, data integration between clinical health and public health enables the state HDU to send referrals to local health departments to provide environmental mitigation of known asthma triggers for pediatric asthma patients on Medicaid. It’s a key component of efforts to reduce ED visits among children with asthma. For the family of the 7-year-old mentioned above, such a referral would help pave the way for a safer living space that would reduce the risk of asthma flareups that require emergency care.
  • • Also in Maryland, an HDU enables stakeholders to track outcomes for diabetes, maternal health and child health by race, ethnicity and gender to better understand the factors that disproportionately affect health by population. This not only gives health leaders a basis for strengthening quality of care and care access, but also provides vital data for reducing care costs and disparities.

Connecting data for better outcomes

Public health interventions hold tremendous potential to improve health outcomes by preventing illness before it becomes less manageable. But the ability of public health entities to respond to the health needs of high-risk individuals and populations requires mechanisms that enable clinicians and other members of a patient’s care team to proactively share this data upstream so the right interventions can be deployed for the right patient at the right time.

We don’t need to spend billions of dollars on a new data system to modernize public health. Expanding access to HDUs — leveraging the infrastructure used to create successful HIEs — connects the dots between clinical health and public health data. It also offers a single, secure source of trusted data for healthcare’s key stakeholders to combine, enhance and exchange health data electronically across settings, providing a foundation for strengthening quality of care, care coordination and community health.

As more states rely on HDUs to combine, enhance and exchange health data electronically among entities, our ability to eliminate disparities in care and health outcomes will deepen — and so will our ability to protect and maintain public health.

Marc Rabner, MD, MPH, is chief medical officer for CRISP Shared Services, which supports six health information exchanges across the country.

Note: This article is part 3 of a 3-part series that takes a deep dive into HDUs. Click here to return to part 1.

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