Revolutionizing health data: The emergence of HDUs
TEFCA is a major factor in paving the way for health data utilities and their potential to reshape healthcare information exchange.
As efforts to implement the Trusted Exchange Framework and Common Agreement accelerate, other types of entities are emerging to support information exchange and other related services.
The growing role of health data utilities is important because they provide increased potential for healthcare organizations to take advantage of patient data in various ways to improve care. They demonstrate that the landscape of interoperability will continue to evolve as TEFCA aims to expand the scope of data exchange.
The utilities, known as HDUs, are similar to health information exchanges in that they operate in specific regions or states. As defined by the Civitas Networks for Health, HDUs have advanced technical capabilities “to combine, enhance and exchange electronic health data across care and services settings for treatment, care coordination, quality improvement, and public and community health purposes.”
In contrast, Civitas defines health information exchanges (HIEs) as delivering electronic healthcare-related data among facilities – doing so by “facilitating access to and retrieval of clinical data.”
Both HIEs and HDUs play key roles in taking in disparate data from all sources and normalizing and standardizing it, says Lisa Bari, CEO of Civitas, the members of which include both types of data organizations. The organizations can de-duplicate patient information and append records to create comprehensive care resources for healthcare organizations, she explains. “We can’t expect smaller providers to do better data quality and they have limitations on how they can do this. Our members are serving a critical role, taking information in and making it worthwhile and useful for exchange purposes.”
HDUs build on this notion of HIEs, with the intent of using the framework for trusted data exchange to support exchange for other types of healthcare information beyond clinical information, notes Melissa A. Kotrys, CEO of Contexture, a nonprofit HDU that provides strategic, technical and administrative support for information sharing to communities in Arizona and Colorado.
HDUs, for example, can move a variety of information that is increasingly recognized as important in providing efficient care, such as that for social determinants of health, advanced directives, payer-related information or community health data, Kotrys says. “We can use the data sharing framework, expanding well beyond the exchange of clinical data to improve advanced community health practices and wellness.”
HDUs can be more responsive to community needs – Contexture based adaptations in its three-year strategic plan recently to offer more capabilities in response to discussions with community members. “Above and beyond exchange, our community wants flexibility in ways they can access information,” Kotrys notes.
Delivering this information places technical requirements on HDUs, such as strong identity management and capabilities for exchanging complex data through extensive integration. It’s crucial for HDUs and HIEs to also meet the requirements of providers, she notes.
HIEs and HDUs have participated in national networks – for example, Contexture is connected to eHealth Exchange, a network of networks active in all 50 states connecting federal agencies and non-federal healthcare organizations. Contexture plans to participate in TEFCA-related exchange, but is waiting to see what the final form will be before making adjustments in its data platform, Kotrys says.
The challenge for HIEs and HDUs – and TEFCA overall – will be to extend data sharing to the endpoints that need it – those smaller offices and organizations that are the recipients of healthcare information. All organizations will be crucial to ubiquitous information exchange.
“We have to ensure that we can balance and align with state regulations that differ from state to state. We know Arizona and Colorado, and ensuring that all entities are in compliance with state regulations,” she concludes. “There will be technical complexities, with different types of providers opting TEFCA and may use different QHINs for TEFCA purposes – how will that be managed at the QHIN level? As QHINs develop all these details, we will evalulate how we stay in compliance.”
Many states continue to develop and remodel state-level health data governance and exchange services to support broader community and key stakeholder needs. However, there is no standard state-level approach to health data and interoperability.