How HIEs Support Interoperability Use Cases for Payers, Providers

When ClinicalConnect Health Information Exchange went live ten years ago to improve clinician access to patient health data for care coordination, the organization became proof positive that HIEs are critical for interoperability at not just the provider level, but also the payer level.

“Our patients take advantage of the multiple healthcare systems in the region and the health systems recognize that,” Phyllis Szymanski, president of CCHIE, explained in an interview with EHRIntelligence. “The hospitals came together and saw a need to exchange health information.”

Since CCHIE’s inception, Szymanski has been instrumental in tripling the size of the HIE to over 21 regional healthcare organizations from the seven founding members in western Pennsylvania, making CCHIE one of the state’s largest HIEs with over 10 million patient records.

“We're quite large in terms of a regional footprint,” Szymanski noted. “It's really been exciting to have CCHIE grow the way it has. We're also connected across the state of Pennsylvania with the other health information exchanges, and we've expanded nationally through the eHealth Exchange.”

Szymanski said that the HIE’s significant growth in terms of patient data over the last few years brought CCHIE officials to consider other ways that the data could support healthcare organizations in the region.

“We’ve watched the industry and we've seen the evolution to other areas of focus like value-based care, health equity, social determinants of health, quality initiatives, and payer initiatives,” she noted. “We realized the opportunity that we had with all of this information and the knowledge that we have with interoperability, so we evolved to support those different areas.”

In the last few years, Szymanski said that CCHIE has purchased additional products to incorporate healthcare payers into the mix by aggregating patient data for quality reporting initiatives.

“As the industry evolves, the payers require having access to this information,” Szymanski explained.  “We work with our payers within our region and we've been really trying to focus on how to get them the data that they need when they need it, similar to the providers. We've been relatively successful in that area and we're continuing to focus on that.”

Szymanski emphasized the importance of ensuring the HIE brings value to both the provider and payer sides, which has required CCHIE to take on the role of a mediator.

“When we talk with our provider organizations and we indicate that we have these payers joining the health information exchange, there's a lot of education that we need to do in order to make sure that they understand that there is value in providing that information,” Symanski said.

“We're like a mediator between the provider and payer population,” she added. “That’s been an interesting shift in our responsibilities. We don't just deliver the data, we make sure that both our providers and payers understand that there is value on both sides by having the health information exchange be the conduit for that data exchange.”

Symanski noted that as the digital health transformation continues to progress, HIEs such as CCHIE are in a good position to support interoperability efforts.

“We've demonstrated success with interoperability,” she said. “We pride ourselves in being very aware of the industry and where it's going.”

Symanski said that HIEs have the ability to aggregate data from multiple sources and provide it in a format that the downstream systems need it in, whether it be a payer or provider. 

“That's where the real value is with the health information exchanges; ¬it's not just a single-threaded approach in how we deliver the information,” she explained. “We really monitor the industry in terms of the standards, and we make sure that we purchase products that support that.”

She also noted that CCHIE works with organizations to help them overcome some of the challenges they might face with their EHR vendors when it does come to data sharing.

“That's where the HIEs really play an important role, is being a mediator, a facilitator, an interpreter, that sort of thing,” she said. “I think that's where we have benefits in the industry and being able to support interoperability.”

Symanski said that CCHIE will be focusing its interoperability efforts on value-based care over the next few years.

“We plan on working with the state health information exchange and the other HIEs across the state to implement a social determinant of health platform, or what's being referred to as a resource and referral tool,” Symanski noted.

She also said that CCHIE will continue to work with payers to address some of the quality initiatives they have around HEDIS reporting and risk adjustments.

Additionally, CCHIE is always considering ways it can use its data “outside the box,” Symanski said.

For example, CCHIE is working on a child abuse initiative with a clinician at one of its participating children's hospitals to identify certain diagnoses and chief complaints that can help clinicians proactively identify if a child is a suspect of abuse.

“It's something innovative from our perspective because the information just isn't being exchanged, but we're really looking at the potential of how we can use the data to be more proactive in how we identify children who might be suspect of abuse,” she said. “This permits the clinicians to engage earlier and really does allow improved patient care, especially within the pediatric population.”

“It's really about looking outside the box of what we've traditionally been used to doing and seeing how we can get creative in terms of improving patient care with the data that we have,” Symanski continued. “It's really exciting to see the potential capabilities of what we can do with this information. It's been great to see the industry evolve with us. We're excited to be part of improving patient care.”