How Health Information Exchange Can Support Public Health, Equity

Health information exchanges (HIEs) have long been the go-to solution for supporting traditional healthcare settings with real-time patient health data at the point of care. But when COVID-19 broke out, it became clear HIEs needed to play a bigger role in medicine. Public health entities and folks focused on health equity came to rely on HIEs, and the HIE in Indiana was quick to step up.

"We say that healthcare is local, but I think patients are certainly moving across county lines, city lines, even state lines to receive care," Drew Richardson, vice president of business and product development at Indiana HIE (IHIE), told EHRIntelligence in an interview. "HIEs are well suited to serve as a data aggregator and a data provider to a lot of those facilities, specifically hospitals and physician practices."

"A hospital may be very interested in diabetes or public health outreach, so they would want to get specific data for the care management team to focus on a population of some sort," Richardson explained.

The pandemic marshalled in two key focus points of the medical industry: investment in public health infrastructure and health equity. But both public health and health equity have data problems, with experts leading in both fields saying they don't have the real-time information necessary to affect tangible change.

According to Richardson, this was a big opportunity for HIEs.

Beginning in 2021, IHIE used an ONC grant to supply underserved communities with COVID-19 vaccination data by creating a weekly cadence of vaccination statistics for each Indiana county.

IHIE provided data to the Indiana Rural Health Association (IRHA), the State Department of Health, and the Office of Minority Health to assist in decision-making surrounding vaccination efforts.

"We could be in the middle to answer specific data questions, gather data, and then be able to distribute that data to organizations, community leaders, and different groups within the state," Richardson said.

"For each specific county, we could see areas that were not taking to the vaccination, which helped inform different outreach programs," he said.

IHIE continues to distribute weekly vaccination dashboards on its website in six different languages for the 92 counties in Indiana.

"We have tried as much as we can to distribute the information to those that are boots on the ground that have the ability to interact change in those communities," Richardson noted.

But the public health application for HIEs doesn't just end with the pandemic. Richardson said that these newly established data feeds could help address conditions such as infant mortality and opioid abuse.

"With COVID, many local health departments, state-run health departments, or other public health agencies were just trying to do anything and everything they could to support the communities," Richardson said. "HIEs were well positioned to help, and a lot of HIEs stepped up to do that."

"Establishing that foundation and that relationship with COVID is really allowing some fruitful relationships and discussions to happen so that we can hopefully be prepared for whatever comes our way next," he emphasized.

In addition to its COVID-19 vaccination data work, IHIE is working to engage underserved communities by offering data sharing solutions to organizations such as federally qualified health centers (FQHCs) that face technical or financial limitations.

"There's a lot of focus on large health systems or large EMR platforms," Richardson pointed out. "Everybody wants to utilize APIs and FHIR and all this great technology, but we've tried to build some solutions that are able to support underserved communities like our FQHCs and some of those areas that tend to get overlooked."

"We're trying to bring those organizations into our data cooperative because we feel like those are some areas that there is a need, and we feel very well positioned to be able to support those organizations on a go-forward basis," he continued.

IHIE's clinical data repository has participation from over 120 hospitals, 19,000 practices, and 50,000 providers.