We often talk about health care as if it were provided by a monolithic, all-encompassing “system.” The data, however, paint a drastically different picture. American health care is a chaotic maze of disconnected systems whose fragmentation acts as a formidable barrier to coordinating the care that will best serve patients.

Case in point: Americans with multiple chronic conditions see up to 16 different physicians in a single year. If you include important non-clinical service providers like therapists, nutritionists, and social workers, that figure can be much higher. For the most part, these health and social service providers are partly or totally unaware of each other’s diagnostic and therapeutic activities. That lack of knowledge undermines the optimal delivery of health care services for patients with the greatest need for coordinated care.

Many other industries whose customers use multiple service providers have overcome this challenge by creating centralized, seamless data interfaces. Financial services consumers can monitor multiple checking, savings, and investment accounts on a single platform. They can use their smartphones to send cash in seconds via different banks.

In health care, however, compiling a patient’s complete health record still requires a herculean effort involving multiple web portals, reams of data files in different formats, and — more often than we’d like to admit — fax machines.

That may change soon thanks to significant recent progress toward interoperability, which is the ability of health care entities to seamlessly exchange patient data. The bulk of that shift has occurred within private networks such as the Epic electronic health record (EHR) system. Epic’s widely used Care Everywhere feature reportedly facilitates the exchange of two million patient records a day. But not all providers have access to these kinds of private data-exchange networks — and that is especially true in the safety net. If progress on interoperability excludes some providers, leaving them fragmented and disconnected, their patients could face greater disparities and dangers.

Harnessing the Power of Data Exchange

That’s why the California Health Care Foundation (CHCF), which has addressed this topic on and off over the past two decades, recently decided to re-engage. CHCF is funding a variety of efforts —  including research, grants, and program-related investments — to make it easier for California’s safety-net providers to harness the power of data exchange to improve care for the people they serve.

As EHRs have become almost ubiquitous, they have become a favored means of exchanging information. Large health systems and EHR vendors have created private networks, like Carequality, that enable providers to securely exchange patient data with each other — as long as they use participating EHR systems. However, safety-net providers are less likely to belong to large health systems or use the EHRs that run on these private networks. That’s why they tend not to benefit from the vast and valuable data exchange those networks enable. For example, a recent survey found rural critical access hospitals are less likely (PDF) to participate in a national EHR vendor network and to rely on non-electronic information sharing than commercial, urban hospitals.

Changing market trends and growing government support for interoperability make this a particularly good time for safety-net providers — with the help of vendors and funders — to close that gap in data-exchange participation. Medi-Cal managed care plans serve nearly 80% of Medicaid patients in California, and they are under pressure to deliver better outcomes while managing costs. They are embracing care coordination as a key strategy for reducing the use of duplicative or unhelpful services and improving clinical outcomes, especially for patients with multiple chronic conditions. This requires health plans to coordinate not only among their network providers but also with outside providers that deliver services “carved out” of Medi-Cal plans, such as substance use treatment. Successful coordination of these services depends on the secure and seamless exchange of patient data.

California has recently put billions of state and federal dollars toward pilot programs like Whole Person Care, which is designed to increase care coordination and data sharing among Medi-Cal providers. They are also pursuing federal funds through the HITECH Act that will incentivize providers to join regional health information organizations (HIOs), nonprofit entities that facilitate the exchange of patient data within a defined geographic area. At the federal level, the Office of the National Coordinator of Health Information Technology and the Centers for Medicare & Medicaid Services just announced sweeping proposals that would place extensive new data-sharing requirements on providers.

Together, these trends make data exchange inevitable for safety-net providers. It is not a matter of if, but of how soon and how successfully they engage. It is in the interest of both patients and providers to ensure the data exchange options available to the safety net are as robust, secure, and cost-effective as those available to private health systems.

The following are some of the key resources and projects CHCF is funding in pursuit of this goal.

Publications

• Promise and Pitfalls: A Look at California’s Regional Health Information Organizations focuses on the status and role of nonprofit regional HIOs that enable data exchange in California’s safety net.
• Overcoming Data-Sharing Challenges in the Opioid Epidemic helps primary care providers navigate privacy protections while expanding access to substance use disorder treatment.
• Catalyzing Coordination: Technology’s Role in California’s Whole Person Care Pilots shares lessons learned about data-sharing technologies that the 25 counties participating in California’s Whole Person Care pilot use. The pilot is an effort to improve care coordination for Medi-Cal patients with complex needs.
• To Switch or Not to Switch: A Guide for Community Clinics Considering Changing EHRs helps clinic leaders weigh the pros and cons of switching EHR vendors, with an emphasis on options for improving interoperability.

Grants

• CHCF is supporting additional efforts to secure and distribute federal HITECH funds to help more Medi-Cal providers and organizations join regional HIOs.
• CHCF is also exploring ways to support local and state efforts to leverage federal funds for improving health care technologies affecting the delivery of care to Medi-Cal beneficiaries.

Program-Related Investments

• Verato helps health care organizations identify and reconcile duplicate patient records, a common barrier to data exchange. Verato is working with California HIOs, including Manifest MedEx and San Diego Health Connect, which expect to participate in the state-led HITECH Act initiative to increase Medicaid provider participation in HIOs.
• Collective Medical helps providers exchange and analyze patient data in real time and within existing clinical workflows. They are enabling more than 120 California hospital emergency departments, including many in the safety net, to coordinate care for patients with complex needs.
• The CHCF Innovation Fund is evaluating other technology solutions that could make patient data exchange faster, cheaper, and more accurate.

To learn more about CHCF-supported patient data exchange projects, check out CHCF’s new Data Exchange topic page. We will update it as we fund more projects and learn new lessons about how California can make the future of patient care more coordinated and more connected.

Hong Truong

Hong Truong is a former senior program investment officer for the CHCF Innovation Fund, where she made mission-driven investments in health care information technology and tech-enabled service businesses, and leads CHCF’s grant portfolio on data exchange and interoperability. Read More

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