HIE Case Study: HIE for Public Health - HEALTHeLINK and Erie County Department of Health

HEALTHeLINK is a culmination of several years of collaborative effort by many stakeholder groups in the Western New York community. HEALTHeLINK, the Western New York Clinical Information Exchange, is a non-profit organization established in 2006 to develop a privacy-protected, community-based system for health care providers and consumers to securely and electronically share important medical and clinical information more efficiently. As this case study illustrates, HEALTHeLINK partnerships include public health organizations such as the Erie County Department of Health (described below). This particular partnership demonstrates how an HIE can improve efficiency in various public health reporting activities through the HIE’s extensive data collection and data access capabilities. 

HEALTHeLINK is a collaborative consortium that includes The Catholic Health System, The Erie County Medical Center Corporation, BlueCross BlueShield of Western New York, Independent Health Association, Kaleida Health, Roswell Park Cancer Institute and Univera Healthcare.

HEALTHeLINK is governed by a twelve member Board of Directors including charter member hospital and payer executives, as well as independent provider, business, State University of New York, and public health representation. The Board of Directors sets the direction and establishes annual business objectives. Strategies are formed through the perspective of HEALTHeLINK’s goal of enabling and promoting technology to support the triple aim of better health, better care and lower costs. 

The geographical area served by HEALTHeLINK encompasses the eight (8) counties of Western New York and is a mix of metropolitan and rural communities.  There are 1.4 million people in the coverage area. The HIE has 891 participating provider organizations representing 5,086 providers as of December 2016.  15,838 users have been trained to date.  A couple of the counties overlap with the Rochester RHIO in that some rural hospitals participate in both.
 

Erie County Department of Health

The Erie County Department of Health responds 24 hours a day, weekends and holidays, to potential threats to public health.

The mission of the Department of Health (DoH) is to preserve, promote and protect the health, safety and well-being of the people and the environment of Erie County by:

  • Acting as the guardian and as an advocate in all matters relating to the public’s health.
  • Promoting healthy lifestyles.
  • Reducing preventable illness and controlling the spread of communicable diseases.
  • Identifying and eliminating health and safety hazards.
  • Protecting and promoting the quality of the environment.

Dan Porreca, Executive Director, HEALTHeLINK, was interviewed on the topic of utilizing HIE for Public Health capabilities and their initiatives. Michael Amato, MPH, Assistant Epidemiologist, Office of Epidemiology and Disease Surveillance and Mary Walawander, Associate Epidemiologist, Office of Epidemiology and Disease Surveillance from the Erie County of Department of Health were also interviewed for their insights.

HEALTHeLINK’s business plan is built around serving as an information highway to assist physicians to provide better care, coordinated care and transitions of care. Its success is demonstrated by the steady growth in number of queries performed: 2.5 million in 2016, 1.6 million in 2015, and 600,000 in 2014. Additional services provided by HEALTHeLINK include results delivery and alert notifications. The HEALTHeLINK website provides a full list of products and services.

HEALTHeLINK faces two major potential challenges to delivering value: financial and technical. HEALTHeLINK is fortunate that its stakeholders and the state of New York provide funding so financial sustainability is not a concern at this time as long as value continues to be demonstrated. From a technical standpoint, to improve data quality, HEALTHeLINK has developed a scorecard tool to start measuring inbound data for quality.  

State law requirements for disease reporting mean following hundreds of cases for multiple disease states. Manual efforts for this reporting have been extremely time-consuming. In 2009, the then Commissioner of Health Dr. Anthony Billittier was aware of the data being collected by HEALTHeLINK and asked his team to determine whether it could be useful. Erie County Department of Health members thought it was a great resource and started to do patient address lookups to determine county of residence for reporting accuracy.

NOTE: A key advantage to use of HIE information for public health is that access can be enabled without patient consent, as it is not required for public health purposes. Over time, the department is doing more and more with the HIE information – multiple times per day and for multiple users, through the strong support of the current Commissioner of Health, Gale R. Burstein, MD, MPH, FAAP.
 

Erie County Department of Health (DoH) Division of Epidemiology and Disease Surveillance uses the information accessed in HEALTHeLINK in multiple ways to support public health efforts. Specific uses include:

  • Demographic use: Through the HIE Master Patient Index (MPI), the DoH uses the ability to look up patient contact information including addresses, phone numbers, occupations and the ability to determine county of residence for reporting accuracy. In some instances, the DoH looks up patient occupation for certain sensitive diseases.
  • Communicable Disease Investigations
    • Lab reports are used to confirm disease diagnosis following community inquiries (e.g. school nurses) and review trends to evaluate disease, assess dates and times of specimen collection in order to follow case definitions for certain diseases, review pending labs, and review laboratory test trends to evaluate patient real time disease progression.
    • Radiology reports are used to rule a disease in or out (e.g. a chest x-ray for pneumonia or an MRI for meningitis).
    • Clinical notes, consults and discharge summaries are used to evaluate full clinical picture of a patient’s course of illness, underlying conditions, lab test interpretations, and treatments while hospitalized.
  • Hepatitis Surveillance
    • All viral hepatitis laboratory tests are reviewed, whether positive or negative.
    • All liver function tests are reviewed in order to identify acute cases and prioritize cases.
    • Data is used to determine Hepatitis B status in both pregnant and recently delivered women required for the Perinatal Hepatitis B surveillance program.
  • STDs
    • Lab reports are confirmed for positive results.
    • Whether patients are pregnant is evaluated.
    • Treatments prescribed for the patients are retrieved.
    • Demographics and ordering physician are verified if they are not on the lab report.
  • Rabies Investigations
    • They access the most up-to-date patient demographic information including alternate phone numbers for exposed victims and animal owners to expedite treatment recommendations. 
  • Food Outbreaks
    • They look up contact information in order to conduct food history interviews.
    • They look up laboratory testing on persons involved in food outbreaks/complaints.
  • Syndromic Surveillance
    • They look up patient information using the medical record numbers provided by the NYSDOH Syndromic Surveillance System to evaluate spikes in Emergency Department visits.
  • After Regular Business Hours
    • They have access to patient medical information after regular business hours to evaluate disease, as the HIE is available 24 hours a day, 7 days a week.

Initially, HEALTHeLINK migrated to Mirth in December 2015. HEALTHeLINK brought in users when planning the transition from their previous vendor. The current system is intuitive for users.

New York state law mandates disease reporting on 67 diseases. Prior to use of HEALTHeLINK, information gathering was extremely time-consuming and inefficient. For example, hepatitis surveillance requires following up on 60-75 lab tests per day. Various data elements must be assessed, including gender, pregnancy status and whether the patient is symptomatic. Review of laboratory tests took days prior to HEALTHeLINK. Now there is time to follow up on all cases. Prioritization is possible due to the availability of liver function tests; cases with normal test results can be given a lower priority for follow-up.

For rabies investigations, the information in HEALTHeLINK has produced timesavings through reduction in public health field visits and cost savings through avoided rabies post-exposure prophylaxis. This is accomplished through provision of the most up-to-date victim and animal owner addresses and phone numbers, which expedites making contact to fill in gaps in initial report information. For example, a person bitten by a dog may have only obtained the owner’s name but not the phone number. With HEALTHeLINK, the DoH has the ability to use the name to find the current phone number and/or address. This allows the investigator to contact the dog owner to determine the animal’s health status within the appropriate period of time to rule out a rabies exposure.

For HIV case follow-ups, with HEALTHeLINK there has been an improvement in success rate in locating HIV cases and contacts due to the availability of medical encounters with current contact information.

For tuberculosis (TB) investigations, TB staff experience timesavings by avoiding manual information requests to hospitals, providers, and laboratories.
 

Implementing HIE for public health capabilities did not cause HEALTHeLINK to experience technical or legal challenges. A key facilitator to use of HIE information is that enabling access can be done without patient consent because it is not a legal requirement for public health uses of HIE data. HEALTHeLINK set up a separate system profile for public health use, making information on all patients available for public health staff use and subject to 100% access audit to ensure appropriate use by the public health staff.

The HEALTHeLINK user interface is user-friendly making the look-up of patient information a positive experience.
 

Sustainability is not a concern at this time as long as value continues to be demonstrated. This public health use case is a strong demonstration of the value that the HIE can bring to the community and works to garner the continued support of the stakeholders and state funding. Existing resources from its stakeholders and the state of New York were sufficient to support the efforts with public health described in this case study.

HEALTHeLINK continues to work with physicians and the Board of Directors to direct strategy, and continues to evolve based on community needs. Efforts include an initiative to develop a data quality scorecard to be a trusted source. This initiative was started due to a realization of a need for data standardization for Chlamydia test results. The DoH gets a daily report on all positive Chlamydia results for Erie County residents through the Electronic Clinical Laboratory Reporting System (ECLRS).  When asked to run a report, it became apparent that there are different ways to identify a “positive” result. This opened HEALTHeLINK’s eyes to the need to standardize its source data. This is a work in progress to improve quality and standardization of data.

In addition, HEALTHeLINK is live with three public health use cases through a Universal Public Health Node (UPHN) developed with the New York State Department of Health: Immunization Bidirectional Information Exchange (IBIE), Syndromic Surveillance (SS), and New Born Screening (NBS).
 

According to Mary Walawander, Associate Epidemiologist at Erie County Department of Health, HEALTHeLINK has helped tremendously with their efforts to improve public health. It took a while for the department to realize the opportunities for use of the HIE information but now the HIE is accessed by multiple users every day. She says that she “can’t say enough” about the advantages of having the HIE’s services at their fingertips. The new process of incorporating HEALTHeLINK data is more time efficient, with less reliance on doctors, nurses and others to provide information to support public health investigations, surveillance and reporting. The HIE is an invaluable tool in investigations of 400-500 rabies cases per year. The demographic data in the HIE contains next of kin and emergency contact information that is so important to expeditious follow-up in these incidents that have significant cost and health implications on our population.

HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology. The inclusion of an organization name, product or service in this publication should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval. The views expressed in this white paper are those of the authors and do not necessarily reflect the views of HIMSS.

 

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