- [Male] Support for Connecting Our Country Saving Lives.

The Healthcare Interoperability Agenda is provided by the Wright Center for Community Health and the Wright Center for Graduate Medical Education.

(bright music) - Hello everybody.

And thank you for joining us for Connecting Our Country, Saving Lives.

The Healthcare Interoperability Agenda.

I'm Dr. Linda Thomas-Hemak, President and Chief Executive Officer of the Wright Center for Community Health and Graduate Medical Education.

This public education program is the second in a four-part series designed to share the current and future promising story of health information interoperability, in local state and national spaces, to engage and empower patients, families, providers, and communities.

Our guests today include Marty Lupinetti, President and CEO of healthshare Exchange.

Also known as HSX, a health data hub for the greater Philadelphia and Delaware Valley regions, including Southeastern Pennsylvania, and Southern New Jersey.

Martin Ciccocioppo, Director of the Pennsylvania eHealth Partnership Program, in the Pennsylvania department of Human Services.

And Kim Chaundy, Senior Director of Operations for the Keystone Health Information Exchange, also known as KeyHIE, a regional health information exchange network of healthcare facilities across Pennsylvania and Southern New Jersey.

Before we get started, you may be asking, what exactly is health information interoperability again?

And why is it so important for me and my family?

Health information interoperability is the ability to seamlessly and safely exchange and access your health information, between your doctor, pharmacies, hospitals and other healthcare and social service providers in real time.

Without complete and seamless health information interoperability, the great promise and incredible potential of electronic health records and public health registries will never be achieved.

Without interoperability, patient care and safety are at risk.

Costs are higher and the transition of our industry to value-based care is jeopardized.

Interoperability also offers you easy access to your own health information, which is extremely important now that we have COVID vaccinations available.

It has the power to track vaccine administration, the type of vaccine administered, side effects, and to generate second dose scheduling efforts.

If interoperability is so important, then why is our American healthcare delivery system not yet connected?

And what exactly is the appropriate role of state and federal government in getting us all connected?

Hopefully today's conversation with three leading Pennsylvania interoperability experts and advocates, will better illuminate how we can accelerate connecting our country and saving lives, the healthcare interoperability agenda.

Let's welcome our first guest, Marty Lupinetti, whose organization is one of only five first round, pioneering recipients across our country awarded a US department of health and human services STAR HIE grant.

Marty, thank you so much for joining us today.

- Thank you, Linda, for having me, very much appreciated.

- So Marty, let's start by you sharing with our audience a little bit about what is HSX and what is your role there?

- So HSX, you know, I like to describe it, as a trust community.

And it was really started as a grassroots effort.

That's a really a community collaborative.

It's a group of stakeholders, healthcare stakeholders, that came together to really want to improve the health of the patients and members that they serve.

So that's really how it came together.

My role currently is President and CEO of healthshare Exchange.

We like to call ourselves a community collaborative, and I call it a community asset and we wanna offer that asset out to the community to the extent possible, to really help improve care.

- So how is it that you got more than 225 healthcare organizations who represent more than 10 million patients, to sign on and actually collaboratively work together in unprecedented ways?

- So I'm gonna say, first of all, and it's a simple answer, but there's so much underneath, this is trust, right?

You needed to establish trust between competing entities, competing health systems, competing health plans.

So the first challenge was coming up with a common set of ground rules for what data sharing actually meant, all right?

So if you can believe this, we have one single data sharing agreement that supports now over about 450 different healthcare organizations.

And they run the gamut from plans, health systems, all the way through the continuum of care, but it was a major event to bring all of those stakeholders together and realize that this is a major step forward in improving the care, improving the outcomes of the patients, they're all trying to serve.

They all have that common interest.

So that was really the start, was getting to that common set of ground rules and continuing to foster and build trust.

- So when we think about as Pennsylvania, how proud we are to celebrate you as one of the five health and human service STAR HIE awardees in this country, can you tell us a little bit about your STAR award, and actually how it's gonna advance and accelerate our achievement of wider scale health information interoperability.

- The great thing that this has fostered, it has brought all of the County departments of health that surround Philadelphia, including the city and County of Philadelphia.

It's brought the state and us closer together, and really partnering to solve healthcare challenges, population health challenges, mainly focused right now of course, on COVID 19 and the pandemic.

So one of the things that this funding opportunity is supporting is a dashboard that we've created, that starts to show capacity around the community and where there are cases of COVID, and where some of the hotspots are.

So the city and the surrounding counties, can make better informed decisions as well as office of emergency management on how to best manage the caseload and where to move patients if needed.

The other thing is it boosted the recruiting of skilled nursing and long-term care facilities.

We've all heard the challenges that those organizations have faced with this pandemic, getting them more connected, and getting them sharing data would be much more helpful.

And having that data more visible to allow better decision-making again, much more helpful.

So we've, we boosted the number of entities that we're connecting and onboarding in that part of the continuum of care.

There's also a case reporting a type of way of reporting population health type measures and information.

We've started down that path.

That's a new standard that supports a better more complete picture for population health reporting.

So that's another area.

The last thing is a COVID registry.

We actually were involved in this with Robert Wood Johnson Foundation, but this funding opportunity allowed us to really take the next step to offer it to more entities across Pennsylvania, more entities across the US, right?

One of the challenges with the pandemic is gathering data and understanding what's working, what isn't, what treatments made sense what don't make sense.

And this registry could go a long way for that during and post the pandemic.

I think we are very open to wanna share this information across the Commonwealth and other neighboring states.

I think this is just the beginning to kinda figure some of these out, and then build these assets so everyone can take advantage of them.

- In Pennsylvania, we're one of three states that has health information disclosure laws that are a bit more stringent than federal laws around confidentiality.

And you at HSX were recently awarded high trust security certification which really validates the fact that you're trustworthy.

Can you tell us a little bit about that certification and what it entails?

- So we're early, early on, and this was recommended by a variety of security officers from our members, our founding members.

We needed to enable more of that trust that I talked about earlier, we needed to establish a security program, right?

It's one thing to have some policies on the books.

It's one thing to do some training, build awareness, but really having a robust program that wasn't just self attesting, but actually had a external independent certification that was attached to it.

So we embarked probably four, I wanna say maybe four years ago on high trust, we thought that was the framework that really accomplished that, it had process, controls, policies, training, tabletop exercises, a variety of things that we were doing in some regard, but this made it more formalized, and it had the external certification.

So it really wrapped a whole program around security.

And we knew for our members to continue to trust us as they offer up more data, as they depend more on the data for the care of their patients as our health plan members depend on how they're launching programs for their members.

We needed to have a pretty high bar for security.

So high trust, this is our second certification.

It's on the newest revision of the high trust framework.

We received that in November.

It took about a year to achieve, it's a major undertaking for a team that's 25 to 30 people, right?

Not a big team but pretty much everyone touched this program to really get it to the level and achieve this certification across the organization.

- Can you share with us some details about what you hope for is the future of HSX, and how the stakeholders can help you, how the government you know, state, federal agencies can help you.

And then most importantly, how the patients and families, and our audience can get engaged and help accelerate and advance what you're trying to achieve in terms of interoperability.

- No, I was hoping Linda you'd ask me that question because right now, right?

As we're in the beginning of the year, and the year we've just come off of, we're doing a pretty serious gut check, if you will, on our services, our value, and really the trajectory of healthshare, where do we wanna take this next?

What do we wanna improve?

What strategies do we wanna employ, and what goals do we wanna set for ourselves?

So we're right in that area right now.

There are certain states where they've been able to identify programs which maybe don't mandate data required to be offered up to be shared, but to participate in the program you need a certain level of data sharing to achieve that program result.

We believe that's we have to continue to look at those programs and enhance those, and make it more of a requirement to share certain data, to participate in those programs, to get the benefit and the result.

We still have people all over the spectrum of what they're willing or not willing to share.

And after a pandemic and what we're living through right now, we believe, and I believe we should be sharing much, much more to get that better pictures so we can better support the needs of our public health partners, and our provider and plan members as well.

There is a lot of empowerment to the consumer in getting access to their data, using the data as they see fit on a device that they choose, to improve and empower them to manage their own healthcare as well as their care team.

So we would encourage consumers to really take advantage of that, really think about how you want to be empowered to help improve your own care.

And some of that's gonna come with certain level of data access and getting access to that.

And we think we can be supportive in enabling that on behalf of many of our members.

So, and we believe that sort of a bottom up approach, versus right, the top down approach.

We also, I think for healthshare, we need to think about chronic disease management.

There are a variety of those, as you know, and I think really dialing into those and what we can influence and workflow, and care best practice through our connectivity, our ability to maneuver information in and out of the care team workflow, I think is a very critical asset that today is providing information, tomorrow can provide best practice.

And better ways of care based on proven, proven outcomes, proven data.

So we wanna go down that path, I believe a little bit.

- Thank you again for talking with us today and for offering us your professional, passionate perspective, about connecting our country, and saving lives.

We look forward to continuing our conversation in the future and learning all that we can from HSX and your efforts.

We're really proud of everything that HSX is accomplishing.

We're proud of your leadership, and we appreciate you as a valuable community asset here in the state of Pennsylvania, improving the health and welfare, not only of Pennsylvania, but Americans.

- Linda, thank you.

Thanks for the opportunity.

- We're now gonna talk to a public health leader.

We're really grateful to welcome, Martin Ciccocioppo, from the Pennsylvania Department of Human Services.

For more than two decades, Martin has been behind almost every advance in the application of health information technology in Pennsylvania.

He has served as a long time advocate of health information technology in the state level, and in the nation.

In addition to his governmental role with the Commonwealth, he also serves as a profession of Health Information Technology, at Penn State University.

Martin, thank you so much for being here with us today.

- Dr. Thomas, it's a pleasure to be with you today and to have a chance to talk with your viewers about interoperability in Pennsylvania.

- Can you share with us how interoperability has helped us combat the opioid epidemic at our state level.

And specifically the role of the PDMP registry - The PDMP, the Prescription Drug Monitoring Program has actually been around for about 10 years now, with legislation that passed in Pennsylvania.

It is a way for physicians, that actually the requirement for physicians to check to see whether or not a patient has filled prescriptions for opioids, prior to prescribing new opioid.

Actually for the first time that a physician sees a patient, they are required to check the PDMP to again determine whether or not that patient is already filling prescriptions for opioids.

It is, it's not just for the opioid epidemic, but it is a useful tool in the fight against the opioid crisis.

And it's also being able to be enabled by health information exchange.

So it's important to know that providers who are connected to health information exchanges can access that information even more easily.

- So Martin, understanding the significance of the PDMP registry, our work in public health registries is not just restricted to the opioid space.

Can you tell us a little bit about the registries for public health that are available in the state of Pennsylvania?

And can we specifically talk about, Pennsylvania's vaccine registry, and the power that that can bring in our COVID response as we roll out the vaccination?

- So the Pennsylvania vaccine registry, or what we call the Pennsylvania State Immunization Information System, or PA-SIIS, that is a registry whereby providers who administer vaccines send information to the state registry.

And that information is then available for the next prescriber to be able to know whether or not that patient has already received a vaccine.

It's really important in the world of the current COVID crisis, because the vaccines that have already been approved require two vaccinations.

So it's important that the information from your first vaccination with the COVID vaccine gets entered into the PA-SIIS so that a provider can query and retrieve information about your vaccination history, and know that you've already received the initial dose and which vaccine it was.

Or they can give you the second vaccine in a timely manner.

If we didn't have a PA-SIIS to be able to help inform the providers, not just on COVID immunizations, but on a variety of immunization, we would be probably providing over immunizations to patients.

If a patient did not know whether or not they received a certain vaccine, a provider would give it again.

And sometimes that could be harmful.

So just knowing the immunization history of the patient even outside of COVID is an important service that PA-SIIS does for Pennsylvanians and health information exchange, again enables providers to more easily access that information.

- There are really exciting developments in emerging the platform of MMIS.

Can you share with our audience what MMIS stands for and how exciting the vision that's unfolding is, to promote getting connected and interoperability?

- Sure.

The MMIS or the Medicaid Management Information System is really the system that allows for the efficient operation of the Medicaid program in Pennsylvania the medical assistance program, It allows for providers to be registered as providers for medical assistance.

It allows for patients or clients that be enrolled in various services for medical assistance.

It also pays the bills and allows for referral within the system.

Uniquely in Pennsylvania we're also creating a resource and referral tool.

We're actually, we've contracted with Aunt Bertha, which is a tool that community providers work with to get referrals and to be able to provide information about clients that they service.

So whenever a patient is seen by a provider, or is even seen by a community provider, and they identify need of that patient, it's not a health need, but what we call social determinants of health, like a food insecurity, housing insecurity, physical, you know, insecurity, job security issues.

That patient can be referred to community providers.

And those community providers then can use their resources to help that patient with a non-healthcare need.

But most of a person's health is really determined by these social determinants of health, not by healthcare.

And the more that we can get those social determinants of health, those security needs of a patient addressed, and done effectively in the community, the better the patient is going to be overall.

So what Aunt Bertha does is it allows a physician who identifies a health need to make a referral to a let's say, a food bank, in that patient's neighborhood.

And they, the referral goes to that food bank, with information about the consumer that needs their help.

Consumer presents themselves at food bank, food bank helps that consumer, food bank then closes the loop with the provider and says that consumer, you know, that you referred to me they came, we provided them the service that they needed, and we were gonna continue to help that patient as needed.

It's a really an innovation for Pennsylvania to have now Aunt Bertha as our vendor for a resource and referral tool - And in primary care, and probably many of the, my specialty colleagues, we recognize that many of the health outcomes of our patients are actually determined not by our care, but by their challenges with socioeconomic determinants of health, like transportation, housing, the ability to afford your medications.

And so the visibility that is actually emerging through the evolution of the Medicaid information system is absolutely incredible and inspiring.

We have the opportunity to speak with Marty Lupinetti from HSX.

And we celebrated the achievement of his organization being awarded one of the first five STAR HIE pioneering grants in this country.

How can HSX's STAR HIE award potentially benefit all Pennsylvanians and advance our shared purpose to get connected.

- So we're real excited that healthshare exchange in Southeastern Pennsylvania was one of the first recipients of the Office of the National Coordinator, Health Information Exchange, STAR Information Exchange recipients.

These grants were very targeted.

There were only five that were awarded across the whole nation.

Healthshare Exchange received one of the original ONC STAR awards.

It is focused on helping health information exchanges or having health information exchanges, help local and state public health organizations to combat COVID-19.

So the work that is being funded by the ONC STAR HIE award for Healthshare Exchange is going to help not only the region in South Eastern Pennsylvania, to understand the the occurrences of COVID, but what they specifically it's gonna be funded by ONC to HSX, is the ability to automatically, whenever a patient's diagnosed, and that diagnosis is entered into a healthcare provider's electronic health record system that just by virtue of that diagnosis being made the EHR is going to know this is maybe something that has to be reported to the city of Philadelphia, or the CDC, or to the state, a state registry.

And what it's going to do is it's going to trigger what's called an electronic case report.

Electronic case report is gonna go from the provider, to the Healthshare Exchange Healthshare Exchange is going to then get it to a national arbiter of this information.

And that arbiter, the what's called the digital bridge is going to determine whether or not that information or that diagnosis is reportable, and who is reportable to.

Based on that information, it will automatically be sent to the city of Philadelphia, or automatically be sent to the Ned's registry at the state, so that they get this required reportable information, takes all the burden off the provider to identify those cases manually and key punch them into a system.

It can also provides a richer set of information to public health entities so that they can react quicker and provide better care coordination, continuity of care, and have a better understanding of, you know, where this incident's occurring.

They can do contact tracing quicker, contact tracing you've heard a lot about probably with regard to COVID, one of the other tools that the city of Philadelphia and some of the surrounding counties are using HSX workers for contact tracing.

HSX is also gonna play a role in helping the provider know if a patient of theirs tested positive for COVID, or got a vaccine for COVID, and that they're gonna need to have follow-up.

- There are connections and relationships that you've been working on for over a decade to make sure that all Pennsylvanians benefit from his STAR award, who are those stakeholders and how will we feel the impact of that work here in Northeastern, Pennsylvania?

- Across Pennsylvania, we have a network of what we call Pennsylvania Patient and Provider Network certified health information organizations, 5P3 uncertified HIOS exist.

They go back as far as 15 years ago, where health information exchange was envisioned in Pennsylvania as a tool for allowing providers to provide the best care possible, for every patient that they see by having access to the most complete and accurate information, timely information about all of their patients on a regional basis initially, but now these HIOS have grown up, are growing larger, are overlapping in this state, they're covering parts of the state that didn't originally have health information exchanges.

So in Pennsylvania, that's short of fabric of health information exchange is made up of clinical connect in Western Pennsylvania, but now clinical connect has grown into the center part of the state.

In the center part of the state, we have Mount Nittany Exchange that also covers a major provider across the Southern tier of Pennsylvania, In the Lancaster area we have something called the Central Pennsylvania Connect Health Information Exchange that covers hundreds of providers across Lancaster and the neighboring counties.

In the Southeastern part of the state, we've already talked about Healthshare Exchange and Healthshare Exchange, it's really pretty ubiquitous for the five County region.

Nearly all of the hospitals are connected to Healthshare Exchange.

Many other physician practices in the region are connected.

Healthhare Exchange has now grown beyond the five counties of Philadelphia in the forest Bourbon counties include counties in South central Pennsylvania, includes providers in the state of Delaware and providers in the state of New Jersey.

So Healthshare Exchange is another part of that fabric.

But in your region in Northeastern Pennsylvania, you're served primarily by, the Keystone Health Information Exchange.

Again, KeyHIE goes back to its roots of, in 2005 where really what's the impetus of the Geisinger Health System, but not controlled by the Geisinger Health System.

The providers came together, and they came together with a common understanding that they shouldn't be competing on who has access to a patient data, who owns a patient data.

What they should be competing on is with all of the data about the patient, how can they best care for that patient and keep that patient healthy?

How can they provide good care whenever the care is needed?

And also continuing coordination of care.

That's really the founding principle of KeyHIE, but it's also in the roots of, or in the DNA of the health information exchanges across Pennsylvania.

What we've done at the state level, so we've tied them all together.

So the Pennsylvania patient and provider network is an infrastructure that is a partnership.

We are the, we are each one by the Pennsylvania eHealth Partnership Program in the Department of Human Services.

So it's really unique that Pennsylvania has this huge investment in Health Information Exchange.

It's really unique that we have the collaboration of so many state agencies and Health Information Exchange.

But this partnership with these regional, in some cases even the statewide Health Information Exchanges, these HIOS, all come together and they make the clinical information about their patients available to providers across the state.

So that if a patient presents, you know, who lives in Philadelphia, but is visiting state college and has to be taken to the emergency room in Westchester County, that provider is going to be able to, one, query for information about that patient and get that patient's clinical information from Philadelphia.

Two, they're going to automatically trigger an alert that goes through the P3N to the Healthshare Exchange and Healthshare Exchange is going to deliver it to that patient's care team.

So if this is a chronic patient, a patient with chronic conditions that a physician is particularly invested in that patient and subscribes to alert about that patient, their physician, their care team is gonna know right away that that patient has been admitted to the emergency department, and be able to intervene right away, will be able to follow up and ensure that there's coordination of care after that patient's discharged.

So this fabric of Health Information Exchange that we have in Pennsylvania is really unique.

Then we've got 5 HIOS, we've got a hub that's operated within the state government.

That, that hub is going to be interconnected with the Medicaid Management Information Systems, that it is going to be interoperable with a resource and referral tool that is specifically focused on whole person care.

And that even though the systems within the state government are Medicaid centric, MMIS, resource and referral tool and the Health Information Exchange is not Medicaid centric.

It is all person focused.

So we are looking out for, and helping to ensure that all patients have their information shared, accessible to their providers through a query and retrieve process, through an alerting process, so that the patient care team can best know, have the best informed care, and provide the best care coordination for all patients.

Again, whole person focused care we've even in Pennsylvania got our health insurers that participate in health information exchange, because their care coordination is one of the keys to continuity of care in Pennsylvania.

- Thank you so much.

And just in terms of a final question, can we give a kind reminder to our audience that when they come into the opportunity to get COVID vaccinated, how important it is about what they expect from the provider distributing those vaccines?

- So a patient should expect that the provider that they're seeing for a vaccine is going to enter that information into PA-SIIS.

But really you should be looking for a provider that not just able to report your immunization to PA-SIIS, but a provider that participates in health information exchange.

You wanna go to a provider that has the ability to find your clinical information, wherever it exists.

You'll also wanna be able to go to a provider that is so invested in your care, your coordination of care, that they get alerts whenever you're being treated in an emergency room or out outside of the area, so that they can follow up with you whenever you return home, or whatever care that you need.

So it's really important, not only to get vaccinated, but it's also important to go to a provider that's got the ability to efficiently report that information to PA-SIIS, be able to query and retrieve information about your immunization history, but a provider that's also able to query and retrieve information from other providers who have seen you, so that they're best informed to be able to provide the best care, the best coordination of care.

Again, in the case of the resource and referral tool also able to make recommendations and referrals to the community providers that might be able to best help you in your current situation.

- So again, privileged to have Martin Ciccocioppo.

thank you so much for joining us today, sharing your insight.

We appreciate that all, everything that you and your agency have done to further our shared purpose and cause for health information inter-operability.

And finally, today we're gonna speak now with Kim Chaundy from Geisinger's KeyHIE Network.

KeyHIE is one of the first health information exchanges in our country.

It serves nearly 7 million patients, in 56 counties throughout Pennsylvania, and in parts of New Jersey.

KeyHIE also serves as the state's hub for data entry.

Its statewide registries including the Prescription Drug Monitoring Program, the statewide Cancer Registry, and the Pennsylvania Immunization Registry among others.

It's KeyHIE's incredible leadership in catalyzing these registries that led to their recent and super exciting news of a United States Department of Human Services, STAR HIE funding award.

Kim, thank you once again for sharing your expertise.

- Thank you.

Thank you very much for having me, and truly appreciate you reaching out to the community, and really engaging them and just enhancing educational experience about interoperability.

So I thank you.

- I've read that the COVID-19 pandemic is helping to fuel health information exchages, including leveraging of analytics.

Can you share with us KeyHIE's great news that validates this is true.

Can you talk about the possibilities around Marty Lupinetti and HSX's STAR HIE award and KeyHIE's STAR HIE award, and how we can connect those efforts to really accelerate our accomplishments.

- The STAR Award is very simple.

We are both striving for the same outcome.

We are striving to help enforce document and track the vaccinations that are being given to our Pennsylvanians.

It is a great opportunity for Pennsylvania to have two STAR awards so that we could come together and really be able to merge the documentation from both HIE's of the vaccinations that are given to our community and be able to identify specific white spots that may be out there for vaccinations that are being missed in certain areas.

So from a Pennsylvania perspective, I think this is an outstanding opportunity for us to really capture the entire population in Pennsylvania.

And when we see that there may be a missing component, a missing area of vaccinations in a particular area, we need to stand up and we need to make them aware of it.

So that that patient population is covered indeed.

Cause the intent of the STAR award is to track, make sure every patient is given the opportunity to receive the vaccination.

- We talked earlier with Martin Ciccocioppo from the state about how many believe that Pennsylvania is leading by example.

So how is your organization, as our regional HIO able to identify COVID hotspots?

And will identifying them provide insight to help stop the spread and lead to an effective public vaccination initiative to get us to herd immunity - We were able to leverage our existing connections with our hospitals, our long-term care facilities, our home health agency, and our private practices, to be able to identify and acknowledge where we saw exposure of COVID positive exposure of COVID to build out and drive heatmaps so that we can allow our executive leaders to form a decision on where and how special areas should be set up to accommodate the public.

- If the health information interoperability and getting connected in our country can save lives and improve the quality, safety, and affordability of the healthcare delivery industry as a whole, why isn't everyone engaged?

What are the barriers?

How can we overcome them?

What are the blind spots or the whitespace?

And what kinda progress are we making?

- Whitespace is something that from a state level, we are trying to really aggressively attack knowing that if we can capture the complete population, it would allow our providers to be well-informed, on where and when the patients are being treated, and allows us to streamline medical information from one provider to another, whether that is sending information into the registries, so the source of truth is always updated timely and accurately, so that it's ready and available for the next time a patient is being seen.

Or if it's simply for an emergency such situation, understanding, you know, the complete perspective of the patient's health and potential side effects that they may have or illnesses that they may have, that maybe an ER doctor would not have known.

So I truly believe we're getting there.

I truly engaged, I hope that our providers and both our citizens speak to their providers, talk about the importance of COVID and the vaccination as well as are they connected within the HIE?

Are they connected within the Pennsylvania footprint?

So that if a patient travels from one area to the next they're assured that their information will be there the next time they arrive at another site or location for treatment - I really appreciate that.

That's very similar to the message brought by Martin Ciccocioppote at the state level of really empowering patients to have the conversations with their providers of please get connected so that you can get my information and it can flow.

That becomes very important when you think about people who might live in Northeastern, Pennsylvania, but then, you know, go South for the winter.

I mean, we have a lot of work to do to be able to track the information for that patient across even state lines.

We have gotten a clear message in the trenches that if you're going to accept stewardship of the vaccine you must report within the statewide vaccine platform and infrastructure.

That is a big vision for advancing interoperability.

And we all know that sometimes that could be painful and it can take a lot longer than we thought.

So how can we promote universal stakeholder engagement in entering the data into paces?

- We need to help streamline the workflow processes to make that interoperable translation from receiving the vaccination to actually registering it at PA-SIIS.

There's no reason why someone would have to enter the information twice.

We need to embed ourselves within their natural workflow to make it seamless, and make it something that everybody wants to do.

Because at the end of the day, it's the entire population that has to do the right thing.

And that's by starting to have the conversation with your provider and becoming very well-educated on the pros and the cons of receiving the vaccination, or not receiving the vaccination.

And once receiving it then making sure that it gets to the appropriate areas at PA-SIIS, so that we have the source of truth updated real time for future use.

- So as we engage additional stakeholders who may not be as advanced in the conversation as several of us working for over a decade on advancing interoperability, what are the ways that the stakeholders can meaningfully engage and feel a part of KeyHIE.

- Some patients already expect that their information follows them wherever they go.

So we wanna make sure each provider is aware of that assumption from the patient's perspective and make it happen.

We wanna make sure that the patient's voice is heard, and that the patient is comfortable that whenever they are seen at another emergent situation or another care site that their information is going to be there and be available for the next clinician taking care of them.

- I think it does bring up, you know, the public education space about opting in, opting out, and where we are as a state with a little bit of the historical context.

Can you kind of do some public education about opting in and opting out?

- Sure.

So the state of Pennsylvania is opt-out.

Meaning healthcare providers can share clinical information for treatment purposes without a consent.

Pennsylvania does have three protected areas, HIV, Mental Health, and Drug and Alcohol Use, those particular area, and the clinical data that would be released does required a patient's written consent to make that available to a care team member.

Those are the areas that we must have the patient's consent before allowing other care team members to have access to that data.

If those three protected area are not participating, or not part of the general chart, or the clinical information, as an opt-out state we can make that available without the patient's consent.

Each of the organizations participating with an HIE gets to choose if they wanna be opt-in or opt-out.

A consent form is always something that we still enforce, and we still recommend, because from a patient's perspective, if they think all of the information is going, they wanna make sure those three protected areas are in indeed going, if that is their choice.

At the end of the day, the patient has a choice on what information can be shared and shared with whom.

So it's, again, it goes back to being well-informed, being educated and communicating both to your providers and to your hospitals where you are receiving treatment, so that they understand what your desires are to making sure your information is available the next time you need it.

- There's been initiatives to promote healthcare interoperability for well over a decade, if not two.

And here in the Northeast, we've had some false starts.

And we landed with one community asset in Juul, which is KeyHIE.

And it was extremely futuristic of the Geisinger leadership at the time that HIE's were gaining traction, and coming into existence to invest in this, as a public health investment in our regional community.

Can you talk a little bit about that history and what it's been like to kinda figure that partnership with Geisinger out.

- So it was definitely on the frontier, the cutting edge, when Geisinger started the overall initiative 15 years ago, about really trying to track and understand where the patients are going, for ease for the physicians.

It was always look at as an opportunity to enhance the patient care, the patient experience.

Listening to our community members at that time, and hearing what was important to them, getting access to pertinent information, having timely access to lab results, being informed of admissions and discharges.

We heard that from our clinicians that it would allow them to be able to treat our community patients more efficiently and more timely.

And we simply just kept going on, what can we do next to improve the patient's care?

It was always at the forefront that we keep the community, we keep the patient in the middle and the patient is what was important to us.

So anyone that touched the patient was something that we felt very adamant about engaging and bringing them forward to be part of this health information exchange.

This isn't one individual facility trying to capture any of the patient data for a particular reason, this was the intent to have all the community come together for wherever the patient is treated, and keep the patient center at mind, and improve and enhance just the general care within our communities.

- So Kim, as one of the leading Executives of our regional health information exchange, which is KeyHIE, can you talk about your structure, including your management team, how big you are, and also how you're governed?

- So the HIE is governed by the membership.

It was very, very important when we established our health information exchange that we brought everyone to the table, so that everyone had a voice to be heard.

Each of the community members, whether they're hospitals, long-term care facilities, home health agencies, or private practices, they all come to the table with a voice.

We have a steering committee that is consistent of representation of five hospitals, four physician practice groups, five long-term care facilities, five home health agencies, a patient advocate, and a payer representative.

This is a voting membership.

There is a one, two and three year awardees that is brought to us by our membership on a voting sequence.

The steering committee reports up to a board KeyHIE Inc, which is also community-based.

There's representation from many organizations that are looking at the needs.

And what is the best situation for our community as a whole, to make sure that we are communicating and sharing our thoughts and our ideas, across the board to better suit both the needs of all of our participating organizations - Right.

Not only at a local level, but also at the level of Pennsylvania and also in our country.

So thank you so much, Kim Chaundy.

Congratulations on the STAR HIE Award that makes us all so proud to be Pennsylvanians.

- Thank you.

- Thank you again, Kim.

And thank you, our viewers for tuning in to this urgent and timely conversation to accelerate, connecting our country and saving lives.

Although our program has gone by so quickly, there's so much more for us to discuss about health information interoperability.

We're extremely grateful for the gracious time and expertise our panelists have provided us today for our collective education and benefit.

Their insight and engaging conversation is most appreciated.

And special thanks to WVA, for hosting such an important public health discussion.

We look forward to the next installment of our interoperability series.

Like all of you, we are excited to continue working towards our preferred future as a community and as healthcare providers.

Everyone stay safe and stay healthy.

And thank you again for joining us.

(bright music) - [Male] Support for Connecting our Country, Saving Lives.

The Healthcare Interoperability Agenda was provided by the Wright Center for Community Health and the Wright Center for Graduate Medical Education.