How health information exchange and interoperability can help drive health equity
To kick off the new year, Abner Mason, founder and CEO of SameSky Health, met with Erica Galvez, CEO of Manifest MedEx, for our ongoing discussion series, Under the Same Sky. As the largest nonprofit health data network in California, Manifest MedEx is an integral part of the state’s health data infrastructure, combining and delivering crucial health information for more than 38 million Californians across every county throughout the state. During this conversation between Abner and Erica, they discussed initiatives by the organization to address health equity challenges to make healthcare data sharing work for everyone. They also focused on the new California Health and Human Services Data Exchange Framework and how it facilitates the secure and appropriate exchange of health and social services information to drive whole-person care. View the recording.
Erica opened the discussion by describing some of the unique circumstances within the state of California. She says that the state has committed to treating people as a whole person, and they want to address not only their medical needs but also a whole host of social drivers that contribute to health outcomes. Erica stated that we know these social factors contribute to health outcomes far more than the care that’s delivered in the doctor’s office, so Manifest MedEx builds and operates digital pipes that essentially determine the way information flows electronically between healthcare or health related organizations. Their core mission is to make sure that every healthcare organization in California has the information they need to improve the quality of care, lower overall system costs, and enhance health, which includes health equity. The organization does this by bringing data together from all the different types of healthcare entities and matching that information at a personal level. Then they curate this information overtime to create a longitudinal health record, which keeps track of things like diagnoses, medications, or procedures throughout different parts of the healthcare ecosystem. “I don’t think we’ve put our systems thinking caps on enough yet with respect to data and the needs for data infrastructure, or the data systems that enable our transformation programs. It’s hard to do because our care delivery system is so fragmented,” Erica says.
“While we ushered in what was probably one of the most impressive digital revolutions in the history of healthcare during those meaningful use years, in terms of electronic health record (EHR) adoption among hospitals and ambulatory practices, we didn’t give adequate attention to other providers that were part of that ecosystem — behavioral health, long-term, post-acute care, social workers, public health, etc. We didn’t pay as much attention and didn’t invest as much financially as we needed to in the interoperability between those systems, and I think we’re dealing with that baggage now. I think we never circled back at a national level to close those gaps, so we are playing catch up, but we’re doing it.””
Abner noted that we’re currently living in a data economy. Data in our society is like gold; it’s a currency. On top of that, healthcare data, because of the nature of its detail, is extraordinarily valuable. This intricate data is necessary in order to build digital pipes and interoperability equitably; however, people, and organizations aren’t entirely bought-in on sharing their data. Erica believes there are three specific challenges surrounding the sharing of data that need to be addressed first before moving forward in expanding the digital pipes:
Transparency
There currently isn’t as much transparency as there needs to be with what happens with people’s data, how it gets used, and where it goes. No one should ever be surprised about what happens with their healthcare data.Trust
Organizations have to trust that other organizations they are sharing data with are going to follow the rules. This requires good governance structures, contractual agreements, and severe consequences if broken.Funding
The technology required to make data sharing secure, identity matching accurate, and infrastructure reliable and resilient is expensive. It will be easier if we invest in it as a public good and build sustainability and an equitable approach to that infrastructure by design at the beginning.
So, after addressing these challenges, what will the next steps be in building the pipes that connect everyone? Erica thinks we need to focus on establishing a digital health data safety net because if we think about that as a pathway to support equity, it ensures that nobody’s left behind. It also ensures that we have many layers at the technical and digital level and don’t have large gaps in connectivity, like we do today. The solution would involve both policy and technology changes, and public funding would also be needed.
Erica explained how California has given some attention to this by passing a bill that required the California Department of Health and Human Services to create and implement a data exchange framework. It requires most healthcare providers in the state to share health information securely and appropriately by the end of January 2024, with a vision towards connecting a broad ecosystem between the care delivery system, clinical care, public health, and social services. Manifest MedEx was recently designated by the California Health and Human Services Agency as a qualified health information organization (QHIO) for the state’s data exchange framework.
This data exchange framework can seem overwhelming and nearly impossible at times, so Manifest MedEx tries to shrink the change and take things on one bite at a time. This year they are leaning into admission, discharge, and transfer messages (ADTs). They realize that an ADT message is by no means a complete view of a complete person, but it’s a small step in building connections between healthcare organizations that could lead to that complete view of a complete person. Erica believes that if you can take bite size chunks and make gradual and incremental progress, then you can make progress faster. By starting with something really actionable, you will add value as a way of demonstrating the importance of building those bigger, more equitable pipes.
To learn more about Manifest MedEx, visit their website: www.manifestmedex.org
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