Strengthening the Technical Advancement & Readiness of Public Health via Health Information Exchange Program (The STAR HIE Program)
The STAR HIE Program is a $5 million cooperative agreement program that is designed to strengthen and expand the ability of health information exchanges (HIEs) to support public health agencies in their response to public health emergencies and pandemics such as Coronavirus Disease 2019 (COVID‑19).
The STAR HIE Program has the following objectives:
- Build innovative HIE services that benefit public health agencies.
- Improve the HIE services available to support communities disproportionately impacted by the COVID-19 pandemic.
The STAR HIE Program will build upon federal investments in HIEs and will leverage work done by the industry to advance HIE services for the benefit of public health.
This program seeks to respond to the needs facing public health agencies by leveraging the unique abilities and characteristics of HIEs. These include, for example, the following:
- HIEs serve as hubs for rich data from a multitude of sources.
- HIEs are often state, local, or regional entities, with a strong understanding of and experience with local health care environments, including policies dictating data use for public health agencies.
- HIEs facilitate competition within the health care system by acting as trusted third parties that work with otherwise competitive health care entities.
- HIEs either actively support public health agencies or have the ability to do so (e.g., activities such as supporting public health reporting, improving data quality, and other data services).
In January 2021, supplemental awards were made to expand immunization information sharing collaboration.
- Original STAR HIE Program Award Recipients
Georgia Health Information Network
Cooperative Agreement Project Title: Expanding Public Health Reporting and Data Enrichment for At-Risk Populations: Georgia VA Facilities, State Corrections, and Unconnected Health Systems
The Georgia Health Information Network (GaHIN) was awarded funding for the ONC STAR HIE Program to support the Georgia Departments of Public Health (DPH) and Community Health (DCH) to better access, share, and use electronic health information, especially data from populations underserved and/or disproportionately affected by the COVID-19 pandemic.
GaHIN is Georgia’s designated entity that serves as the nexus for health information exchange across the entire state of Georgia. GaHIN directly connects four service area regional HIEs, five of the largest health systems in the state, the eHealth Exchange, four Care Management Organizations, and five state agencies including DPH and DCH.
The State of Georgia has established a COVID-19 Registry under an interagency agreement between DPH and DCH. As the bi-directional gateway among state agencies and providers, GaHIN is actively contributing data to that registry.
The cooperative agreement project consists of two activities to increase and enhance COVID-19 reported data. The first is to increase the reporting of results to this and other public health registries from targeted populations. The first activity has three parts:
- Connect clinical facilities of the Veterans Administration across the state to increase reporting of COVID-19 results to the COVID-19 registry and other state public health registries.
- With Morehouse School of Medicine HIE Bridge, GaHIN will connect state correctional facilities across the state to increase the reporting of COVID-19 results to the COVID-19 registries and other state public health registries.
- Connect hospitals that are not currently sending COVID-19 test results through GaHIN.
The second is to enhance the value of the reported data by combining electronic lab results with demographic and other clinical data from across GaHIN’s broad network.
- GaHIN has plans to expand Public Health Reporting and Data Enrichment for at-risk populations that are currently not connected to GaHIN and therefore not contributing COVID-19 data for public health: Veteran’s Affairs facilities, State Corrections facilities, and Unconnected Health Systems (i.e. hospitals and facilities).
- In the first year, data reported by the VA relative to COVID-19 tests or other results/criteria established by DPH will be subject to the data enrichment process.
- In the second year, it will expand to data reported by ethnic minority populations through GaHIN to DPH relative to COVID-19 tests or other results/criteria established by DPH.
Health Current Arizona
Cooperative Agreement Project Title: Utilizing a Statewide Health Information Exchange to Facilitate Electronic State & Federal Hospital Reporting for Public Health Surveillance
Health Current is using STAR HIE Program funding to strengthen the existing health information exchange (HIE) infrastructure in Arizona with a goal to improve the public health response to the current COVID-19 pandemic and other emerging public health threats. This two-year project has two main objectives.
The first objective is to improve the timeliness, accuracy, and completeness of hospital reporting of key COVID-19 healthcare data, including but not limited facility hospitalization metrics, personal protective equipment (PPE) inventories, and ventilator inventory and utilization. With this information, the Arizona Department of Health Services (ADHS) is able to efficiently direct healthcare resources to facilities, providers, and geographic regions in greatest need. Given the disproportionate impact of COVID-19 on racial and ethnic minority communities, including tribal communities, this ability to equitably distribute potentially life-saving resources is a key component towards addressing COVID-related health disparities and improving health equity.
The second objective of this project is to reduce hospitals and health system burden related to state and federal reporting requirements, by utilizing the HIE as a data intermediary. Hospitals spend significant staff resources daily to complete manual reporting when such reporting can be automated utilizing the HIE infrastructure as a foundation. Given the significant strain that the pandemic is having on all healthcare providers, but particularly on hospitals, the burden reduction created by effective utilization of the HIE will have lasting impacts on the healthcare community and public health system both in the short term and beyond the pandemic.
The expected outcome of project efforts is to improve pandemic monitoring and progress, to improve the state’s path to recovery and to optimize the delivery of high-quality healthcare to all Arizona residents, regardless of residence, race or ethnicity, age, or income level.
Health Current has developed a two-year work plan, which includes recruitment of at least eight Arizona hospitals and health systems to participate in the project. Health Current staff will work directly with these hospitals to ensure all data fields are appropriately mapped and to expand interfaces to other hospital systems, such as supply tracking applications that contain PPE inventory information, thereby transmitting that information to the HIE. Simultaneously, Health Current is working with ADHS to establish an interface to their preferred platform, EMResource, to electronically receive and consume the information delivered from the HIE.
To accomplish this work, Health Current is working in close partnership with ADHS, the Arizona Hospital and Healthcare Association (AzHHA), and the Arizona Health Care Cost Containment System (Arizona’s Medicaid authority), as well as its advisory council and workgroup governance structure, to ensure multi-stakeholder collaboration. All project findings and lessons learned will be shared locally and nationally throughout the course of the project.
Kansas Health Information Network
Cooperative Agreement Project Title: Building the Nation’s Electronic Infrastructure to Respond to COVID-19
To effectively respond to the COVID pandemic, health IT infrastructure must be in place to transport data quickly and effectively to public health and ensure healthcare providers have the medical information to provide safe and effective care. This requires ongoing monitoring of patient’s COVID-19 virus activity and a simple method of providing this information to providers and the public health authorities responsible for decision-making.
To achieve this, three critical problems have emerged that KONZA will address during the two-year cooperative agreement project period.
Most healthcare providers do not have the technical infrastructure to electronically report patient’s lab results to public health. Many have been manually reporting COVID lab results to state public health entities using Excel spreadsheets. This created problems as manual reporting is prone to errors and is a significant burden. Due to the ramping up of COVID-19 testing, providers and public health are concerned that it will become impossible to keep up with the manual reporting of COVID-19 lab data.
The KONZA team is addressing this problem by enhancing the lab data that is already gathered for health information exchange (HIE) and combining it with existing HIE data to create lab messages compliant with ONC Certification requirements for public health reporting, improving accuracy, and reducing the burden of manual reporting.
To manage the spread of the virus, public health officials need access to real-time longitudinal medical information for COVID positive patients. This includes demographics, contact information, diagnosis, test results, vaccinations, and characteristics that can help determine risk for inpatient hospitalization. Healthcare providers in communities disproportionately impacted by COVID-19 need the same information to care for their patients.
KONZA adapted an alerting platform to provide real-time COVID diagnosis to the Kansas Department of Health and Environment. KDHE requested additional information be added to the platform to create a COVID registry. This would provide a longitudinal view of the patient’s COVID care including vaccines, reinfections, immunity, and other information needed by state public health departments. Rush University Medical Center, Chicago, IL, will assist with this work and it will be available to public health departments in KS, MO, GA, SC, LA, MS, CT, NJ, and Northern California as a part of the KONZA network.
It is essential that provider facilities engaged in testing and providing care to COVID patients share health information with other providers and public health. If not, it is impossible to have an accurate view of the spread of the virus or to provide safe care to patients.
HealthShare Exchange of Southeastern Pennsylvania, Inc.
Cooperative Agreement Project Title: STAR HIE Program Leveraging Health IT Strategies for Delaware Valley Public Health Agencies
Under this two-year program, HealthShare Exchange (HSX)— a Health Information Exchange (HIE) in Philadelphia that covers three states and more than 12 million people—is establishing services benefitting public health agencies in their current fight against COVID as well as future communicable disease threats, and improve HIE services available to support communities disproportionately impacted by COVID. Specifically, HSX will:
- Modernize the region’s pandemic response with automated Application Programming Interfaces (APIs) providing case finding, contact tracing, and immunization data based on the emerging Fast Healthcare Interoperability Resources (FHIR ®).
- Facilitate public health agency use of the Delaware Valley COVID-19 Registry currently in development, which will provide COVID-related data (identifying or anonymized data depending on the use case in the Observational Medical Outcomes Partnership (OMOP) common data model.
- Create new clinical data connections based on public health agencies proprieties, closing gaps in the current surveillance system with real-time laboratory results, electronic initial case reports, and other clinical data types.
- Increase partnerships with local public health officials, to mitigate gaps in the Philadelphia region’s public health response to COVID-19 and to prepare for future public health emergencies, including disasters and pandemics such as COVID-19.
This strategic portfolio will impact the region’s response to one of the COVID-19 pandemic. Philadelphia is the poorest large city in the US, with 400,000 residents, 26% of the population, living in poverty and suffering from many of the associated health-related consequences. We are home to a racially diverse city, with 44% of residents being African American and 15% Latino—two groups disproportionately affected in the pandemic. Southeastern Philadelphia also accounts for 47% of all Medicaid recipients in the state, including 48% of children on Medicaid.
Our approach is to strengthen the HIE infrastructure and leverage existing Health IT standards and other federal investments. It will provide our public health colleagues with the tools they need to be informed, effective, and efficient in containing COVID and future outbreaks. The program is governed by a Steering Committee that includes representatives of the many public health agencies in our region, who is helping us prioritize the work and ensure our approaches and the data we provide is usable and fit for purpose.
HSX is the Delaware Valley’s HIE covering Pennsylvania, New Jersey, and Delaware with over 16,000 providers participating in our network, exchanging data on more than 12 million patients. We have supported our members and our local public health agencies throughout the COVID-19 pandemic in multiple ways. This includes helping to identify infected patients providing demographics and clinical context for the agencies’ lab results and supplying contact information for contact tracing. It also includes providing population level-information for situational awareness.
Texas Health Services Authority
Cooperative Agreement Project Title: Situational Awareness for Novel Epidemic Response: How Health Information Exchange can Strengthen Readiness of Public Health via HL7 FHIR
The Texas Health Services Authority (THSA), HASA (a regional HIE covering multiple regions in Texas), a local hospital partner, and Audacious Inquiry (Ai)is leveraging their collective expertise to demonstrate how HIE services can better support public health departments and hospitals as they execute state and federal reporting requirements for the COVID-19 response. Specifically, the partnership is conducting a proof-of-concept pilot to demonstrate real-time, automated exchange of hospital capacity and other situational awareness data through application programming interfaces (APIs) using HL7® Fast Healthcare Interoperability Resources (FHIR®).
A primary immediate aim of this initiative is to reduce reporting burden and human error inherent in current hospital capacity reporting processes by improving and increasing the technical connectivity between health care organizations and public health agencies. Like much of the rest of the country, Texas has been challenged by state and federal requests for hospital capacity data during the COVID-19 response. Since early in the event, the Texas Department of State Health Services has been collecting and reporting required information to the federal government on behalf of hospitals in the state. The data is collected daily from across eight regional health care coalitions, which routinely collect hospital capacity data using one of two systems, EMResource and WebEOC. Because the current reporting system is largely manual, it requires an individual from each participating hospital or health care organization to populate these databases once a day. While this process has been working adequately, Texas recognizes that the system does not provide a real-time update on hospital capacity and is time-consuming for the hospitals and public health authorities involved.
To improve existing statewide health care situational awareness capabilities and reporting processes, the partnership is using the ballot draft of the HL7 FHIR Situation Awareness for Novel Epidemic Response Implementation Guide that has been developed under The SANER Project to standardize data elements, extract them from underlying hospital data systems in an automated fashion, and enable public health authorities and response agencies in Texas to view these data in real-time via a dashboard and reports. In addition to the immediate value that can be provided to the COVID-19 response, automated electronic reporting having widespread benefits for health care situational awareness in future disasters. Given that Texas has experienced 12 major disaster declarations in the last five years alone, this development has potential to be widely impactful for the state.
THSA has found widespread support for this proposal among public health and health care partners including the Texas Department of State Health Services, Dallas County Health and Human Services, Texas Medical Association, Texas Interoperability Collaborative, Texas Association of Health Plans, Texas Organization of Rural and Community Hospitals, and Texas eHealth Alliance. THSA also garnered support from national organizations, including the U.S. Centers for Disease Control and Prevention (CDC) and Carequality. All partners recognize the potential to advance the state of the art of emergency preparedness and response while better serving the populations and communities most impacted by COVID-19 and other disasters.
Recipients of Supplemental Award - Improving COVID-19 Vaccination Data: Connecting Immunization Information Systems to Health Information Exchanges
Alaska E-Health Network, Inc.
BRONX RHIO, INC
Camden Coalition of Healthcare Providers
Colorado Regional Health Information Organization (CORHIO)
Greater Houston Healthconnect
INDIANA HEALTH INFORMATION EXCHANGE INC
Michigan Health Information Network Shared Services (MiHIN)
Myhealth Access Network, Inc.
Public Health Foundation Enterprises, Inc.
The Health Collaborative
The Rhode Island Quality Institute
West Virginia Health Information Network
WESTERN NEW YORK CLINICAL INFORMATION EXCHANGE, INC.