Posted on: August 27, 2021

Data quality is a must-have for a health information exchange (HIE). I spoke about the importance of this at length in last month’s post. I also mentioned that, in the current environment—where providers have numerous choices for accessing remote data—HIEs need to do more than just make quality data available. HIEs need to focus on making unique data available, through applications powered by SMART on FHIR technology, to ensure continued success.

Look Beyond the Traditional Data Sources

One way an HIE can differentiate its application and, by extension, itself, is to make data available from sources that are generally not easily accessible from within the electronic health records (EHR) system of providers. Most of these information sets help identify underlying issues contributing to health disparities, allowing providers to address the whole health of an individual, not just what’s presenting at face value. For example:

  • Patient data from pharmacies, community-based organizations and skilled nursing facilities
  • Institutional, public health and government data, including medical and pharmacy claims, prescription drug monitoring programs (PDMPs) and immunization registries
  • Social determinants of health (sDOH), including information from patient surveys and assessments like Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) or Activities of Daily Living (ADL)
  • Patient-generated data, collected from self-monitoring devices like at-home blood pressure cuffs and personal blood sugar meters

Connect the Dots

Data that is accessible through HIEs has, to this point, mostly been contributed directly from providers and other healthcare sources. What I mean is that the data comes through the HIE and, maybe with a little cleanup, is made available for users to access as-is. While this is helpful in getting a patient’s health information all in one place, ultimately each provider still needs to do manual work to put the pieces together and gain a full view of each patient’s health.

As technology companies, though, HIEs are—or should be—able to analyze the data being shared through their systems. Once analysis is complete, making the correlated data available eliminates some of the manual work for providers by identifying immediately actionable steps. Some examples of this analysis include:

  • Comparing the results of tests or screenings performed in the past 12 months against standards established by HEDIS to identify whether a patient has any gaps in their care that should be filled (e.g., does a diabetic patient have an A1C test result on record in the last 12 months, indicating their condition is controlled? Does a female patient over age 50, without a history of double mastectomy, have a mammogram screening on record within the past 24 months?)
  • Aggregating quality measures to indicate overall performance (e.g., the percentage of hypertensive diabetic patients in a provider’s care who are on an ACE inhibitor)
  • Using risk scores or predictive analysis to measure the clinical or financial risk of a patient (e.g., is a patient recently discharged from the hospital at an increased risk of readmission within 30 days?)
  • Ensuring structured patient data sufficiently describes the “illness burden” of a patient (e.g., are conditions and diagnoses coded with general “unspecified” codes or are they coded with more specific codes to indicate whether the patient’s condition is controlled—such as diabetes unspecified versus diabetes being controlled with insulin or oral hypoglycemic medications?)

Source the Experts

SMART on FHIR applications offer the ability to link to external websites or even embed other applications within them. When HIEs provide this within other applications, providers don’t have to navigate away from their EHR to perform a search through an internet browser. Instead, they can find information directly from expert sources, as recommended by the HIE. Examples include:

  • Enabling providers to quickly identify and make referrals to social services by linking to social service directories (e.g., or internal directories based on standards
  • Helping providers improve data they submit to health plans by embedding health plan applications—with access to care plan documents and coding tools—within the HIE’s application
  • Launching public health registries and databases such as vital statistics directly through the HIE application
  • Viewing advanced directives or other legal orders pertaining to end-of-life care

When I began talking about SMART on FHIR technology in my blog two months ago, I entered the conversation quoting the movie Field of Dreams: “If you build it, they will come.” The build in this case being an application that uses SMART on FHIR technology to put HIE accessible data into the hands of providers where and when they need it. But building it was just the start. I’ve spent the past two blogs diving into how we keep them coming back—first looking at the most very basic of needs (quality data), and here, defining what will differentiate one application from another.

It’s clear the path to a homerun is continued exploration of the technology and how we, as HIEs, can use it to showcase the breadth and depth of our capabilities. Simply giving providers what they expect will get them to play on our field once or twice. Exceeding expectations and giving them what they need, without them even realizing they needed it, will have them returning regularly.

Oh! Before I put this baseball analogy to bed, and in case you hadn’t heard, there was a sequel to Field of Dreams! Ok, maybe not exactly what one would consider a movie sequel, but the field was played on again a few nights ago—and it looks like Ray Kinsella did save the farm.

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