It’s not a minor feat when a health information exchange is able to not just survive, but thrive, for 15 years. But Rochester RHIO, which serves around 1.5 million individuals across upstate New York, has done just that. The secret to their success? A willingness and ability to “listen to the community and respond to what they need,” said Andrea Richardson, who has been with the organization for 6 years.
There were, of course, other factors, such as securing buy-in right out of the gate from key stakeholders, and having the foresight to expand beyond the clinical realm. “Clinical data is where we began, and it’s still the backbone of the HIE, but we’ve really tried to integrate with different types of entities,” Richardson noted.
As a result, Rochester RHIO is considered “one of the most progressive and innovative HIEs,” and is constantly striving to improve, whether than means creating a community health indicators report, or embracing the use of social determinants of health. Recently, Richardson spoke with Kate Gamble, Managing Editor of healthsystemCIO, about the organization’s continuous evolution, and how they’re partnering with companies like Nextgate to provide accurate clinical data at the point of care.
- For Rochester RHIO, a qualified entity of the statewide health information network of New York, is “considered one of the most progressive and innovative HIEs because of our focus on community entities outside of the clinical realm.”
- For any HIE, the true value comes in being able to “integrate data from otherwise siloed EHR systems,” said Richardson, which entails “working with data source to make sure they’re capturing data the same way.”
- The key initiatives for Rochester RHIO in recent years: rolling out a new data aggregation platform, and working with NextGate to improve data integrity through patient identification and matching.
- One of the projects Richardson is most proud of is the community health indicators report, which has “allowed our community to have a clear understanding of our overall health” by including SDOH data.
- In the six years since Richardson became CIO, “there has been an evolution in technology, and a learning curve related to that. But we have amazing staff that has really risen to the challenge every time.”
Q&A with Andrea Richardson, CIO, Rochester RHIO
Gamble: Hi Andrea, thanks so much for joining us. Let’s start with a high-level overview of Rochester RHIO.
Richardson: Sure. Rochester RHIO was one of the first community health information exchanges in the country. We were founded in 2006. We serve about 1.5 million residents in 14 counties in upstate New York, from Buffalo and Auburn down to the Pennsylvania border.
We’re a qualified entity of the statewide health information network of New York (SHIN-NY). And we’re considered one of the most progressive and innovative HIEs because of our focus on community entities outside of the clinical realm. For example, we’ve worked with corrections facilities, we’ve had a focus on social determinants of health for many years.
Clinical data is where we began, and it’s still the backbone of the HIE, but we’ve really tried to integrate with different types of entities. We have a research partnership with Indiana University, and we provide a community health indicators report, which is a health report card for our area. So there are definitely a lot of exciting things going on.
Gamble: You said Rochester RHIO started 15 years ago, which is remarkable considering what we’ve seen in the HIE space. How has the organization been able to buck the trend?
Richardson: It’s been a combination of things. Initially, we had a lot of buy-in from regional health systems and payers in our area; they really supported the organization at its inception.
“We want all the data”
We’ve also focused on different types of data, and we’ve proven our value in being able to integrate data from otherwise siloed EHR systems. We’ve had strong relationships with data providers through the years. We joke that in the beginning, we would take any data they could give us. We wanted all of it. Over time, that has evolved to standardization and normalizing data, and working with data sources to make sure they’re capturing data the same way and codifying it the same way, wherever possible. Obviously each source is a little different, but we’ve tried to implement community standards within their capabilities, which has been helpful.
Early resistance to data sharing
Early on, there was some resistance to the idea of sharing data, especially something like SAMHSA data, which is closely protected. Fortunately we were able to overcome those obstacles, thanks in part to rule changes that were made at the federal level.
And of course, during the last two years, Covid has changed everyone’s focus. It has also highlighted the important role HIEs play in public health, and has shined a light on our capabilities. However, as we’ve added new data sources with different levels of capability, incorporating new types of data and having to standardize that has been challenging.
Staffing has also been issue. For us, trying to keep our staff engaged while working remotely, and hiring qualified staff during this pandemic have certainly been challenging.
Gamble: That’s something we’ve heard across the board. How are you working to address the talent shortage, especially when there is such high demand?
Richardson: One way is by highlighting our flexibility as an organization. We’ve recently expanded our recruiting to look outside of our local region. With so many people successfully working remotely, it has opened our eyes to the fact that people don’t need to be in the office to be a contributor.
“Change in perception”
Gamble: You mentioned the hesitation early on about sharing data. Is that something that’s constantly changing? What has Rochester RHIO’s approach been?
Richardson: It has definitely improved, but people still have concerns about what’s happening with the data. They want to be aware of what we’re doing; they want to ensure that their patients are still their patients, and that the information is representative of their organization.
And of course, we have standards as far as data integrity. We’re certified through HI-TRUST and CMS’ QE (Quality Entity) program, and we’re starting the NCQA process. We also go through certification through New York State. Data integrity is very important to everything that we do.
I think that because of the controls that are in place around consent, we’ve seen a change in perception when it comes to the importance of sharing data.
Ensuring data integrity
Gamble: That’s important. So, what would you say are some of the key initiatives your working on now?
Richardson: Probably our biggest project in 2020 was our implementation of the Meridian DAP (Data Aggregation Platform). We migrated our clinical query portal to a new product developed by Aigilx Health, which is a wholly owned subsidiary of Rochester RHIO. We developed that portal to meet our community’s needs, to allow us to be more agile in meeting those needs, and to have more control over what we offered. The partnership with Aigilx was huge in helping to develop the backbone of our infrastructure.
Our EMPI, which is from NextGate, is also a core component in ensuring data integrity through patient identification and matching. Our goal is to provide a holistic view of the patient’s health and wellness across the care continuum, and those products allow us to do that successfully.
Providing data to patients
We’re also working with Ciitizen to provide data directly to patients. As an HIE, that’s not something we’ve done. Our data comes through sources that have relationships with patients, and so this is new. We’re the first HIE to implement Ciitizen’s Cures Gateway, which enables us to provide information to a patient’s personal health app. That helps us stay in compliance with information blocking rules, and it allows patients better access to their data from multiple sources.
Gamble: That seems like a logical move. Patient portals have been around for a while, but have never been able to take the next step.
Richardson: It goes back to what I was saying about the patient identity verification. We don’t necessarily have a personal relationship with the patient, but the data sources do, meaning the health systems, FQHCs and the primary care providers. From their perspective, patient portals make more sense.
The partnership with Ciitzen has been a key component in us being able to satisfy the requirements without adding staff to do identity verification, and without having to develop a patient portal of our own. It would’ve been too costly, and so the partnership with Ciitizen has been great.
Health report cards
Gamble: What are some of the other initiatives on your plate?
Richardson: Another thing we do is to provide a community health indicators report. It’s sort of a health report card for the region, covering areas like smoking cessation, high blood pressure, diabetes, and obesity. Instead of relying on surveys, we’re able to use actual data. This helps us provide a clearer picture that isn’t clouded with political, technical, or legal challenges, and it has allowed our community to have a clear understanding of our overall health.
Gamble: How are you able to obtain that data?
Richardson: There’s a website called Roc Health Data; it’s publicly available data, because it’s all identified and aggregated. We work with an organization called Common Ground Health and the University of Rochester Medical Center, which is one of the two large health systems in our area. And so the data are available for anyone to view.
Health equity & SDOH
Gamble: You’re collecting a lot of data, what about social determinants? How are you incorporating that into the care picture?
Richardson: When we do things like community health indicators, we include race and ethnicity data. We’re actually working the Data Health Equity project, a two-year initiative focused on race, ethnicity and gender, and understanding how those impact health inequities and systemic racism across the board. That’s just kicking off, but we’re exciting to sink our teeth into it.
We’re also working with working with health systems and all of the data sources to understand how they’re documenting and ensuring consistency so we know that when the data get to us, we’re actually comparing apples to apples.
Gamble: What’s the biggest difference between an HIE and a CIE?
Richardson: Clinical data is a key piece of it. In our region, the CIE also incorporates data from community-based organizations and social services, as well as the education system. We’re a participant of the Systems Integration Project (SIP), which is championed by Congressman Joe Morelle of New York State, and led by our located United Way. We’re excited to see where that goes, and participate in whatever way that we can.
Rochester RHIO’s evolution
Gamble: Switching gears a bit, how long have you been with the organization?
Richardson: A little over six years.
Gamble: So it’s been a while. What do you think have been some of the biggest changes in that time?
Richardson: Part of it has been the expansion of data. That’s been a big part — working with different types of data and data sources. Rochester RHIO has always been willing and able, thanks to our talented staff, to develop new types of interfaces. Obviously there are requirements for all of the different certifications, and all the different types of data that have varying levels of value to our community. But we’ve always strived to listen to the community and respond to what they need. That’s been there all along, but it has evolved quite a bit to what it looks like now.
The technology, of course, has changed. I’ve been here for two migrations now. I came in at the tail end of the first, and now we’ve gone through the second, which is the Meridian data aggregation platform. That has played a key role in allowing us to stay nimble.
So there has definitely been an evolution in technology, and a learning curve related to that. But we have amazing staff that has really risen to the challenge every time, and I could not be more grateful.
Gamble: It sounds like you guys are definitely doing some great work. Thank you so much for taking the time to speak to us, and best of luck going forward.
Richardson: No problem. Thank you!