Lisa Farren (Host): Hello everyone and welcome to Crushing Healthcare, where we explore diverse perspectives regarding the state of healthcare today, and gutsy visions for a more affordable, accessible, equitable, and sustainable healthcare model. So, my name is Lisa Farren. Welcome. I'm excited for today's discussion. We have two healthcare professionals who are knowledgeable and enthusiastic to share their expertise today.

I think as everyone knows or can agree, healthcare is most efficient and effective when information follows the patient, when a patient's health information and history is readily available for all of the patient's providers to access their information to improve clinical decision-making and improve care. How can this be achieved when a patient is under the care of multiple providers, each using different electronic health records? Well, enter the Health Information Exchange or HIE for short. It's an acronym you're likely to hear in more than one instance in this episode, so be aware, HIE. Specifically, we're going to talk about Connie, which is Connecticut's Health Information Exchange, and the value it brings to healthcare in the state. I'm going to start by introducing our guests, both of whom are keenly aware and close to the topic.

First up, Jennifer Searls is the Executive Director at Connie, Connecticut's designated Statewide Health information Exchange in 2021. Jen led the successful launch of the HIE program after three earlier failed attempts. Today, Connie is connected to all of the major health systems in Connecticut. A majority of the primary care practices and provide services to state agencies, including the Department of Social Services, the Office of the Chief Medical Examiner, the Department of Public Health, and the Department of Developmental Services. Prior to joining Connie, Jen held leadership positions at Southern New England Health Care, more commonly known as SoNE Health and at ProHealth Physicians.

We also have with us Renee Broadbent. Renee is the Chief Operating Officer at SoNE Health. She's a healthcare professional with extensive experience in healthcare operations, technology, and digital strategy, previously serving as the Chief Information Officer and Information Security Officer at SoNE. Prior to joining SoNE, Renee served as senior manager at Wolf and Company, and as Associate Vice President of Population Health Information Technology and Strategy at UMass Memorial Healthcare in Worcester, Massachusetts. Throughout Renee's career, she has led major initiatives including medical economics, enterprise EMR strategy, data security, and analytics. Renee led the initiative to not only connect SoNE Health to Connie, but to be one of the first organizations to do so. Renee serves on several healthcare and technology advisory boards. She's been an Adjunct Professor at Southern New Hampshire University and is a certified healthcare compliance professional, accomplished author, frequent speaker and presenter, and a founding member of Bluebird Leaders, an organization with a mission to support and advance women with careers in health information technology. We are in really good hands today. So, welcome, Jen and Renee.

Renee Broadbent: Thank you.

Jenn Searls: Thank you.

Host: All right. So, enough about hearing my voice here. Let's dive into the world of Connie. First, a bit about how it came to be, and then we'll explore the values and the benefits it brings to healthcare here in Connecticut. First, let's kind of lay the foundation for today's discussion by starting with the basics, especially for anyone listening who is completely new to this topic. Let's explain what is a health information exchange. How does it differ from an electronic medical record or a health record?

Renee Broadbent: So, an HIE gathers information from a lot of different sources and centralizes it, creating a great detailed medical profile of a particular patient, right? Whereas an EMR is really sort of specific to a provider facility. And there's many, many different ones that any organization can have. The benefit of the HIE is then that sort of takes away that differential and having different EMRs. So if you're a patient and you might have your primary care who might be on one EMR, or you might have a specialist on another EMR.

And what that does is it creates disparate records. So, you've got a little bit of your medical record here, and a little bit of your medical record here. And oftentimes, these systems, although it's better than it was several years ago, don't exchange data freely. Therefore, you have sort of an incomplete medical record. The HIE takes care of all of that, because all of the data goes to the HIE, and then not only can organizations that need that data access it, they get it in a more real-time fashion. And those individuals who are taking care of patients, whether they're doctors or nurses or other types of providers, can have a detailed 360 look at that patient. So, it solves a lot of medically-related information. It also saves organizations from having to go and get data from lots of different sources to complete their own work.

Jenn Searls: If I can, I also jump in to add a little bit of color related to Connecticut. So, everything Renee said is, of course, accurate. The other thing I would say that surprises people, and it frankly surprised me, because Connecticut is the size Connecticut is, from the data that Connie has been able to gather, we have more than 350 different electronic medical record systems in the state of Connecticut, which is frankly astounding considering the size. So when you have all of those disparate medical record systems, as Renee pointed out, you've got little pieces of information about a patient in various medical records and no easy way to pull that information all together so that a patient's provider is able to see their complete information in one place. And that's what Connie was built to try to solve.

Renee Broadbent: That's a great point, Jen. It is astounding to me, as the person in an organization responsible for consolidating different medical records. You know, just in our network alone, when I first started here, we had over 60. I mean, that's incredible.

Host: Yeah, it sounds like medical information or health records can be very fragmented. And you're right, for a state our size, that's kind of astounding. So, that lays good groundwork of why connie is important. So, let's get a little more granular, if you will, specific to Connecticut. So, what is Connie specifically? What's its history? How did it come about? Why did it come about?

Jenn Searls: So, the state of Connecticut has attempted unlike many states, two or three, probably three prior attempts, maybe four, depending on which lore you believe. And in some cases, they were a little earlier, they were sort of ahead of the game and provider organizations weren't ready. In other cases, the organization that was set up just didn't work very well for what Connecticut needed.

So in 2017, the legislature passed a law enabling the development of an HIE program. And then, also decided rather than having it be a state agency, decided to create an organization to run the HIE program. So, that's what Connie is. Connie is an independent nonprofit healthcare technology organization, which is a mouthful. But our job is to run the HIE program for the state of Connecticut. And we started in kind of strange times in that we really kicked off at the end of 2019 going into 2020. We set up a board, we set up the organization. We hired myself. And what we found was we had these incredible tailwinds, in part because the state collectively or the healthcare ecosystem in the state, I think, collectively said, "We can't fail at this again, we're going to make this work."

But the other thing that happened, as we all know, COVID was happening. And I think it became very clear that we were not all as integrated as we thought that we were. And sort of things like COVID test results, COVID vaccine records were not as widely shared as organizations would've hoped. So, we had these tailwinds of not wanting to fail an HIE, and then also the experience within COVID. And so, we were set up, we started running.

The other really great thing that the Connie board did, was select a company called  CRISP Shared Services as its vendor. And the key reason why this was so good and so auspicious for Connie and for the state is that this is a shared infrastructure with what was, at the time, three or four other states, has now grown to many more states. But it meant that we were able to really focus on policy, governance, the Connecticut laws around data sharing, and not have to set up an entire technical infrastructure because one had already been built. So, that meant that we signed a contract with  CRISP Shared Services and somewhere in the October-November timeframe.. And we were up and running by May of 2021. We had data flowing. And so, you can see that that sort of decision by the Connie Board really enabled us to get up and running.

We have a couple of other things that make us slightly unique. One is that we have a really open and transparent governance. We are an independent nonprofit organization, but we function under a lot of the roles that a state agency might. So for example, our board meetings are all open. Anyone can participate. Anyone can come to our board meetings, make public comments, see our minutes, watch the recordings of our board. And we're committed to and are required to have multi-stakeholder governance. So, we are not set up to just benefit the state, for example, or just payers or just providers or just hospitals. We are really meant to be here as a neutral and trusted entity across all of those stakeholders.

And then, finally, we also have a mandate for connectivity. So, there is a law in Connecticut that says if you are licensed to provide healthcare services in Connecticut, you are required to connect to and participate in the statewide HIE. And so, I think all of these things combined have really led us to be fairly successful and up and running in fairly short order.

Host: That is so interesting. Thank you for sharing all that. So it's been a little bit of a bumpy road initially. But, wow, once you got going, it sounds like it really flew quickly, which is great. And I like the transparency, the open governance. I love that the board meetings are available to anyone in the public. So, it's transparent, which I think is great.

So, now that we know a bit about the history and how we got to where we are right now this point in time, let's talk a little bit about its impact and what the benefits are for a statewide HIE. So Renee, with SoNE Health connected to Connie, can you share some of the way SoNE uses the data from Connie and the benefits of having this type of data available?

Renee Broadbent: Yeah, definitely. So, just to reiterate, we were super excited that this was happening. As a person who's worked in Connecticut a few times in my career and was around for the first few go-arounds, I can certainly say that this is very exciting, because it's so successful right now.

And so for an organization like SoNE, it really does help us facilitate, like, the clinical integration. We have a lot of providers in our ACO. And, well, in our organization, in our bylaws, we sort of limit the variation on EMRs. There's still quite a few of them that are out there. You're always going to have several. You're never going to get everybody on the same EMR, because of their specialty or whatever.

And the HIE is a really good venue for aggregating all this data on the patient, especially the ones that we manage. Connie does provide us that method. They give us a single point of contact to obtain this clinical information. We can get data next to near real time sent to us to solve a lot of clinical quality measures and things like that.

And it helps us also manage the patient's behavior and satisfy our contractual obligations. You know, as an organization and a value-based care organization, we have many contracts with payers, that we have certain targets and metrics that we're required to complete. And often times, those metrics require lots of data, not just the claims data. But also clinical data that comes from EMRs and other data sources, absent of having something like an HIE like Connie, we're left to try that costs a lot of money, and isn't always effective. Where if you have all that data in one source, it makes it extremely efficient. So for example, like our care managers, they use it when managing and dealing with patients.

And I think one of the things I want to emphasize is that we talk a lot about Connie, and it's this data aggregator. And it does get data from lots of rich sources and things like that, but it also is very helpful for care managers and other clinical folks to really go in there and see a lot of data on a patient, right? So, you can get a login if you're a provider and you can go in. We all have logins here and we can go in and manage our patients. And you don't have to worry about the data security. It's accessible, it's secure, it's efficient. You could access it if you're a provider. And the patients in your office and you want to look for a specific piece of data, you can actually log in and see it, while you're actually looking at your patient or talking to your patients, right? So, you have that 360 view. It is a centralized location. And again, it's more real time, especially if your patient has been to a lot of different specialists or has their data kind of fragmented.

I mean, just myself as a patient, I have a couple of different doctors. Some of them are on the same EMR, some of them are on different EMRs. And, you know, trying to get data between them is often challenging. It helps us drive action for a complex care management. We have a lot of patients that are, say, sicker than other patients, right, that really need heavy-duty management from our care managers. Connie allows us to see all that information in one place, so we can actually help and guide and get those patients on the path to wellness.

And it also gives us insight to things like medical adherence and more real-time interventions if we have to get directly involved with the patient on a more immediate basis. So, we really do leverage Connie for our data. We have really taken taken the opportunity in our organization to not only encourage, but require our providers to connect to it through our governance and through agreements. Our staff is trained on and they actively use it. And they will often talk about that they come up with a million other use cases for how they can actually leverage Connie. So, that's a good thing as well.

Jenn Searls: That's awesome. If I can maybe throw in some other things too that I don't know that I considered when I first started running Connie. But one of the areas that we see real benefit for provider organizations is being a conduit to state agencies. So, for example, to the extent that a provider or a health system is required to submit data to a particular state agency, because we are already connected to all of the health systems, most of the large provider organizations, many primary care groups. We can really facilitate being that conduit, which saves money for provider organizations. It saves hassle for provider organizations, because now you're not setting up another interface to go to a state agency. But it is also very cost-effective for that state agency, because now they're not spending resources developing multiple what's called point-to-point interfaces with every provider organization in the state.

So, you start to see that when we develop this infrastructure that connects healthcare organizations across the state, it really can be leveraged in additional ways to make things easier and more cost-effective for state agencies, providers and, frankly, us as taxpayers, which is one of the real benefits that I see of a statewide HIE that's mandated for connectivity, is we really can. And as Renee said, once people are aware of this, folks start using the data and information and think, "Oh, you know what? This would be really great for X." And assuming it's legally allowed, assuming we've gone through things like understanding consent requirements of a particular use case and all of the other things that we do, you start to see some real efficiencies from a statewide HIE.

Renee Broadbent: Yeah. And, you know, one of the things that's really been helpful for SoNE is that Connie has really gone above and beyond, soliciting and having advisory groups and different work groups to really improve the HIE. And that makes all the difference in the world. Because that, first of all, collectively gets everybody swimming in the same direction. And two, it does leverage those use cases and keep that creativity. And it helps Connie from a strategic standpoint, right? What else do we need to add? How else can we improve this and make it better? And then, we end up with the HIE and the data and all the support that we need to actually meet our goals as an ACO or a healthcare system or a payer or provider.

Host: It's all very interesting. So, what I'm hearing is, in terms of looking at the advantages, it's a wide-angle view. I mean, there's many different ways Connie can inform and enhance clinical decision-making and improve patient care. It provides a central source of data to inform care management, particularly with the more complex patients, as you mentioned, and creates an infrastructure that can hopefully bring our healthcare system to something that's more cost-effective and efficient, which as we all know, that's a big sticking point for everyone in healthcare right now. So, it sounds like there's just so many advantages. And what you both said as far as—I caught a collaboration piece. It's not just Connie, but it's Connie and all the users and those that are connected to make sure that there is this goal, if you will, to constantly improve it and find ways to move it forward and just make it more usable, more accessible, and just really increase its value.

Renee Broadbent: Yeah, I think that, if you've been in healthcare long enough and you know that what makes better patient care, what makes cost-effective care, it is understanding what that data is, right? And if you have been person responsible—and both Jen and I have been that person to go get all of that data—the difficulty in doing that, the level of cooperation, variation, and wanting to do it versus not; cooperation from the EMRs. Having an effective HIE takes all of that away, because you get it in a single location. So, the value that it brings, especially one that is as good as Connie and as effective as Connie, it is invaluable across many different use cases.

Jenn Searls: Yeah, I always like to tell stories because I feel like that can help drive it, because there's, I think, very much a macro lens of how Connie is valuable, which, for sure, I think an organization like SoNE is really looking at, right, is how do we maximize the value of this data and information to take care of the patients for which we are responsible.

Renee Broadbent: Just one last thing, not to take away from the patient piece of it, but I'm going to date myself here, but I was responsible at one point in time for helping implement a portion of HIPAA, HIPAA Security. And everybody forgets that one thing in HIPAA, that P word, portability. The intent of HIPAA was to have portability of your records, be able to see them, take them anywhere you want. That necessarily hasn't happened. I mean, sure, you can get into your EMR, and you can do that. But the HIE actually checks that box.

Host: Let's talk a little more about that. So, in terms of what specifically for the stakeholders, patients, providers, the value it's bringing, you gave us an example for patients, but are there other examples? Are there examples for providers, are there examples for payers even, of how the HIE is supporting and advancing healthcare delivery?

Renee Broadbent: Well, I think from a provider standpoint, it supports the clinical integration, the approved patient care across different systems. So, you're not limited to just that one focal point, you can go across the networks and multiple networks. The duplicity in the work that it eliminates is phenomenal. If you're in a hospital, it does leverage a downtime procedure, or even in a physician office. If you're down, like your systems are down, if you've got like an EMR vendor who decides it's a good idea to do a system upgrade in an inconvenient time, you do have the opportunity to use it.

 I think just the complete picture of the patient is probably the most overarching value that it brings. Because we haven't had that today, and we do have that. And the safety issues that we just talked about and the continuity of care, I think, are two very significant issues.

And I think patients too. Patients have a centralized portal now. They can see everything at once. I mean, I have the health app and stuff like that, but I have multiple portals as a patient. Some of them I'm able to connect and some of them I'm not, right? So, an HIE really kind of solves that issue for me. I can consolidate my record. I can send it to the provider, et cetera.

And then, the payers, of course, can leverage it as well, supporting some of the things like value-based care, reduction of things like unnecessary testing, avoiding readmissions. And that helps us on our side to see that as well and can do some data-driven clinical decision-making. It kind of checks the box for a lot of folks.

Jenn Searls: Yeah. And from the patient perspective, there's also a transparency and an accountability. You can request an accounting of disclosures, which we will share with you, to let you know who has had access to your data, which I may not be something that folks are aware of.

Also, if I can jump in also on some of the state benefits, right? So, the Office of the Chief Medical Examiner uses Connie quite extensively, because in the course of doing a death investigation, they may not be aware of who a patient's primary care or main provider or clinician has been. Using Connie, they're not only able to get that information, but they're also able to get information that enables them to do their death investigations much more efficiently than they had been doing them in the past.

The Connecticut Poison Control, the Chief of the Connecticut Poison Control Center, did an amazing podcast interview where she really talked about how she and her team leveraged the use of Connie for any potential poison exposure and can then coordinate with, let's say, Children's Medical Center for a patient that's been admitted with a potential poisoning. And rather than sort of trying to chase down clinicians in the hospital to find out what's going on with a patient that had previously called the Poison Control Center, they're able to log in and coordinate care much more efficiently, which has been amazing for them. They've called it a game-changer for poison control.

And then, DDS or the Department of Developmental Services, has a responsibility for investigating any acute injuries or acute episodes with the persons that they treat and are under their care. So, using Connie and being able to get access to real-time information when the people they care for are hospitalized enables them to much more quickly and efficiently investigate any acute episodes, right? So, rather than just hearing "Jen's in the hospital," I can look at Connie and say, "Oh, Jen's in the hospital, but it's for a stomach bug" or whatever the case might be. It enables them to be more efficient. So, there's sort of many orders of value across the healthcare ecosystem.

Host: So many examples I never would've thought of. So, thank you. I just find that so interesting. The chief medical examiner examining death of a patient, the poison control. Wow! It's mind-boggling. It has tentacles and it really can impact so many different things, which is great.

 So, I want to backtrack a little bit. Because one thing that you said, Renee, you mentioned value-based care and that's something here on Crushing Healthcare, we always kind of come back to value-based care. And so, I was hoping you could share a little bit about that. And specifically, if you have examples and you too, chime in Jen, on how an HIE supports value-based care.

Renee Broadbent: We've talked a little bit about the clinical data as an example, often you have multiple payer contracts across different types of things, at risk with MSSP, Medicare Advantage, all kinds of different contracts that you can be engaged in, as an example, we are.

And a lot of those require different types of things to close quality gates and metrics and things like that. And one critical component is the clinical data, checking A1cs, breast cancer, colon cancer screening, a lot of those types of things. And that data is found in the clinical data. And so for us, in order to satisfy that, we have to have that data, right? And when you have a ton of EMRs, then you have to go mine that data in many ways, the HIE solves that problem and consolidates it on a specific patient so that you can actually have that and close it, right?

So from a value-based care perspective and in our contracting, this is a huge win for us, because it saves a ton of work for our quality people and our technical people as well to get that data, especially since it's mostly close to very real time, which is huge. Usually, value-based care organizations in the past, we're used to working almost exclusively with claims, which are often three to four months lagged and also not up-to-date with what, say, a physician would see in their EMR.

The other piece of it that it supports is there's a lot of regulations that come out that we have to be in compliance for. And one of them coming is MCQM, which supports a quality metric. And when we get to 2027, everything has to be completely electronic. We can't submit anything manually anymore. So, Connie is going to help us do that. And this would be true for any ACO that was participating in MSSP, right? So, it's a CMS, Medicare program. So, this helps us tremendously, because now we will be able to do all of that. We'll have all the necessary data to be able to load that electronically

 And it goes back to the coordination of care, transitioning patients from one care to another. So if you have a patient that's getting discharged from a hospital and they have to go into a SNF, which is a skilled nursing facility, it really helps our care managers get them and their records and their data along and where they need to go. And it also can work on things like patient safety related to reducing medication errors and, as we mentioned, adverse drug interactions.

Host: Okay. Yep. I like it. A lot there. It sounds like, yes, the HIE is certainly empowering the delivery of value-based care, time savings.

Renee Broadbent: The other thing I like too—is one of the things that I think is really important for any patient is to be involved in your own care. Be educated about your care with your providers, regardless if you just have a PCP or you have a couple of specialists, you need to be able to empower patients to be involved in that care and take control over their health information.

As a person who is in a technology field, who's in a healthcare field, I am very actively involved. I know where all my patient records are, you know, I know how to use all the tools and things like that. But that's not a widespread skill that the average person might have, right? An HIE gives you that opportunity. It's one place and it's got all that information. So, you're not managing multiple EMRs and data and all that. And it gives you the opportunity to take control over your own data, which is what everybody should do.

Jenn Searls: I agree wholeheartedly. I mean, it's one of the functions or tools that we have as a patient portal, that we think is particularly important for those folks who have providers in multiple systems, or you're taking care of a parent. That is in multiple systems and need a way to consolidate all of that information. Because without all of that information, how do you actually take control of a situation or be empowered to help make healthcare decisions for your parent or for yourself?

I'm similar to Renee in that I probably would like one portal, but I don't mind navigating them. I feel comfortable navigating them. But not everyone is in the same situation. And so, having a singular view where you can get all of your information pulled together is really helpful.

Host: So, this is all really good information. So, I'm going to think about what our listeners might be thinking. And so, this is all really great. It seems like it's benefiting everybody. So, what is the cost of Connie? Does it cost doctors or healthcare professionals to connect to Connie? Are clinicians paying for it? Tell me about how that works.

Jenn Searls: It is good news. It's free. Connie doesn't charge anything for connecting to Connie and providing data. You may find, depending on your EMR, you may find that your EMR does charge an interface fee. We've worked really hard to have what we call a hub-based strategy, meaning that, as we've gotten folks registering to participate in Connie, which is the first step of getting connected, one of the reasons I know we have more than 350 different medical records is because part of that registration is letting us know who your EMR provider is.

And what we've tried to do is find those EMR providers that have a lot of clients in the state. So, I'll just pick Athena as an example, and go to Athena, and rather than saying to every single clinician or provider practice in the state, "I need you to go to Athena and work on this." We've worked with Athena directly to build a hub. And that hub then already has a connection into Connie with the data that needs to be coming into Connie and with the views of data back into the Athena EMR. And then, it's a much simpler matter of you contacting, let's say, your Athena project manager or account manager, and getting connected or ECW or GLACE or any of the other electronic medical record systems that are out there, that generally should result in a reduced cost. And sometimes it can be free, depending on the EMR.

Renee Broadbent: I'll just add on to that, it's a simple connection. I'll tag on to Athena. Because we do have a very large number of our providers that are on it here in the SoNE network. It's a simple connection, it takes no time, versus if you are on an EMR, that's this single EMR out there, standing alone by itself, you have to work with them. They have to create the interface. This hub function really does work very, very well. And on some of these EMRs, as Jen noted, including ours, it doesn't cost anything. There's no cost to the provider at all. So, that works out really well.

Host: That's awesome. Thanks for clarifying about the cost, and it sounds like there's no excuse for our providers not to be connecting. So as we sort of wrap up today's discussion, I just kind of throw it out to both of you. Are there any remaining thoughts you'd like to share?

Renee Broadbent: In terms of our network here, if you're listening, if you're not connected to Connie, please connect. We provide lots of support and resources for that. We have education. We sent you a little tips and reminders. We've given you the EZ QR code for Connie to just scan, and it tells you how to connect. They have a great project team there, and they can make it very seamless for you.

Many of you are on an EMR that has the hub, as Jen noted. So, very easy to do. If you are a patient, ask your provider if you're listening to this, "Are you connected to Connie?" And have the conversation with them, see how you can get connected and look at your health record. Consider using Connie if you're managing healthcare for yourself, for your parents, or across multiple healthcare organizations. You know, I live in a state that doesn't have an HIE that's as effective as Connie. But it would have come helpful when I was managing a loved one's healthcare, across many providers that was very time-consuming, and required me to track a lot of information.

So, if you are a provider, get connected. If you're a patient, make sure your provider is connected, then you leverage all of your opportunities to use Connie to manage your health records.

Jenn Searls: Yeah. And if you are a practice administrator or a medical assistant or a nurse in a provider's office, consider also talking to your patients about what it means that you guys are connected to Connie. We have a ton of resources on the Connie website, which is conniect.org. And if you go there, we have a Connie University, which will take you through a number of videos to help you figure out how to use Connie. It will also give you sample posters and languages and patient notices that you might want to consider, because what patients have told us is they like to hear about Connie from their providers, understand that in a 15-minute visit that may not always be possible for the clinician to do, but there's certainly information that you can put up in your practices that we're happy that, like I said, is on our website, is available to download, that can give patients the information they need to know about Connie, which I think is really critical as well.

Host: Very nice. Thank you. I like when we can wrap up a discussion with a solid takeaway. And it sounds like there's definitely solid takeaways. And Connie University, good name. I think that's great. I'm definitely going to check that out myself.

So, thank you, Jen, thank you, Renee, for all the great information you shared today. I learned a lot about Connie. I'm sure those listening have as well. And we have some really good takeaways that we can all take into action right away. So, thank you for joining us and thanks for everyone for listening. Let's remember that we all have a role to play in healthcare transformation. So, join us in Crushing Healthcare.