Oregon health officials and providers gathered at a June meeting of the Health Information Technology Oversight Council (HITOC) to describe where data exchange is working and where it is falling short. HITOC, a committee of the Oregon Health Policy Board created by the state legislature in 2009, sets health IT strategy for Oregon. During a panel session, executives from health systems, a rural clinic, a university, and an insurer outlined specific gaps — some technical, some policy-driven — that continue to limit how well patient information moves between organizations.
From IT product to care capability, but not without noise
Seth Harriff, manager of information systems applications for Portland-based Legacy Health System, said his organization has treated data sharing as a care delivery capability rather than an IT product. “It is something that augments the care that is delivered by giving people information that they wouldn’t otherwise have access to,” he said.
Legacy was an early adopter of data exchange with the VA, the Department of Defense, Social Security Administration, referral exchanges with OCHIN, and infectious disease reporting. The system also adopted TEFCA early. But Harriff added: “Now we’re contemplating the potential of harm that comes with sharing a lot of information about our patient population.”
Small clinics face platform overload and cost barriers
Nick Powers, CEO of Winding Waters Clinic — a Federally Qualified Health Center in rural Wallowa County — described the pressure of managing data connections with a tiny staff. “We rely on expertise from OCHIN primarily for interoperability,” Powers said.
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He stressed that his team cannot afford to jump between many platforms. “The fastest way to hear concerns from a workforce or to burn out a workforce is to have them trying to switch platforms.” For Winding Waters, almost all data exchange comes through OCHIN Epic, because the clinic needs the scale and integrations that a large vendor can provide at a sustainable cost.
That dependence on a single vendor is not unusual for small rural providers, but it does create risk. If the vendor’s system has a weakness or a gap, every connected clinic inherits it. And the options for an alternative are extremely limited when the workforce is just a handful of people.
TEFCA’s rollout remains a “roller coaster” for OHSU
David Dorr, M.D., chief research information officer at Oregon Health & Science University, said the group responsible for patient privacy at OHSU has had “consistent concerns about the rollout of TEFCA and the people who can jump on to the network, and the issues around privacy for that.”
“We’ll push for better patient access through individual access services through TEFCA. We want patients to be able to direct this when it’s really important. On the other hand, we want the ability to have clearly structured information available through these QHINs so that we can perform decision support on it,” Dorr said.
He noted that OHSU does not own the data flowing through the QHIN, which means the inferences drawn from it could be incorrect.
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Dorr also pointed to fragmentation of rules and policies across different levels of government. “The fragmentation of rules and policies has led to a pretty challenging system of information exchange in which to interact, and we probably need to really address that, not just at the state but the federal level.”
Insurer sees value in prior authorization data but slow traction elsewhere
Ravi Nanayakkara, IT manager for data integration services at PacificSource — which runs coordinated care organizations in Central Oregon and other regions — said the overhead of maintaining data exchange infrastructure is high.
His organization is enabling API features and partnering with Epic.
“I think where we will see true value is probably with the prior authorization data. That will really support a member fairly well, but with others we’re not seeing the level of traction that we would hope to see,” he said.
Harriff had earlier noted that gaps are not just about technology — they are also geographic and socioeconomic.
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“There are lots of pockets where we’re unable to get information that is important to our ability to deliver care,” he said.
The picture that emerges from these accounts is one of uneven progress: some organizations have made headway with specific exchange partners, but the larger promise of a friction-free flow of clinical data is still out of reach.
Dorr suggested a focused approach for Oregon.
Instead of trying to solve everything at once, the state should identify where the biggest gaps are. “I would say that behavioral health is one. We have really vulnerable people there, and the gaps are enormous. The work on health-related social needs is really good. There’s a huge gap there that continues, so maybe thinking of a system where those groups are lifted up is important.”
