On October 28, we were joined in our coalition meeting by the team from the Colorado Regional Health Information Organization (CORHIO) to learn about their innovative and successful efforts to build a robust statewide health information exchange network in Colorado.
Heather Culwell, State Health Initiatives Director began by introducing CORHIO, which turned 10 years old this year––and recently joined with Arizona-based Health Current to form a regional organization, Contexture. As Culwell said, “The merger allows us to continue the level of focus and dedication that’s already in place, while also working to identify best practices and info sharing across state lines. We all know we don’t stay in one state forever.”
Then, to further introduce CORHIO and its broad reach in the state, Culwell pointed to the numbers to illustrate their user base and level of data sharing across the state of Colorado:
Culwell also noted the state agencies with which CORHIO partners, including the Office of eHealth––the product of a Colorado executive order signed in 2018. The executive order paved the way for the Colorado Health IT Roadmap, a process not unlike the one California is beginning now in the wake of AB 133. As Culwell noted, the development process involved “broad stakeholder input to align and focus across the state, leading to efforts to coordinate HIT, advance HIE, and coordinate across agencies.” She also noted that the Roadmap has been updated in 2021 to focus on equity, virtual care, and increasing access to health information.
Next, Ako Quammie, VP of Data Management, discussed the history of health data sharing in Colorado, noting that “the state has applications and agencies that are siloed, and have been that way since the 1980s.” He continued, “ New solutions take time to implement and create silos of data. When those silos are up and running, that data has to be integrated with existing data points. The state of Colorado was looking to gain greater insight into these use cases.”
Quammie then compared two systems of data matching: probabilistic matching system, which the older, siloed systems in Colorado used, and a referential system, which CORHIO uses and has worked to broaden. The examples below shows how CORHIO matches two different records for the same individual:
As Quammie noted, “Record A and Record B wouldn’t match up in a probabilistic matching system because the information is different.” With referential matching, there’s a repository that sits between the records, and the data is being constantly curated and indexed. CORHIO now has a success rate of 86.8%.
Quammie then presented three different use cases for CORHIO’s system.
Use Case 1 illustrates CORHIO’s Master Patient Index, a referential patient database. CORHIO worked with the state to get data files from legacy systems, and incorporate them into their identity matching.
Use Case 2 illustrates CORHIO’s ability to unite eligibility data for three different benefit systems: WIC, Medicaid, and SNAP. This is crucial, as many Coloradans are eligible for multiple of these interrelated systems.
As the slide showed, CORHIO was able to find tens of thousands of records for patients who were eligible for more than one system, and may not have known.
The third use case––and perhaps the most urgent––was a way to track COVID-19 data.
Regarding the COVID-19 immunization dashboard, Quammie said, it was “hard to track vaccination because patients can get them at multiple locations. In Colorado, the vaccination tracking systems use the probabilistic matching, not referential. As for testing, most states are not set up with an existing system. At this point, many people have had 10-20 COVID tests at multiple testing sites.” The dashboard generated thanks to CORHIO’s innovative system has made tracking this crucial data simpler, and is continually improving.
Next, Lauren Girard, Director of Healthcare Quality Improvement, briefly discussed CORHIO’s electronic clinical quality measures reporting (eCQM) practices.
Over the years, Girard said, “We’ve learned so much… We have to have that trusted data, and continued commitment to…improving the data, because otherwise when we walk into practices, nobody wants to work with us.”
In the Q+A portion of the presentation, the CORHIO team was asked about startup and ongoing costs for the system. Culwell noted that CORHIO “started out in the Legislature, with a very small budget, in the $1-2 million range. Now, we get federal matching in addition to state funding.” And even though the HITECH funds are sunsetting, funding for CORHIO will continue through other CMS funding streams at a 75/25% rate.
The team was also asked about what they do in the instance that smaller practices don’t have IT capability, or already use EHRs that don’t have great capability––and if there is a scalable approach to improve data quality. Girard stated, “The primary way to get through that is we do have the resources to provide tech assistance; my recommendation is to get any funding you can.” She continued, saying that in Colorado, “The state provides onboarding funding, and active and onboarded practices get quarterly support.”
It’s safe to say that CORHIO’s innovative and robust approach––created through Colorado’s Health IT Roadmap––is a roadmap in and of itself, for California to build an equally creative and well-funded resource benefitting millions of patients across a diverse state.