The Austin, Texas-based Connxus health information exchange is eyeing expansion — both geographically and in terms of services offered. The HIE recently joined the Patient-Centered Data Home (PCDH) effort, enabling seamless data transfer across the U.S. Originally formed by an alliance of local safety net providers in 1997, Connxus now has partnerships across eight Central Texas counties. The HIE’s CEO, Eliel Oliveira, M.S., M.B.A., recently spoke with Healthcare Innovation about the state of interoperability in Texas and nationwide.
Oliveira has a lengthy and impressive resume in the interoperability sphere. Prior to joining Connxus, he was a senior director at the Harvard Pilgrim Health Care Institute (HPHCI) in the Department of Population Medicine at the Harvard Medical School. Earlier, he led the division of Health Informatics in the Department of Population Health at the Dell Medical School at the University of Texas at Austin and also served as the CIO at the Louisiana Public Health Institute (LPHI) in New Orleans, where he led the design and implementation of the Research Action for Health Network (REACHnet) as a Clinical Data Research Network node in the national Patient-Centered Outcomes Research Network (PCORnet).
HCI: Can you talk about some of the growth Connxus is seeing?
Oliveira: We have expanded to cover eight counties in Central Texas. Now I think there is a great opportunity to expand to other regions of the state. Texas has launched a program called ATLIS (Aligning Technology by Linking Interoperable Systems) that provides incentive payments to hospitals and managed care organizations for partnering with HIEs to achieve and build on certain data-sharing milestones.
HCI: Your organization started with a focus on the safety net population. Has that guided some of the work that you do in terms of population health or whole-person care? Or connecting community-based organizations?
Oliveira: Yes, it has guided us, and we spend quite a bit of effort on coordinating with social organizations. We have been carefully moving our branding from a health information exchange to a health data utility. I know there are other definitions out there across the country, but our definition is that we believe that in order to improve health, you have to have more than clinical data. The non-medical drivers of health are always critical. We collaborated with the Michael & Susan Dell Foundation on the Accountable Health Community, and the results are pretty impressive. It’s all about community health workers helping individuals navigate for social care. We have the social workers on staff, which is not very common for organizations like ours.
HCI: Staying with the health data utility concept, do you have strong connections with regional or state public health agencies, and is that part of your conception of what a health data utility should be involved in?
Oliveira: I guess one of the advantage of being in Austin is we have both Austin Public Health and state public health right here. And then we have our hospital district, which is called Central Health in Austin. Population health is another key layer of that health data utility mindset that we have. But we think differently than other HDUs across the country. In the case of Texas, given its size, it’s hard to have one source of data. From here in Austin, I have to drive nine hours to get to El Paso, and it’s a different story there. So the regional wisdom in Texas creates complexities. I think that’s one of the reasons we have five HIEs in the state.
HCI: Are there parts of the state that that don’t have HIE coverage or where there’s not a strong HIE presence?
Oliveira: There are. We can see a white space between central and west Texas — between us and El Paso, because there’s not a lot of population there, to be honest. It is very dry, with very long distances to travel to anything. And then there isn’t an HIE in North Texas. Dallas is also very limited. It seems like Dallas decided a while back to have the hospitals use Epic’s network. But you’re missing the FQHCs. You’re missing the behavioral health data. They all use different systems, right? So you’re getting the picture from hospitals, but that’s very limited. Actually I just met with the director of public health in Dallas, and that’s exactly the point I was making to him — that we could support the Dallas region. So that’s part of the expansion that we have in mind is going up I-35 through Waco and Fort Worth.
HCI: For a while, we were seeing mergers and consolidations among HIEs, such as between the ones in Arizona and Colorado. Do you think we’ll see more of that?
Oliveira: We used to have 12 HIEs in Texas, and now we have five left, so consolidation has happened here, too. Maybe we have gotten to a stable state in some ways, where whoever was serious about it has stayed.
Contexture is a different case. I never imagined that Arizona and Colorado would become one, but the model that I have seen that seems to be catching on is HIEs selling or partnering with their solutions, as opposed to a takeover. I couldn’t see how someone in New York, for instance, is going to understand what the legislators in Texas are doing and be able to manage two different legal frameworks from different states. What we have done is partnered with Oklahoma and we are utilizing their tech stack, because it’s FHIR-ready, but we keep our independence, and support each other to be independent because we believe in local governance.
HCI: You are participating in the Patient-Centered Data Home effort from Civitas Networks for Health. Can you talk about what’s involved in participating in that and the benefits for patients and clinicians in your area?
Oliveira: It’s a completely free service. From a technical standpoint, it’s just a matter of putting agreements in place and connecting to one of the five nodes in the country. We can basically get any ADT [admission, discharge and transfer] from across the country for individuals receiving care elsewhere who are from our region. That message gets routed to Connxus, and then we deliver that in less than a minute to the primary care providers. As far as I know, this is the only push network in the nation instead of the data being pulled, right?
HCI: I read that you’re also co-chairing a learning health systems workgroup at Civitas and leading the development of a national HIE-based research data network. Can you talk about what some of the goals are?
Oliveira: The reason that I jumped on that is because I have a bit of experience in research, from helping build PCORnet and then the FDA Sentinel network at Harvard Pilgrim. It’s uncommon for HIEs to get involved in research a lot. One of the things we are doing is getting all the HIEs to combine details about where the population gets care, so we can have a sense of how much fragmentation we have nationally. We are looking at that as well from the perspective of fragmentation across EHRs, because when we look at our data and in other HIEs individually, what we see is that less than 4% of individuals have their data in only one EHR. The average is between four to seven EHRs. The fragmentation is the key thing that we’re working on — first to just show how fragmented the system is, across vendors, across organizations, and across the nation. After that, the goal is to put together a basic query infrastructure so that we can actually do basic study feasibility queries across HIEs. We need to start slowly, but that’s the next step. From there, we could look at how we could help a pharmaceutical company or NIH researcher to select the locations where they can collaborate on the ground.
HCI: I saw that you were a member of the ONC Health Information Technology Advisory Committee (HITAC) and a member of its Annual Report Working Group. What’s the status of HITAC now? Is it on hiatus?
Oliveira: I don’t know anything. There has been no formal communication one way or the other. That is part of the Cures Act and was defined by law. So unless somebody changes the law, technically it still exists. But we haven’t met since December, and everybody’s just on hold waiting to see what is the direction. I think we may hear in the next couple of months what the next steps are.
HCI: What’s your take on TEFCA? Will Connxus connect to it via a QHIN or are you in a wait-and-see mode about that?
Oliveira: We are in a wait-and-see mode, because we did some evaluation with our health systems and organizations, and there were a few things that they were quite concerned with. If you look at the announcements from CMS and the White House, there was no mention of TEFCA at all.
HCI: You put out a statement pledging to be a part of the Trump effort at CMS on interoperability. What does becoming a “CMS aligned network” mean to your organization? How could it impact how patients interact with their own health data?
Oliveira: I feel that we have got some great alignment with what the White House was saying in that announcement, and what we have always believed would be the pathway forward. The Cures Act in 2016 basically told us that patients should have access to their data without special effort, right? We got funding from ONC in 2019 to pilot that. We built a platform that did just that: the person would sign on one time, in one place, and get all of their data from our region — all using FHIR.
We also collaborated with another HIE in California on capturing mental healthcare consent in the clinical settings and then visualizing that in a distributed fashion through the HIE to clinical providers using FHIR. And that worked really well.
My point is, we have tested all the pieces that I think the White House is talking about. I’m working on convincing leadership here in Travis County that we should deploy a system in the community here where individuals have one place to go to access all the data. We can manage consent in a central place, and we can provide services in a coordinated fashion.
