Bolstering Public Health With EHR Data in Minnesota
In 2021, Healthcare Innovation wrote about a presentation by the Minnesota EHR Consortium, whose goal is to improve health by informing policy and practice through data-driven collaboration among 11 of the largest health systems across Minnesota. Last week, leaders of the effort provided an update on a project called Health Trends Across Communities (HTAC-MN), a data collaboration of health systems and public health agencies to develop comprehensive community health data infrastructure in Minnesota.
Returning to speak at the NIH Collaboratory Grand Rounds last week was Tyler Winkelman, M.D., division director of General Internal Medicine and co-director of the Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare, as well as an associate professor in the Departments of Internal Medicine and Pediatrics at the University of Minnesota. He was joined by Dave Johnson, who’s an epidemiology informatics manager at Hennepin County Public Health.
Formed in March 2020, the Minnesota EHR Consortium (MNEHRC) initially facilitated collaboration between health systems to address gaps in COVID-19 data sharing and communication. They were able to develop the technical infrastructure to aggregate and share EHR data for real-time public health needs. Winkelman described how they built out a common data model at each of the health systems using Observational Medical Outcomes Partnership (OMOP), a common language for EHR data.
“This was an iterative process, but ultimately we've had 11 of the largest health systems in Minnesota join this collaboration,” Winkelman said. “We partner closely with the Minnesota Department of Health, Hennepin County Public Health and other local public health agencies, and our mission is to improve health by informing policy and practice through data-driven collaboration among members of Minnesota's healthcare community.”
As Winkelman explained during his previous talk at the NIH Collaboratory, the EHR Consortium has been successful in part because it has had a keen focus on privacy. Using OMOP and the distributed data scheme, data sit at the health systems and are analyzed there. Then summary data are sent to a central site for aggregation. “We aren't creating a single large repository,” he said. “The patient data stays with the health systems, and we're operating in the world of summary data. The entire collaboration is voluntary. Folks can choose which pieces they want to be involved in, which they don't, and what's most relevant for their particular system.”
The HTAC project offers a dashboard with information on a range of chronic, behavioral, and mental health conditions in Minnesota. Health professionals, service organizations, policy makers, community leaders, and others can use HTAC reports and dashboards to help develop and evaluate policies and programs, assess health needs, and identify assets at state, regional, and local community levels.
Hennepin County Public Health’s Johnson explained that public health departments’ foundational capabilities include assessment, planning, data and epidemiology. He noted that a recent statewide cost and capacity assessment of Minnesota’s public health system was recently completed by the University of Minnesota in partnership with the state health department. It gathered information from all local public health departments to assess their ability to carry out these foundational capabilities. “From these assessments, significant gaps were identified in areas of data and epidemiology, policy development and health equity and not surprisingly, smaller health departments have less capacity, frequently having folks doing data work without formal training in data, and who also had many other duties and responsibilities on their plates,” he said.
A key data-related activity of local public health is known as the community health assessment, which informs prioritization of health issues for strategic planning within health departments across the state. These assessments are required of local public health agencies through funding from the state health department, as well as being a key activity evaluated for public health accreditation, Johnson said.
At the same time, IRS code requires that hospital organizations conduct a very similar type of assessment known as a community health needs assessment. These are required every three years, and hospital organizations are required to develop an implementation strategy to meet the community health needs that are identified through their assessments.
"Therefore, this creates a shared interest among local public health and healthcare providers in completing these assessments, and this shared interest led to the formation of the Center for Community Health in the Twin Cities metro area, which is made up of representatives from local public health, health providers and health plans,” Johnson said.
One of the key objectives of this group from its inception in 2012 was around coordinating shared assessment activities and developing shared community action plans across the partners, Johnson explained
"A particular strength of this HTAC project has been the fact that it has brought these partners together in new ways, bringing together folks with strong data interests from both the healthcare provider perspective as well as the local public health perspective, which has helped us develop new relationships and ways to prioritize our work that have led to new opportunities for collaboration in our shared interests,” he said.
Using electronic health records was identified as a shared interest of the Center for Community Health Partners. “From the outset, folks recognize that this was an untapped resource that could really help inform our community health assessment activities,” Johnson added.
This shared interest led to some early efforts that were led by Hennepin County through a project called the Private/Public Health Informatics Collaborative. The major focus of this early work was around creating leadership awareness in organizations and buy-in for the need to develop shared indicators from electronic health records.
It took many years to develop the data-sharing agreements from the different health providers to permit data to be shared amongst the partners, he added. Although COVID interrupted this project, it also provided an urgent business case for collaboration to share data to inform the COVID response. This wasthe basis, or one of the key activities, that was the early work of the EHR Consortium. They quickly developed a technical infrastructure to accomplish that data sharing, and they also develop reporting capabilities to share that information across partners. As COVID became less intense, the priority of data sharing for developing broader community health indicators became possible, and along with that, there was also this funding from the health department, which allowed financial resources to support this idea.
“We did a lot of assessment work early on in the project, asking partners how they could use shared electronic health record data, and community health needs assessments topped the list,” Johnson said, “but there was a broad variety of other important functions that were identified, ranging from grant applications, program evaluation, strategic planning information to help demonstrate and track health disparities, getting buy-in from decision makers, along with many others.”
People mentioned that this would allow for more timely data, he said. “Some of our data sources in public health can take months to years in order to finalize, and some of our key survey projects also have long timelines and are only done on a periodic basis. So having more timely data would allow for a more ongoing approach to community health assessment.”
They also identified that this data can help build partnerships within those groups that are contributing data, as well as with community organizations. “We also identified that having data from electronic health records on health conditions could allow other data sources, like surveys, to focus on other priorities, such as social determinants of health. We're starting to gather information from data users who are going to our dashboard through an online survey asking folks to provide information about how they're using the data, and this helps provide us with early insights about the value that's added from this data source.”
At the NIH Collaboratory presentation, Winkelman and Johnson were asked if it would be possible to replicate this approach in other states. “We’re working on a grant right now to try to replicate this model in another state, and it's specifically trying to replicate it in order to set up a mechanism to evaluate 1115 re-entry waivers,” Winkelman said. “These are new Medicaid initiatives to turn on health insurance for people while they're incarcerated. But if it works, we would have an example of how this could get turned on in another state. In the state that we're hoping to build it out in, half of the healthcare in that state already is delivered through the university there, which has OMOP. So I think it's an easy starting point to look at places that have a relatively consolidated healthcare market where there's an OMOP infrastructure already built out, which many universities have now because of their COVID collaborations with NIH.”
