In 2020, ONC launched Strengthening the Technical Advancement and Preparedness of Public Health Agencies through the Health Information Exchange Program (STAR ​​HIE) using funding from the Coronavirus Aid, Relief and Economic Security Act (CARES Act). The program was expanded in 2021 to add support for improving immunization data sharing between Immunization Information Systems (IIS) and HIEs. The West Virginia Health Information Network (WVHIN) was among 22 recipients to receive a total of $20 million from ONC through the CARES Act.
We sat down with WVHIN Executive Director Sonya Chambers to learn how the STAR HIE program has helped WVHIN support state health agencies in sharing health information during the COVID-19 pandemic. (Answers edited for clarity.)
What has the STAR HIE program funding been used for?
ONC’s STAR HIE program has really served as a catalyst for much of our COVID-19 activity, both with direct funding and by creating a closer relationship between WVHIN and the state Bureau of Public Health. In fact, the Bureau of Public Health were the ones who spotted the STAR HIE Program Request for Proposal (RFP) and sent it to us. That involvement led to greater coordination and collaboration between us and the Bureau of Public Health, which grew even more during the pandemic.
The STAR HIE program enabled us to create two important tools to help track and distribute a COVID-19 vaccine: (1) ImmuTrack tool to support providers and payers, and (2) WVHIN Reporting Services Heat Maps to support public health officials. The ImmuTrack tool enables providers to view their entire patient panel and the vaccination status of those patients in a single document. The tool is searchable by dose, age, geography, race and ethnicity and includes chronic conditions for Medicaid patients. The same data can be fed into more complex systems. Previously, providers had to make requests to the state’s IIS on a patient-by-patient basis, which is incredibly tedious and slow.
WVHIN Reporting Services Heat Maps display vaccine data at the population level and can be customized in a variety of ways, including by county, zip code, census tract, age, race, ethnicity, Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances. and Disease References (ATSDR) Social Vulnerability Index, in total number or percentage compared to averages and more. As you can imagine, these types of maps have been very useful in targeting vaccine distribution efforts. The resulting reports were used by the WV Bureau of Public Health, regional epidemiologists, local health departments, Federally Qualified Health Centers (FQHCs), the Partnership of African American Churches (PAAC), and higher education.
Both of those tools were critical to making the state better prepared to deal with COVID-19 as the pandemic unfolded.
FIGURE 1. Unvaccinated persons by region
FIGURE 2: Unvaccinated, black individuals by county
What were the problems/challenges and how did the STAR HIE funding help?
We had several challenges. When COVID-19 first hit West Virginia, only four hospitals or hospital systems in the state were electronically reporting COVID-19 lab results to the state. We were working with them to join the Electronic Laboratory Reporting (ELR) program, but the West Virginia ELR certification process takes several months and many hospitals had other technology priorities.. Because of WVHIN’s existing strong relationships with hospitals, we were able to partner with a state health agency to provide 21 lab feeds in hospitals with just COVID-19 in just two short weeks. We are now working to expand these streams to full ELR streams to better prepare for the next big flare.
Another challenge was race and ethnicity. It’s clear that minority populations are more likely to be disproportionately affected by COVID-19, and in the immediate scramble to get as many tests as possible, race and ethnicity information was often not collected when the pandemic first began. However, we were able to use demographic data from WVHIN’s existing hospital and provider data streams, which we call our Master Patient Index (MPI), to help the state cut the percentage of unknown race and ethnicity classification in half. We also provide this functionality for vaccine distribution. The WVHIN Reporting Services Heat Maps have been and continue to be important in identifying areas lagging in vaccination rates. This allows us to work directly with community organizations like PAAC to engage communities of color and identify high-risk patients who have not yet received vaccinations.
Data cleanliness is another constant challenge, as data is often incomplete or changes frequently. For example, many West Virginians travel to a border state like Ohio for care, and vice versa. If a West Virginia resident needs to get vaccinated at a Walgreens in Ohio, it can present challenges with incomplete or even duplicate data. Our MPI continues to be instrumental in matching vaccination data that is inaccurate or incomplete and/or merging duplicate records.
How will you build on this work and what are the future plans for WVHIN?
We plan to expand ImmuTrack for use beyond COVID-19 vaccines, as it may be useful for other vaccines such as chicken pox or even childhood vaccines. We will also create heat maps for policymakers and public health officials to better understand gaps in vaccination status by geographic location.
Funding from the STAR HIE program was not only instrumental in advancing our COVID-19 activities, it also enabled us to demonstrate progress that led to us receiving two additional CDC grants: High-risk and disadvantaged, including racial and ethnic minority and rural communities grant and (2) Immunization Equity and Priority for Populations Disproportionately Impacted by COVID-19 grant to continue our work. Furthermore, we continue to work with public health officials and the IIS on data cleansing as part of the Immunization Data Exchange, Advancement and Exchange (IDEAS) collaboration. We also use the CDC’s Health Disparities and Vaccine Equity Grants to provide analysis on things like breakthrough cases and reinfection rates. In addition, we provide automated reports that combine vaccine status, post-vaccination positive COVID-19 tests, deaths, and any relevant inpatient or outpatient visits.
We’re also exploring some work related to social determinants of health (SDOH), particularly being able to show referrals to community organizations for things like food insecurity, transportation insecurity, and more. Ultimately, that work seeks to close the referral loop and give the patient’s care team more context about the patient’s overall situation.
What role do you think HIEs play in improving health?
Our experience in supporting the state Bureau of Public Health in the response to COVID-19 has shown that HIEs are well positioned to bridge the gaps in our current statewide public health infrastructure. I think the biggest thing we’ve been able to demonstrate is that HIEs are nimble and flexible, two attributes that are absolutely essential in a crisis like the global pandemic.
HIEs have existing connectivity and powerful data and analytics capabilities that many local governments lack. HIEs also have the ability to complete patient compliance and data cleansing. For example, if someone moves and later changes their name, we can help figure this out. Another is that HIEs can not only support public health agencies with data access, but also then provide that data to providers to improve patient care. HIEs play a uniquely important role.
Learn more About WVHIN: Learn more About ONC’s STAR HIE Program.