Description

Although rural healthcare organizations are an integral part of any state's healthcare ecosystem, they typically do not have the resources or funding that larger health systems do for Health Information Exchange (HIE), patient-centered outcomes research, connectivity, and cybersecurity/cyber resilience.

In 2009, the federally-designated rural health network Rural Health Partnership of North Central Florida (RHP) led the development of the CommunityHealth IT network to help with these types of healthcare delivery needs. CommunityHealth IT is an incorporated Florida nonprofit, housed at the Kennedy Space Center, that helps improve community health and medical community financial viability.

The network is made up of regional stakeholders, including learning institutions, economic development, medical facilities, behavioral health, school boards, and the VA.

CommunityHealth IT's development was originally supported through a Federal Office of Rural Health Policy 2011-2013 Rural Health Information Technology Network Development grant. From 2013 until now, CommunityHealth IT's efforts have also been supported by Centers for Disease Control and Prevention (CDC) and Patient Centered Outcomes Research Institute (PCORI) grants.

In 2018, CommunityHealth IT was awarded a State of Florida Advancement of HIE, a 3-year project where behavioral health centers, Federally Qualified Health Centers, oncology groups, Rural Health Clinics, and rural and Critical Access Hospitals across the nation can receive reimbursements to integrate with CommunityHealth IT's HIE.

Services offered

One of CommunityHealth IT's primary services is MyHealthStory. MyHealthStory is a secure, centralized data repository that uses traditional HIE to connect medical, behavioral health, and social services to patients. This allows for better care coordination, patient education, and patient engagement with medical and behavioral health professionals outside of an office visit.

This video gives an overview of MyHealthStory.

With patient consent, MyHealthStory allows for:

• Assessments and screening evaluating a patient's:
  • Health risk
  • Social determinants of health
  • Functional capacity
  • Diseases
• Survey development and dissemination
• Electronic referrals
• Patient health data integration
• Flexible secure messaging inside and outside of the system
• HIPAA-compliant texting
• Care team calendar sharing
• Information exchange
• Patient access to clinical records and communication with care team members

MyHealthStory's stores the following information about each patient: 

• Current medications and health problems
• Demographics
• Current care management programs
• Self-management goals
• Care team members

Benefits of MyHealthStory for healthcare providers:

• Providers can apply for Federal Communications Commission's advanced payments and reimbursement
• Enhanced care coordination
• Shared longitudinal record for care teams
• Shared cost for opportunities across provider care team

In addition to MyHealthStory, CommunityHealth IT also includes the following services for their users:

• CommunityHealth IT Consortium – Leverages regional HIT resources such as the Federal Communication Commission's Healthcare Connect Fund.
• Trainings and Certifications – Performs HIT-related evaluations, trainings and consultations to help first responders and healthcare delivery ecosystems prepare for cybersecurity threats. Works with the Professional Association of Health Care Office Management to ensure practice managers are proficient in EHR implementation and adoption.
• Leadership and Change Management – Provides workshops that give leadership and staff tools to effectively navigate change and align priorities. Programs used include Situational Leadership®, the DiSC Personality Profile Assessment, and the Myers-Briggs Type Indicator Assessment.

A news story featured on Tampa Bay's Fox 13 describes the ease of receiving healthcare help electronically (RelayHealth uses MyHealthStory technology).

Results

Since 2011, MyHealthStory has achieved the following:

• Provided 306,656 Florida patients with data
• Engaged 66 Florida facilities
• Involved 140 Florida primary and behavioral health providers with patient data exchange
• Hosted 1,339 messages from providers in May, 2018 alone
• Saw 3,455 patient-initiated record views, updates, and edits in May, 2018 alone

The CommunityHealth IT Consortium is currently helping 207 sites in 13 states access funds from the FCC Healthcare Connect Fund.

Honors received by the CommunityHealth IT Network include:

• CommunityHealth IT leadership helped write the "Cyber Health Practices" document developed by the Cybersecurity Act of 2015 Task Group, leveraged by Health and Human Services. The document is currently being pre-tested in 5 locations nationwide.

• Endorsed by Enterprise Florida, North Central Florida Trauma Agency, Physicians Care Partners, and the Marion County Medical Society
• Appointed to the national Veteran Initiated Electronic Care Coordination (VIECC) by HHS
• Appointed to the OneFlorida Clinical Research Consortium and Data Trust Program
• Appointed Stakeholder Advisor of the White House Office of American Innovation on issues related to health information sharing, cybersecurity, and HIT interoperability.
• Appointed to the U.S. Healthcare Sector Coordinating Council Joint Cyber Working Group
• Leadership received a 2013 Critical Access and Rural Hospital Champion Award from the head of the U.S. Office of the National Coordinator for Health Information Technology.

Challenges

The following are challenges CommunityHealth IT has encountered while working with rural facilities across the nation:

• Although lack of affordable broadband access is still an issue, the increased funding to the FCC Healthcare Connect Fund Program is helping with this issue. However, certain safety net providers such as for-profit Rural Health Clinics and free or faith-based organization clinics are not able to access this funding.
• Rural safety net providers do not often have HIT departments like their urban counterparts. In 2018, the Population Health Information Sharing & Analysis Organization developed a program that helps small to medium sized healthcare organizations with data breach reporting, identification of cyber attacks happening in real time, and the automatic mitigation of those threats.
• Marketing and outreach is limited for CommunityHealthIT because grants typically do not cover HIE expenses when communities are interested in partnering.
  

Replication

• Use shared community patient portals to help boost patients' engagement with their own healthcare needs.
• In working with local partners that are a part of a national corporation, be aware that your collaborative project can be stalled or slowed. Allow for more cushion in your timeline when setting goals for project completion.
• Helping rural communities start and establish HIT projects can take years. Prioritize the application of additional grants in order to continue the influx of money to support your partner projects.
• A verbal promise from an EHR vendor may not be honored. Having a HIT legal representative assist with contracts before signing is key.
• EHR and other technologies can be expensive. Develop a strong business plan and negotiate costs on behalf of members.
• Consider joining an Information Sharing and Analysis Organization (ISAO) to meet regulatory requirements, reduce cyber risk and identify cyber threats in the healthcare environment. Under Presidential Executive Order 13691, ISAOs are to:
  • Voluntarily disseminate critical cyber and related information
  • Communicate critical cyber and related information to help prevent, detect, mitigate or recover from the effects of a cyber systems' interference, compromise, or incapacitation
  • Analyze cyber-related information to ensure critical digital systems' availability, integrity, and reliability

Contact Information

Kendra I. Siler-Marsiglio, Ph.D., President
CommunityHealth IT
904.318.5803
kendra.siler@communityhealthit.org