Building on What Works to Connect Rural Utah

May 27, 2026May 28, 2026 by Ryan McLelland

Author:

Ryan McLelland

Chief Technology Officer (CTO)

Advancing healthcare interoperability is not just about adopting the latest technology. It is about building sustainable systems that serve everyone, especially the communities that have their own unique needs and healthcare dynamics.

UHIN leadership recently returned from the Civitas Networks for Health Annual Fly-In in Washington, D.C., where 20+ leaders from health information exchanges, health data utilities, and regional health improvement collaboratives spent the week in 47 meetings on Capitol Hill. As Utah’s state-designated, nonprofit Health Information Exchange, UHIN was at the center of those conversations. The message Civitas members carried into every office was consistent: locally governed, community-led organizations are the implementation layer that turns federal policy into real-world results.

That message landed at exactly the right moment. The Rural Health Transformation Program (RHTP), a $50 billion, five-year federal investment created by H.R. 1 (the One Big Beautiful Bill Act), is moving from announcement to execution. Utah received $195.7 million in first-year funding, with up to $500 million expected over the life of the program. How states deploy those dollars between now and 2030 will shape rural healthcare for a generation.

Here is what stood out from our time on the Hill, and what it means for Utah.

1. Rural Providers Need to Be at the Center

The ongoing debate over the Rural Health Transformation Program (RHTP) funding centers on a critical question: who is best equipped to help alleviate the struggles of medicine?

While the $50 billion investment has drawn a surge of venture-backed firms, there is growing concern that these entities prioritize a five-year revenue “exit” over the generational stabilization required to fix medical deserts and workforce shortages.

The Civitas perspective argues that the most effective stewards of this capital are the local, mission-driven organizations already embedded in these communities. The rationale for prioritizing nonprofit HIEs, local providers, and public health agencies is rooted in the specific challenges they are uniquely qualified to address:

Why Local Stewardship Matters for Rural Challenges:

With 50% of rural hospitals operating at a loss, venture-backed models often cherry-pick profitable services. Local providers, however, focus on maintaining “unprofitable” but essential lifelines like maternity care, preventing the expansion of maternity deserts.
Private firms often rely on temporary “locum tenens” or remote-only solutions. In contrast, local agencies invest in the “grow your own” strategy, which is 5.4 times more likely to result in long-term physician retention in areas where 70% of the population faces primary care shortages.
Technology-only solutions from external contractors often fail because they ignore the low health literacy and poor broadband infrastructure prevalent in rural zones. Local HIEs and public health offices have the “boots on the ground” track record necessary to help an aging population navigate these digital hurdles.

2. Don’t Reinvent the Wheel

A consistent thread across every conversation: state and federal dollars have already built much of the interoperability infrastructure RHTP now depends on. Health Information Exchanges, Health Data Utilities, All-Payer Claims Databases, and Quality Improvement Organizations are the connective tissue of community health data. They are already in place, they are governed by the people they serve, and they have decades of investment behind them.

The temptation with $50 billion of new federal money is to spin up something new and shiny. That impulse carries a real cost. Every dollar spent rebuilding what already works is a dollar not spent improving care in rural communities. Civitas members made the case repeatedly: the smart move is to strengthen and extend infrastructure that has been earned and tested over years, not to start over from zero.

This is the work UHIN has been doing in Utah for 30 years. The CHIE already moves clinical data securely across providers, payers, and public health partners. Our recently modernized, FHIR-aligned platform is ready to scale to meet the use cases RHTP is asking states to solve.

3. The Reality of RHTP, Honestly

There was real candor in these meetings about how the program came to be. RHTP was created by the same legislation that carried significant Medicaid changes. Several Civitas members and Congressional staff spoke about deep regret tied to those cuts. To be clear, many in the room do not view RHTP as a win. They view it as the reality we now have to work with, and they were honest that the program, on its own, will not offset what rural hospitals stand to lose when the funding window closes in 2030.

That said, this is the world we are operating in. RHTP is the tool in front of us, and Utah received $195.7 million in first-year funding to put it to work. The question is not whether to engage. It is whether we engage thoughtfully enough that, five years from now, rural Utah is in a stronger position than it is today, not facing a steeper cliff.

That requires honesty about the math. It also requires the kind of long-game thinking that nonprofit, community-governed organizations are built for.

4. Sustainability Is the Whole Game

If there was one word that came up in nearly every meeting, on both sides of the aisle, it was sustainability.

Some rural organizations cannot even absorb the funding being offered. They do not have the bandwidth, the technical staff, or the procurement infrastructure to take a fire hose of federal dollars in a 12-month window and turn it into durable change. That is not a failure on their part. It is a structural reality of rural health that this program has to plan around.

The harder problem is what happens in 2030. Programs stood up on five years of grant money have a way of collapsing the moment the money stops. The work that will outlast RHTP is the work that fits inside infrastructure that was already going to be here, supported by sustainable funding models, governed by people accountable to the communities they serve.

What This Means for Utah

UHIN exists for a simple reason: Interoperability for all. Better costs. Better care. That mission predates RHTP, and it will outlast it.

With 25 of Utah’s 29 counties designated rural, and many rural Utahns traveling more than an hour for hospital care and four to six hours one way to see a specialist, the case for a connected, statewide data foundation is hard to argue against. Rural providers need clinical, claims, and public health information harmonized in a way that is computable, real-time, and actually useful at the point of care. That is the foundation that makes everything else possible, from analytics and clinical decision support to the AI applications coming next.

UHIN has spent three decades building toward that picture. We operate a FHIR-aligned, statewide exchange. We coordinate data every day across hospitals, EHR vendors, payers, and public health agencies. We know rural Utah, because we have been showing up there for a long time.

If RHTP is going to deliver what rural Utah needs, the infrastructure to do it does not need to be invented. It needs to be invested in.

Get Involved

If your organization serves rural Utah and you want to talk about how the CHIE can support RHTP-related initiatives, or about what a sustainable, trusted, connected data foundation looks like in practice, reach out to us here. We are ready to roll up our sleeves.

References

Borders, T. F., Youngen, K., & Cecil, J. (2026). The social determinants of health—Rurality and pregnancy. PMC – NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC13095225/ Cited by: 5

CDC. (2026). Geographic and sociodemographic patterns in prevalence of diagnosed diabetes, US, 2021–2024. Preventing Chronic Disease. https://www.cdc.gov/PCD/issues/2026/25_0288.htm

Frontiers. (2026). Digital twin virtual hospitals and rural health disparities: a six-country comparative study (2018–2024). Frontiers in Public Health, 14. https://doi.org/10.3389/fpubh.2026.1741438

Orimaye, S. O. (2026). Roadblocks to rural health: State transportation policies’ impact on health care access in Virginia’s rural communities. American Journal of Public Health, 116(2), 175–179. https://doi.org/10.2105/AJPH.2025.308285

Youngen, K., Cecil, J., & Borders, T. F. (2026). How 2026–2030 digital health policies impact access & patient engagement. Rural & Underserved Health Research Center Publications. https://digitalcommons.liberty.edu/cgi/viewcontent.cgi?article=3008&context=research_symp

UHIN Connects Utah: Building the Healthcare Network Our Communities Deserve

March 10, 2026March 10, 2026 by UHIN

Graphic of data flowing through outline of Utah

Author:

UHIN

Healthcare works best when information moves as seamlessly as care itself.

With the right data and context, decisions are made faster and with greater confidence. When organizations share information responsibly, operations become more efficient. When communities invest in shared infrastructure, everyone benefits.

That’s the promise of healthcare interoperability. Realizing this promise of a fully connected network requires more than just agreeing with the philosophy – it requires organizations to take specific, concrete actions to participate.

A Shared Vision for Better Care

Utah’s healthcare community has long understood something essential: no single organization delivers care alone.

Patients move across settings. Doctors collaborate across systems. Health plans support care across populations. Government partners steward statewide health priorities. Outcomes depend on timely, accurate information wherever care happens or when decisions about patient care are made.

Interoperability makes this possible not by replacing existing systems, but by connecting them. It creates a foundation where information flows securely, consistently, while supporting a myriad of use cases.

This foundation is what UHIN provides today.

Infrastructure That Grows Stronger Together

UHIN operates Utah’s health information highway, the Clinical Health Information Exchange, or, the CHIE.

Utah’s shared infrastructure gives healthcare organizations secure access to comprehensive patient records across organizational boundaries.

Utah’s health information highway is designed to support all organizations who assist in the care, treatment, and health of Utah’s patients, including different providers across different systems to work as a single team to support the care journey of their shared patients. Effective information exchange requires infrastructure that adapts to how different stakeholders actually work: providers making real-time clinical decisions, health plans coordinating care across populations, and public health agencies tracking community-level outcomes.

The CHIE is a Shared Network

Managing dozens of point-to-point integrations is expensive, creates operational drag, and limits visibility across the care continuum. A shared network offers a different model: one connection that enables information to move across care settings, organizations, and systems.

Utilizing the CHIE, clinicians gain access to timely patient context, health plans can better support coordinated care and quality efforts, and public partners gain clearer insight into healthcare activity across the state. This all makes coordination easier to manage at every handoff – Health Plan to Provider, Health Plan to Health Plan, and Health Plans and Providers to Public Health.

Common Governance Instead of Fragmented Agreements

Trust is foundational to healthcare information exchange. The CHIE establishes a consistent, locally governed framework that supports responsible data sharing. Rather than navigating a patchwork of agreements, policies, and exceptions, UHIN welcomes organizations to participate within clear standards that promote accountability, transparency, and confidence across the ecosystem.

You save costs that are related to manually responding to data access and data sharing requests, and eliminate the time and expense spent on multiple legal and data transfer agreements – the CHIE already has them.

Common Stewardship Instead of Vendor Dependency

Infrastructure should serve the community it supports, not shift direction with market cycles or commercial priorities. UHIN operates as a neutral, non-profit utility, ensuring that Utah’s healthcare connectivity remains guided by community needs. Providers, payers, and public stakeholders collectively shape how the network evolves, supporting long-term sustainability and adaptability.

Together, these principles transform interoperability from a technical capability into a shared asset that grows stronger as participation increases.

Help Shape the Future

How do you know if your organization is helping build the healthcare network we all want to improve health outcomes and reduce costs?

To start, you should ask yourself and members of your organization these five questions:

1. Are you realizing the full value of interoperability?

Compare the membership fee to what you would have to pay to establish separate legal agreements and interfaces with each agency that UHIN connects with or manually respond to and submit records requests.

2. Are you using shared data to improve patient outcomes?

Connecting the pipe is the first step to make a real clinical difference. The next step is integrating CHIE data into workflows ensures providers actively use shared context to make smarter, safer decisions.

For example, Granger Medical Clinic used CHIE ADT alerts to grow patient identification from one per week to 750 per month, cutting readmission rates by 61%.

Tanner Clinic and Connect TCM brought their average readmission rate down to 4% — far below Utah’s 13.9% and the national average of 14.6%.

3. Are you actively sharing?

Passive consumption helps one organization; active sharing strengthens care coordination, improves outcomes, and elevates the entire system. Sending ADT feeds, lab results, and patient records in real time ensures everyone has the information they need, when they need it. Sharing a comprehensive, high-quality record empowers better clinical decisions and reduces gaps in care.

4. How is this community asset funded?

Your financial support through donation or membership sustains the maintenance, innovation, and long-term growth of the data sharing infrastructure that serves us all. UHIN also applies for grants to support the important work the CHIE provides to our community.

5. Do you want to be more engaged, but don’t know how?

For Current CHIE Users: Assess if your organization is helping shape the future of interoperability by asking yourself the questions above. Then, log in at www.uhin.org today to experience the modernized CHIE Platform firsthand. If you need a hand with your account, please contact customer support.

For Former CHIE users or New Organizations: Visit the CHIE Platform page to get the information you need to get started. If you’re ready to connect to the CHIE, you can get started here.

The value to the community of the exchange is realized when every participant holds themselves accountable to these standards. Organizations that ensure their data is timely, complete, and accurate (and who financially support the infrastructure) are the ones shaping the future of Utah healthcare interoperability.

To join this vital cause, organizations must implement the following concrete steps:

1. Move from consumption to contribution: Care does not begin or end within organizational boundaries. The network is strongest when you contribute the timely, complete, and accurate data that the next provider in the chain needs. Organizations must connect to the CHIE and actively share data, specifically by setting up ADT feeds, patient records, and lab results.

2. Align your care teams: Healthcare is a team effort. Shared infrastructure enables collaboration, but only if your internal workflows support it. Ensure your teams are utilizing the data available in the CHIE to gain a complete picture of patient history.

3. Tackle community challenges together: Leaders who build community infrastructure recognize that progress accelerates when stakeholders work from a shared foundation. Participation strengthens not only individual organizations but the resilience and responsiveness of Utah’s healthcare system as a whole.

4. Commit to the infrastructure: If you are relying on the network but not supporting it, becoming a paying member ensures this resource remains available and robust for the long term.

These leadership choices shape how care is delivered today and how it will evolve tomorrow.

A New Chapter for the CHIE

For organizations that have connected to the CHIE in the past, now is the time to take a fresh look.

UHIN’s platform has been modernized and enhanced to better support today’s care delivery needs. The CHIE is more capable, FHIR-aligned, and better positioned to scale as the healthcare community grows. The CHIE is working to assess statewide membership and data quality to improve the data available to the community. Providers, health plans, and public partners engaging with the CHIE today are experiencing a network designed for the future of healthcare in Utah.

If you’ve tried it before, you may be surprised by how much better it is now.

Across Utah, organizations are already using shared infrastructure to support care delivery, coordination, and statewide initiatives.

Screen grab of CHIE dashboard — New CHIE Dashboard

Moving Forward, Together

Behind every data feed, every alert, and every shared record is a patient whose care depends on a connected, informed care team. Utah’s information highway is in place. Its power is unlocked when every organization on the care continuum commits to using it fully. That’s how interoperability becomes more than a technical achievement — it becomes a promise kept to the people we serve.

Here is how to get involved:

For Former CHIE users or New Organizations: Visit the CHIE Platform page to get the information you need to get started. If you’re ready to connect to the CHIE, you can get started here.

UHIN Joins Utah Coalition to Improve CKD Detection & Care

May 8, 2025May 8, 2025 by UHIN

UHIN Supports Statewide Effort to Improve Chronic Kidney Disease Detection and Care in Utah.

The Utah Health Information Network (UHIN) is collaborating with Comagine Health, the Utah Department of Health and Human Services (DHHS), and the One Utah Health Collaborative to relaunch the Utah Chronic Kidney Disease (CKD) Coalition. The coalition is focused on improving early detection and management of CKD across the state, using data to inform and support its strategies.

UHIN’s Utah Clinical Health Information Exchange (CHIE) is being used to help develop an alert system that will notify primary care providers when lab results suggest CKD but no diagnosis has been recorded. This alert system is designed to help improve follow-up and diagnosis rates—addressing the reality that 50% of individuals screened for CKD currently do not receive a formal diagnosis or follow-up care.

Additionally, UHIN is evaluating aggregate health data to support early intervention strategies based on methodologies from the National Kidney Foundation. The coalition is exploring the potential for DHHS grant funding to support the implementation of these strategies if data and provider interest support it.

The broader initiative also includes supporting local health districts and clinics in their CKD care efforts and expanding awareness and education around treatment options for end-stage renal disease, such as home hemodialysis and peritoneal dialysis.

UHIN’s involvement is centered on providing the data and tools needed to help health care partners make earlier, more informed decisions in CKD care.

Leveraging Data for Public Health: UHIN’s Role in Tracking Post-COVID Conditions (PCC) in Utah

February 25, 2025February 25, 2025 by UHIN

Author:

UHIN

UHIN has played a pivotal role in a recent Centers for Disease Control and Prevention (CDC) project aiming to track the burden, distribution, and impact of Post-COVID conditions (PCC) in Utah. This initiative, detailed in a study published in BMC Public Health, leverages electronic health records (EHRs) and data from The CHIE (Clinical Health Information Exchange) to identify and analyze cases of PCC, commonly known as long COVID. Researchers aim to understand the prevalence, demographic distribution, and healthcare utilization patterns associated with PCC.

The study provides insights into the long-term effects of COVID-19 and highlights the importance of continuous surveillance to address the ongoing health challenges posed by the pandemic.

Visit BMC Public Health

UHIN’s Involvement in the Project

UHIN, as the only HIE in Utah, was an important contributor to this research. Since 1993, we have been committed to reducing healthcare costs and improving the quality of care through secure electronic data interchange. Our extensive network connects healthcare insurers, physicians, hospitals, laboratories, local health departments, and state agencies, enabling seamless data sharing across the state’s healthcare ecosystem.

In this project, UHIN provided a limited dataset including PCC cases and patient trajectories over time. By providing a limited dataset, UHIN was able to support the project, as allowed under HIPAA, while maintaining patient privacy and data integrity.

Collaborative Approach

A collaborative approach fostered partnerships among various healthcare entities, facilitating the aggregation of diverse data sets. Partners in this work are BeyondHIE, Indiana University, Boise State University, the Bronx Regional Health Information Organization (Bronx RHIO) and Comagine Health (our affiliate partner). This inclusivity enabled a more comprehensive understanding of PCC, as data from different sources provided a holistic view of patient experiences and outcomes. UHIN’s commitment to interoperability and data standardization was key to harmonizing information from multiple providers, ensuring consistency and reliability in the study’s findings.

In Conclusion

The success of this project underscores UHIN’s vital role in national health initiatives. By serving as a central hub for health information exchange, UHIN not only supports clinical care but also empowers research efforts that address pressing health concerns. Our infrastructure and expertise in data management are assets in the ongoing battle against COVID-19 and its long-term effects.

Our involvement in this PCC surveillance project adheres to our mission to enhance healthcare through innovation, collaboration, and inclusiveness. By providing the tools and frameworks necessary for comprehensive data analysis, we are proud to continue to contribute significantly to public health research and the improvement of patient care.

What is a Health Data Utility?

December 23, 2024December 23, 2024 by Navina Forsythe

Author:

Navina Forsythe

There is a national trend of Health Information Exchanges (HIEs) evolving into Health Data Utilities (HDUs). What is a Health Data Utility? The Consortium for State and Regional Interoperability defines a HDU as “a locally governed, public-private resource providing a source of truth for robust clinical and non-clinical data” to benefit state and other members of the healthcare ecosystem by providing data.

Much of the conceptualization of HDUs was done by Civitas Networks for Health, The Maryland Health Care Commission & CRISP, and the Consortium for State and Regional Interoperability. The HDU is the next phase for HIEs, recognizing that the data in an HIE is a valuable resource that can be utilized beyond just single patient lookup. It can be utilized for quality improvement, population health, research, and combined with other datasets for advanced analysis.

Data is the Lifeblood of an Organization

There is a saying that data is the lifeblood of an organization. Data is critical to identify areas and populations of need, understand and describe current status, evaluate interventions, improve efficiency, inform decisions, discover and adapt to changing conditions, and drive innovation. The COVID pandemic highlighted both the need for data and to identify gaps in data accessibility. The federal government has been working for the past two decades to improve the collection and availability of data to improve health care through initiatives such as the Health Information Technology for Economic and Clinical Health Act (HITECH), the formation of the Office of the National Coordinator (ONC), the 21st Century Cures Act and its Information Blocking provisions, and the Trusted Exchange Framework and Common Agreement (TEFCA) for national health information exchange. HDUs provide the infrastructure for data accessibility.

What HDUs Can Do

Data is critical to identify areas and populations of need, understand and describe current status, evaluate interventions, improve efficiency, inform decisions, discover and adapt to changing conditions, and drive innovation. The COVID pandemic highlighted both the need for data and to identify gaps in data accessibility. The federal government has been working for the past two decades to improve the collection and availability of data to improve health care through initiatives such as the Health Information Technology for Economic and Clinical Health Act (HITECH), the formation of the Office of the National Coordinator (ONC), the 21st Century Cures Act and its Information Blocking provisions, and the Trusted Exchange Framework and Common Agreement (TEFCA) for national health information exchange. HDUs provide the infrastructure for data accessibility.

Necessary Conditions

Necessary conditions for a HDU are considered to be a shared vision, political will/state policy, broad stakeholder participation, multi stakeholder governance, a legal framework, mature use cases, data privacy and security, and secured funding. The American Language Exchange Council has developed model language for a Statewide Health Data Utility Act. They believe that a “state health data utility can help achieve better patient outcomes, and improve overall health and wellbeing of the people of the state. It can also reduce the cost of healthcare services by creating a more seamless, transparent, and modernized approach to sharing health information. The health data utility will comply with all federal and state privacy laws and allow for an opt-out for patients who choose not to share their data.”

In Conclusion

UHIN established the Utah Clinical Health Information Exchange in 2007 to bring together a patient-centric, longitudinal record amongst disparate healthcare systems and organizations. We strive to make data accessible for better costs and better care. Evolving into an HDU, while also balancing patient privacy needs, is the next step.

CIVITAS Call for Public Comment: HDU Framework Supplement Version 1

Civitas Networks for Health invites public comment on the draft HDU Framework Supplement Version 1, which outlines critical updates to the existing Health Data Utility Framework. This supplement highlights actionable strategies for advancing health data governance, interoperability, and equity across states and regions.

Comment Deadline: January 31, 2025

Access the HDU Framework Supplement Version 1:

Download

Comments: Feedback Form or via email to hdu@civitasforhealth.org

Unlocking the Potential of FHIR: An Overview of its Impact and Future

June 26, 2024August 1, 2024 by Ryan McLelland

Author:

Ryan McLelland

Chief Technology Officer (CTO)

As the CTO of UHIN, I’ve seen firsthand the challenges and frustrations of trying to achieve seamless interoperability. Data silos, incompatible formats, and outdated standards have long hindered our ability to share information effectively. But HL7® FHIR® (Fast Healthcare Interoperability Resources) offers a glimmer of hope, a path toward a more connected and efficient healthcare ecosystem.

Understanding FHIR: A Paradigm Shift

FHIR represents a paradigm shift in healthcare data exchange. Unlike older standards like HL7 v2, which often resemble complex, rigid blueprints, FHIR is akin to a set of modular building blocks. These blocks, called “resources,” represent discrete units of healthcare information – a patient record, a medication order, a lab result, and so on.

The true power of FHIR lies in its flexibility. Resources can be combined and exchanged in various ways to suit specific needs. Need to share a patient’s medication history with a specialist? FHIR allows you to do that without sending the entire medical record. Want to integrate a new mobile app with your EHR system? FHIR’s web-friendly technologies make it easier than ever.

Dispelling the Myths: FHIR is NOT a Panacea

While FHIR offers immense potential, it’s important to be realistic about its limitations. It’s not a magic wand that will instantly solve all our interoperability woes.

First and foremost, FHIR is a standard, not a solution. It provides a common language for exchanging healthcare data, but it doesn’t address the underlying technical and organizational challenges that often impede interoperability.

Second, FHIR is not a plug-and-play technology. Implementing it requires careful planning, technical expertise, and collaboration among stakeholders. Organizations with legacy systems may face particularly daunting challenges.

Finally, FHIR doesn’t guarantee interoperability. While it facilitates the exchange of data, it doesn’t ensure that the data will be understood and used consistently across different systems. Achieving true interoperability requires not just technical compatibility but also semantic interoperability – the ability to interpret and apply data in a meaningful way.

The Benefits of FHIR: A Catalyst for Innovation

Despite its limitations, FHIR offers significant advantages over older standards. Its flexibility, ease of use, and strong community support make it a powerful catalyst for innovation.

By adopting FHIR, healthcare organizations can:

Improve data sharing: FHIR enables more granular and tailored data exchange, making it easier to share information with the right people at the right time.
Accelerate development: FHIR’s web-friendly technologies lower the barrier to entry for developers, potentially leading to faster innovation.

For example, UHIN’s Clinical Health Information Exchange (the CHIE) is currently migrating to a new FHIR-enabled platform. Built on a highly scalable architecture, the platform allows for more efficient and secure sharing of data across enterprises.

The Road Ahead: A Strategic Approach to FHIR Adoption

To reap the full benefits of FHIR, healthcare organizations need to adopt a strategic approach. This involves:

Developing a clear roadmap: Start by defining your interoperability goals and identifying specific use cases where FHIR can add value. Transitioning totally functional workflows from older specifications to FHIR, just for the sake of using a more modern data structure, won’t create new healthcare outcomes on its own. We need to use FHIR when it’s appropriate and when it will provide the most advantage to our interoperability goals.
Building a strong foundation: Invest in the necessary infrastructure, tools, and expertise to support FHIR implementation.
Collaborating with stakeholders: Engage with vendors, partners, and other stakeholders to ensure that FHIR implementations are aligned and interoperable.
Focusing on education and training: Ensure that your team has the knowledge and skills to work with FHIR effectively. While the FHIR structure can lead to an easier onboarding of software engineers, it also increases the complexity of a given use case by having multiple resources required to accomplish the same goal that a single CCDA may have solved previously. HL7 International offers online courses covering the fundamentals (for a price) and educational videos on its YouTube page here.
Embracing a culture of innovation: Foster a willingness to experiment and adapt as FHIR evolves. Many early adopters of FHIR were burned by the rapid change that occurred from version to version of FHIR. Knowing that there will be maturation of the standard is important to understand before starting an implementation.

Conclusion: The Future of Healthcare Data Exchange is FHIR

FHIR is not a silver bullet, but it is a significant step forward in our quest for interoperability. By embracing FHIR and addressing the challenges it presents, we can unlock a wealth of opportunities to improve healthcare delivery, enhance patient outcomes, and drive innovation.

The future of healthcare data exchange is FHIR. Let’s seize this opportunity to build a more connected and efficient healthcare ecosystem.

The Power of Resilient and Redundant Healthcare Technology Systems

May 15, 2024May 15, 2024 by Brian Chin

Author:

Brian Chin

Chief Executive Officer (CEO)

Redundancy and resilience are two foundational principles to ensure healthcare technology systems remain functional, particularly in the midst of challenges and disasters, like outbreaks and data breaches. This became apparent during the COVID-19 pandemic and recently in light of the Change Health Care incident. Establishing redundancy and resiliency in healthcare technology ensures sustained, comprehensive interoperability. This is critical particularly in healthcare, where any system failure can have serious consequences for patient care. As healthcare becomes more digitized and interconnected, the complexity and potential vulnerabilities of these systems also increase. This necessitates a stronger focus and shared responsibility to build resilience and redundancy into healthcare technology systems.

Resilience is defined as the ability to prepare for, manage (absorb, adapt and transform) and learn from shocks (source: National Library of Medicine). Given the interoperable nature of our healthcare ecosystem, resilience focuses on identifying and filling gaps between systems, networks, and connected ecosystems.

Redundancy is defined as provision of duplicate, backup equipment, processes, pathways or systems that immediately take over the function of existing functionality or business processes (source: Gartner). For instance, if a primary server fails, a backup server can take over, ensuring that patient data is still accessible and that critical healthcare services can continue. Following the Change Health Care incident, The American Hospital Association (AHA) made recommendations about “backup technology which renders the backups “immutable” — unable to be deleted, altered or encrypted.”

Building a resilient and robust healthcare technology system involves strengthening human resources, infrastructure, and technological capacities. This includes investing in technology training for healthcare workers and building robust and resilient IT infrastructure. It also means promoting strong primary healthcare interoperability, which heavily relies on interconnected data sharing for health data management, communications, and HIPAA-compliant claims management. This is specifically relevant in times of crisis.

For example, at the start of the COVID-19 pandemic, UHIN initiated real-time notifications from hospitals and labs in and around Utah that could be sent directly to healthcare providers, ACOs and care managers. This focus on interoperability enabled all stakeholders to monitor and coordinate care more effectively for their patients, especially those in greater need of physician intervention. Real-time notifications enabled participants to act swiftly, reduce manual labor, and access data from care partners more easily. UHIN continues to deliver COVID-19 lab result alerts today.

Building resilient and redundant healthcare technology systems is not just about investing in technology. It’s also about investing in the people who use these systems. Developing partner relationships is key to building resilient and redundant healthcare technology systems. By fostering collaboration and open communication, organizations can jointly tackle the complexities of healthcare technology, ensuring that systems are robust, adaptable, and capable of supporting seamless interoperability. Strong partner relationships also facilitate the sharing of best practices, innovative solutions, and technical expertise, thereby enhancing system resilience and redundancy. Ultimately, these partnerships contribute to a more reliable, efficient, and patient-centered healthcare technology ecosystem.

The Benefits & Challenges of Interoperability in Disaster Recovery

When it comes to interoperability, which refers to the ability of different systems and organizations to communicate and exchange information effectively, the healthcare ecosystem relies on maintaining seamless operations in times of success and disaster. There are both benefits and challenges associated specifically with disaster recovery for interoperability. Let’s explore them in more detail:

Benefits:

Data Accessibility and Availability: Interoperability in disaster recovery ensures that data remains accessible and available across different systems and organizations during and after a disaster. This capability enables timely decision-making, efficient coordination, and effective response efforts.

Collaboration and Coordination: Disaster recovery for interoperability promotes collaboration and coordination among various entities involved in the recovery process. It allows different organizations, such as emergency responders, to share critical information, resources, and expertise, thereby enhancing overall response effectiveness.

Rapid Information Exchange: Interoperability facilitates the rapid exchange of information between different systems and stakeholders. This enables real-time situational awareness, timely updates, and the ability to make informed decisions based on accurate and up-to-date data.

Seamless Integration: Disaster recovery efforts that prioritize interoperability ensure seamless integration between disparate systems. This integration enables smooth data flow, eliminates information silos, and enhances the overall efficiency and effectiveness of the recovery process.

Challenges:

Technical Compatibility: Achieving interoperability in disaster recovery can be challenging due to the need for technical compatibility between different systems, platforms, and protocols. Integrating legacy systems with newer technologies, addressing data format inconsistencies, and ensuring seamless communication can require significant effort and resources.

Data Standardization: In disaster recovery scenarios, different organizations often use their own data standards, formats, and terminology. Harmonizing and standardizing these diverse data elements can be complex and time-consuming. Without consistent data standards, interoperability may be compromised, leading to delays, miscommunication, and errors.

Security and Privacy Concerns: Interoperability in disaster recovery requires the secure exchange of sensitive information among multiple entities. Ensuring data confidentiality, integrity, and availability while maintaining privacy rights is a significant challenge. Robust security measures and protocols must be in place to protect against unauthorized access, data breaches, and potential misuse of information.

Governance and Policy Alignment: Coordination and governance among multiple stakeholders are crucial for effective disaster recovery interoperability. Aligning policies, procedures, and decision-making frameworks across different organizations can be complex, especially in large-scale disasters involving multiple jurisdictions and diverse stakeholders. Clear governance structures and collaborative frameworks must be established to overcome these challenges.

Conclusion

In conclusion, interoperability offers numerous benefits in times of success and during disaster recovery, including data accessibility, collaboration, rapid information exchange, and seamless integration. However, challenges such as technical compatibility, data standardization, security concerns, and governance issues need to be addressed to maximize the effectiveness of interoperability efforts in the face of disasters. Organizations and stakeholders must work together to develop robust solutions that enhance interoperability while ensuring the resilience and reliability of their recovery processes.

While challenges persist, it’s important for organizations to work together to address these issues and ensure they’re able to reap the benefits of interoperability. Community engagement, including involvement of patients, providers, health plans, and other stakeholders in the design and implementation of health technology systems can ensure they are interoperable, effective, and align with their distinct needs and preferences. As technology continues to evolve, resiliency and redundancy will become increasingly important to achieving interoperability. Organizations that prioritize interoperability will be better equipped to succeed in today’s digital world.

The future of healthcare technology systems will depend on their capacity to adapt and evolve in response to new challenges and changing conditions. This means not only being able to respond effectively to immediate crises, but also preparing for long-term changes and uncertainties. By taking a comprehensive and multifaceted approach, we can build healthcare technology systems that are robust, resilient, and redundant in a way that meets the needs of everyone in healthcare.

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The Future of Healthcare Cybersecurity

March 28, 2024April 3, 2024 by Keith Roberts

Author:

Keith Roberts

Information Security Analyst

The experiences of 2023 have underscored the critical importance of cybersecurity in the healthcare sector. Per HIPAA Journal, “133 million records were exposed or stolen” in 2023. The recent Change Healthcare cyber incident, which is still impacting the healthcare ecosystem, indicates that 2024 could likely be another record-breaking year for healthcare cyberattacks in the U.S.

Ransomware attacks are the fastest growing threat in the U.S. The U.S. Department of Health and Human Services (HHS) and Office of Civil Rights (OCR) identified a 278% increase in cyberattacks involving ransomware from 2018-2022. To clarify, this is just the data breaches that were reported to the OCR.

The fallout from a ransomware attack is comprehensive:

Loss of personal health data
Loss of trust by patients, members, customers and partners
Decrease in employee productivity and morale
Extensive system downtime
Legal and regulatory fines
Steep financial implications, like paying the ransom and the cost to get systems back up and securely running

The global average cost of a data breach in 2023 was $4.45 million, a 15% increase over 3 years.
IBM Cost of a Data Breach Report 2023

The alarming rise in cyber threats – namely ransomware – highlight the urgent need for enhanced cyber resiliency and robust security measures in healthcare. The healthcare sector is predicted to continue its investment in cybersecurity, focusing on resilient data management practices, threat detection, and employee training, while expanding into new technologies (like artificial intelligence) and collaborative efforts.

Here are five ways to reduce your risk and secure personal health information (PHI) from cyberattacks

1. Consistent Data Management Practices

Consistency is key, especially when it comes to basic cyber protection. These five stepping stones are just a start to laying out a consistent cybersecurity plan.

Create a secure cybersecurity policy – Establish a firm security stance, then periodically review, modify and update policies and procedures in response to environmental or operational changes affecting the security of Electronic PHI.
Encrypt data – Convert data to ciphertext that can only be read if decrypted
Backup data – Ensure PHI data are backed up frequently, at least nightly, and stored in a HIPAA-compliant data center
Update systems and software – Verify information systems are up to date with the latest security patches and diligently check programs for updates.
Assess and monitor vendors – Ensure that third-party vendors agree to a business associate agreement (BAA) and monitor their activities to be sure they adhere to the policies. Review vendors to ensure compliance on a consistent basis.

2. Detection

As Benjamin Franklin said: “If you fail to plan you are planning to fail.” Detecting and addressing vulnerabilities in advance of an incident is critical to ensuring a strong security posture. The investment in audits and technology improvement almost always outweigh the costs of a ransomware attack.

Implementing a threat detection strategy is critical to identifying and preventing data breaches. Healthcare institutions and security leadership, like the chief information security officer (CISO), are investing more in security infrastructure. Guidehouse’s 2024 report found 85% of respondents’ organizations planned increases to their 2024 digital and IT budgets, with cybersecurity listed as their top investment priority. This demonstrates the industry’s commitment to safeguarding patient data.

By 2026, organizations prioritizing their security investments based on a continuous threat exposure management program will realize a two-thirds reduction in breaches.
Gartner

3. Employee training

To err is human and healthcare employees are no exception. Taking a human-centric approach to organizational security can cultivate shared cybersecurity responsibility, which in turn could dramatically reduce the chances of a data breach, HIPAA violation, and the costs associated with both. Given that social engineering now represents more than 50% of incidents (per Verizon’s DBIR Report 2023), the focus on the human element is pivotal to securing your data.

Adopting this approach can (1) increase awareness of accidental and intentional HIPAA violations, and (2) empower appropriate responses to social engineering. Ultimately staff need to make decisions and take action. However, leadership must engender the organizational identity around shared security responsibility.

Instilling the values of cyber detection and resiliency helps employees feel more invested. If they understand what’s at stake, then they can make quicker decisions and adhere to monotonous, daily security measures, like multi-factor authentication (MFA).

By 2027, 50% of large enterprise chief information security officers (CISOs) will have adopted human-centric security design practices to minimize cybersecurity-induced friction and maximize control adoption.
Gartner

Employers and employees should be aware of the human elements that factor into data breaches, including:

Stolen credentials – Implement a strong password protocol that eliminates easy to hack passwords or the use of post-it notes with passwords on desks.
Phishing – Monitor email (and other technology) and train employees to recognize signs of phishing, such as unusual messages from leadership or HR, and clicking on links or attachments from unknown sources.
Error and Misdelivery – Ensure employees review the recipient of all of their communications so they don’t send PHI or other data to the incorrect audience.

One place to start: Conduct regular employee training.

Healthcare organizations can use a wide range of training programs and courses to keep employees up-to-speed on the latest security best practices. Updated approaches will mitigate insecure employee behaviors and tackle outstanding cybersecurity risks.

Security leaders should continue to review vendors and software to ensure they meet all requirements (such as HIPAA regulations) to effectively evaluate and educate staff, and reduce overall risk.For small and medium sized employers who have limited resources, HHS is providing free cybersecurity training courses for their staff.

4. Artificial Intelligence (A.I.)

Like nearly every other sector, the healthcare vertical is actively exploring and investing in A.I. Specifically, how it can improve data security. In fact, 73% of CIOs said they’re increasing investments into A.I. and Machine Learning (ML) (Per Gartner, 2024 Gartner CIO and Technology Executive Survey).

A.I. solutions present vast opportunities for automation: from visualization of networks, to identifying vulnerabilities at scale, to detecting suspicious behavior. Furthermore, machine learning models and A.I.-driven security can aggregate knowledge from previous experiences (in your own system and broader ecosystems) to predict and quickly respond to abnormalities. This knowledge can accelerate cyber defense within an organization and empower health systems to take proactive, automated measures to protect its network.

Before considering A.I. or another new technology, healthcare companies should continue to focus on shoring up foundational security technologies. This includes firewalls, encryption, and MFA.

5. Collaboration

One entity cannot secure everyone. Healthcare is built on interoperability. The strength of every single bond can determine the success or failure of our ecosystem. Hospitals, payers, providers, third-party vendors, and government entities must work together to ensure our security against cyber attacks.

Collaboration between healthcare institutions is anticipated to increase. While the use of disparate systems creates barriers to collaboration, the focus on standardization and interoperability can develop a more holistic, resolute system. By sharing knowledge and resources, we can collectively strengthen our defenses against cyber threats.

The U.S. Government continues to put cybersecurity in the healthcare industry at the forefront, instituting policies in the National Cybersecurity Strategy that will address cyber threats. Learn more about the HHS and the National Cybersecurity Strategy here.

In Conclusion

Early investments in consistent practices, detection, employee education, new technologies and collaboration can ensure a strong security posture that offsets potential costs of recovery and crises of confidence caused by a data breach. The lessons learned from 2023 have made it clear that cybersecurity is not just an IT issue, but a patient safety issue. As we move into the future, it is critical that the healthcare sector continues to prioritize and invest in cybersecurity measures to safeguard patient data and ensure the seamless delivery of healthcare services.

Health and Tech Professionals Gather Once Again at the 2023 HIT Conference

September 1, 2023December 18, 2023 by UHIN

Our annual Health Information Technology Conference (HIT) will return to Salt Lake on Wednesday, October 18 at the Conference Center at Gail Miller Campus, SLCC. This year, we’ll look towards the “future of healthcare interoperability” with speakers, leaders and professionals from across the healthcare and technology continuum. While we will also celebrate the fact that 2023 marks our 30th year as an innovative organization, we will keep our focus on what’s coming up in the world of healthcare and technology. Some of our most exciting topics include:

Artificial Intelligence in healthcare
Billing for today and beyond
Cybersecurity
Digital transformation in healthcare
Documentation burden
HL7 and FHIR
Health equity
Health Data Utilities (HDUs)
Medicare updates
Mental health and burn out
Population Health

Keynote Speakers:

Dr. Angela Dunn, Executive Director of the Salt Lake County Health Department, will deliver our welcome keynote address in the morning.

Joy Rios, founder and host of the HIT Like a Girl podcast, will present the afternoon keynote address.

We look forward to seeing you on October 18th!

Provider Credentialing and Provider Enrollment: What’s the Difference and Why Does it Matter?

May 30, 2023May 30, 2023 by UHIN

Provider enrollment is crucial for health plans to ensure that members have access to a full range of services. Credentialing verifies a clinician’s training and licensing. Enrollment establishes the technical connection between the provider and the plan. The processes can be complex and time-consuming, but partnering with dedicated enrollment experts – like UHIN – can help streamline the onboarding experience and accelerate success in a highly competitive marketplace.

Why Enrollment Matters

Health plans are constantly looking for better ways to serve the insured, from developing innovative wellness benefits to making it easier to access high-quality, affordable care in the community.

Provider network development is a huge component of this quest for continuous improvement. Contracting with the right mix of providers – and enough of them – ensures that members can get a full range of services within an acceptable time frame.

Building this ecosystem isn’t always easy, especially when it comes to the nuts and bolts of bringing clinicians on board. Provider credentialing and provider enrollment are equally critical, yet they can often cause confusion and problems on both sides of the plan-provider relationship.

In fact, providers not being registered/credentialed with a payer is the #1 reason for denials. The #2 reason for denials: the provider did not complete the payer-required process for enrollment.

Both steps – credentialing and enrollment – are crucial. However, even the fundamental differences between the two activities aren’t always clear, especially because they bump up against each other during onboarding. It’s important to understand what’s involved in each process, how they work, and why finding the right partner matters so much to health plans as they grow and mature.

What is Provider Credentialing?

Provider credentialing is the act of verifying that a clinician has the correct training and licensing to practice in their area of expertise. It’s similar to an extensive background check. The process starts after a provider submits a request to work with a practice, health system, or health plan. Collecting this extensive dataset can take up to three months or longer.

While UHIN does not currently support the credentialing process, certain industry applications are in place, including the CAQH credentialing application. Until the credentialing process is complete, a provider cannot finish the rest of the enrollment process with a health plan. This is especially important for 98 percent of providers in the US who participate in Medicare and Medicare Advantage. In addition, nearly every health plan, including Medicare, requires EDI enrollment in order to start getting reimbursed for services.

What is Provider Enrollment?

Once a provider is officially welcomed into the network, the majority of health plans will require them to complete Electronic Data Interchange (EDI) enrollment, which is the technical connection between the provider and the plan. EDI enrollment allows providers to submit electronic claims to the plan and receive remittance for their services.

Electronic claims submission is nearly universal in the medical industry, according to the latest CAQH index report. In 2022, 97 percent of claims submissions transactions occurred electronically, giving both providers and health plans a strong motivation to ensure they are appropriately connected.

Unfortunately, neither the administrative nor the EDI enrollment processes are standardized across different health plans. This forces providers to juggle many different requirements and documentation requests for each individual payer. The complexity of managing requests from a slew of disparate plans and providers can lead to mistakes and omissions that extend the timeline.

Even more information may be required during EDI enrollment than credentialing. This can take an additional four to six weeks (or longer) on top of the credentialing timeframe. This is especially true if extensive contract negotiations are necessary or IT challenges get in the way.

In addition, smaller provider groups often do not have enough people-power to devote exclusively to enrollment, making it even more difficult for plans and providers to work together effectively.

UHIN’s Enrollment Team provides detailed next steps for enrollment based on each specific payer and transaction type for each case. Additionally, we provide defined next steps to move forward with enrollment, based on the payer requirements. UHIN can be reached at enrollment@uhin.org and we will be happy to provide enrollment direction, advice and helpful support through the EDI enrollment process.

How Can Health Plans Streamline Enrollment Processes?

Just like many other areas of the healthcare ecosystem, provider EDI enrollment can significantly benefit from digitization and strong partnerships with expert teams. The widespread lack of standardized processes means plans and providers have to consider each request as a one-off, which can take a great deal of time and effort to parse through without some help.

Charting a Course for Success

When working with providers, health plans should offer clear and detailed instructions on the information needed and the deadlines for delivering it.

Plans should assess their needs by charting out their existing enrollment workflow and identifying any bottlenecks that lead to lag time. Often, these pain points are related to delays in collecting information from providers and internal delays in processing paperwork once received. The result of these delays are wild swings in average completion time for provider onboarding, which creates unpredictability on both sides of the relationship.

Finding the Right Support

On the internal front, plans should seek out enrollment partners that can field provider requests on behalf of the payer, taking the task off the shoulders of health plan staff. It should take a specialist enrollment team less than one business day to process a request once all of the information is received. There may be additional waiting time depending on the unique payer requirements.

Health plans and providers should make sure they are working with a dedicated enrollment team that can take deep dives into problem-solving when unique technical or administrative challenges arise, such as a technology enhancement that can lead to the need for a process rewrite.

An experienced partner, such as UHIN, offers an expert enrollment team to help navigate the complicated enrollment process. Although we do not currently provide credentialing support, we have a proven history in expediting and accurately guiding providers through the enrollment process. Our enrollment team is based in the US and delivers in-depth knowledge and support to make the enrollment process as frictionless as possible. We can handle any questions you may have in this complicated and critical process.

Partnering with the Right EDI Enrollment Experts

Enrollment involves complex activities with many moving pieces. Getting them right is vital for the success of health plans and provider groups. By understanding the nuances of the process, plans and providers can start to tackle the pinch points that make network development so challenging. Plans that enlist the help of dedicated partners to take on key tasks, such as enrollment, have a better chance of creating a smoother onboarding experience and accelerating their success in a highly competitive marketplace.

UHIN’s enrollment team offers years of experience helping providers through the enrollment process. We provide direct support and in-depth knowledge to expedite the enrollment process and get providers over the finish line no matter how complex or unique the process may be.

Are you a current provider with a UHIN account and interested in learning more about enrollment? Contact enrollment@uhin.org or customer service at 877-693-3071.

If you’re new to UHIN, click below and tell us how we can help streamline EDI enrollment onboarding and relieve burdens for your health plan!

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