In their rural health transformation plans, many states are investing in connecting rural provider organizations to health information exchanges (HIEs). But states with more advanced HIEs or health data utilities are envisioning more sophisticated innovations. 

For instance, the narrative for Maryland’s program envisions CRISP increasing provider data sharing and data quality through outreach, integrations, automating manual feeds and targeted technical assistance for new rural providers.

But it also expects that CRISP will pilot AI technology to improve clinical workflows. It describes the state health data utility as working to implement AI search functionality to allow providers to search the HIE for specific encounters, diagnoses, and medications. This will be developed with provider input and piloted in select rural areas. 

The state also wants CRISP to develop predictive alerts that notify care teams when a patient’s risk level changes based on HIE data.

In the behavioral health data sharing realm, the state wants to build a central registry for methadone dosage information among opioid treatment programs, EMS, and hospitals and share EMS and hospital overdose data with local health departments to facilitate more rapid outreach and treatment initiation. It also wants to enable access to the HIE from EMS EMR platforms to emergency providers with patient clinical and care management information and extract mobile integrated health reporting from community paramedicine to incorporate in the HIE.

Still another goal is to develop interoperability capabilities for commercial and CRISP tools through standards or FHIR APIs that allow screening and referral platforms to exchange electronic health data efficiently and securely, and integrate screening data with EHR vendors.

Finally, the state proposed allocating RHTP funding to CRISP for a centralized telehealth infrastructure. As Maryland’s backbone of interoperability, CRISP will enable telehealth to operate as part of an integrated healthcare ecosystem by connecting telehealth platforms with EHRs and supporting standardized data exchange for real-time information sharing.

Integrating AI to enhance functionality of the Indiana HIE

Indiana plans to spend $66.5 million over the five-year funding period on rural HIE transformation. Noting that Indiana’s HIE network connects about 120 hospitals and supports transitions of care between connected providers; the state adds that an estimated 700 rural healthcare facilities are not connected. One-time financial incentives will be provided to rural health systems to support start-up costs associated with the initial implementation. A cost sharing model for these one-time incentives will be determined to ensure rural health systems invest in determined upgrades.

Through this initiative, the state will connect about 450 rural healthcare facilities, including CAHs, rural hospitals, private practices, FQHCs, community mental health centers (CMHCs), Certified Community Behavioral Health Clinics (CCBHCs), child welfare providers, skilled nursing facilities, health departments, correctional facilities, and EMS.

The state said it would modernize the provider portal from within the HIE that allows connected providers and state partners to access the suite of integrated health data. Indiana’s project narrative says this includes exploring the potential for integrating AI technologies to enhance the functionality of the HIE, ensuring a thorough evaluation of its feasibility and benefits in areas such as:

• Ability to reduce medical error by evaluating for drug interactions
• Natural language processing to inform clinical decisions and reduce clinician burden of chart search
• Predictive analytics for population health and disease states
• Evaluating outcomes and quality of services to inform value-based decisions
• Develop individualized tailored treatment plans
• Decrease healthcare utilization (radiology, labs, testing) through clinical decision tools.

The state said that IHIE will integrate mobile integrated health (MIH) and Community Paramedicine Programs into HIE to support development and availability of critical dashboards and coordination between EMS and other provider types. It claims this will strengthen the rural healthcare ecosystem by addressing long-standing data gaps within the current HIE, including through the development of targeted dashboards to boost service speed and quality. This could lead to enhanced care coordination, improved health/public health outcomes for chronic diseases, infant mortality, behavioral health, and cut overall costs.

Community information exchange in Michigan

Data integration pilot projects will support four cohorts of left-behind provider types, including EMS, rural clinics, FQHCs and community-based organizations to develop data exchange solutions. Rural sites will be selected based on high EMS volumes and rural community needs.

Shared EHR in Vermont

Vermont is taking an unusual approach by incentivizing adoption of a shared EHR platform to strengthen data sharing and care coordination across the state. The state’s project narrative notes that while the Vermont HIE (VHIE) provides a robust platform for secure health data exchange, Vermont’s hospitals and providers currently use a variety of EHR systems that cause administrative burden, increase complexity, and cause staff who work at multiple facilities to use different tools. This new initiative would implement a shared EHR that complements and continues to contribute data to the VHIE. 

Participation would be voluntary and designed to achieve seamless data exchange, support improved image and lab sharing, enhance cybersecurity, and allow advanced data analytics. The state believes that leveraging the VHIE’s existing infrastructure for state-wide sharing, while promoting a shared EHR, would reduce administrative burden, improve care coordination— particularly for rural populations—and advance statewide health system integration.