Denise Hines  00:06

So when we talk about maternal health, you know, it’s it’s almost shocking how dramatic of a problem this is in our in our country. And it’s not just a women’s issue. It’s a human issue. According to the CDC that more than 60% of pregnancy-related deaths are in America are preventable.

Gregg Masters  00:27

PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via digitally curated content for omnichannel distribution and engagement. Connect with us at www.PopUpstudio.productions. Welcome, everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co-host of pop Health Week. Joining me in the virtual studio is my partner colleague and co-host of PopHealth Week Fred Goldstein president of Accountable Health LLC. On today’s show our guest is Denise Hines who holds a doctorate in health administration, is a certified project management professional and admitted fellow of the Healthcare Information Management System Society who serves as the HIMSS Chief Americas Officer, Dr. Hines is an award-winning nationally recognized expert in healthcare technology. She has more than two decades of healthcare experience in a variety of settings including health systems, physician offices, home health technology vendors, consulting state government and revenue management. Dr. Hines was named Chief Americas Officer for the Health Information and Management System Society or HIMSS in January of 2019. She has been a member of the HIMSS board of directors and is the Chair Emeritus for HIMSS North America board of directors. Dr. Hines has been instrumental in advancing healthcare conductivity in Georgia, ensuring physicians have the information they need to deliver quality care. Through her work at the local, state, and regional level. Dr. HIne has improved technology adoption and advanced its exchange. So Fred, with that introduction over to you help us get to know Dr. Hines.

Fred Goldstein  02:18

Thanks so much, Gregg and Denise welcome to PopHealth Week.

Denise Hines  02:21

So thank you, Fred.

Fred Goldstein  02:22

Yeah, it’s a pleasure to have you on, you’ve got a really extensive background across a lot of areas of IT and interconnectivity. I’d love for you to give our audience a sense of some of your prior work and what you’re doing now.

Denise Hines  02:32

Very well you know Fred I hate to admit it, but I’ve been in this space for about 30 years now. Which is amazing. When I think about my career, my entire career that focused on healthcare, Health Information and Technology, really work into design systems and doing implementation, supporting technology, working with vendors health systems  I love to work on HIT policy, funding opportunities, I’ve worked on HIPAA, worked on directly with providers that help them with their technology, adoption and implementation. So what I think my most favorite space in this industry is working with outreach and education, helping providers to understand the value of HIT. I think when I think over my years, I probably attended almost every medical specialty association to meet providers where they are to talk to them about the value of health IT and even going on-site to meet with them to help them understand how to use systems and submit quality data to federal agencies accessing funding as well to support their work, and then leading health information exchanges, data extraction, so all for the purposes of improving health outcomes. So I live at that sector of policy, technology and funding. But now Fred, I think I’m at a point in my career where I really want to consider using my platform, or continue using my platform really to help solve some of those complex healthcare problems including diversity and inclusion and health equity issues for underserved communities and underrepresented populations. So all that, in a nutshell, is my couple of minutes still about my 30-year career.

Fred Goldstein  04:15

I really do want to get into the issues around health equity, things like that, and applicability of IT to it. But before that, could you talk a little bit about your work with Georgia’s HIE, and what that is and how that works?

Denise Hines  04:28

Sure, in Georgia, we have a statewide Health Information Exchange and my role is to serve as Executive Director. In that role we are an award-winning health information exchange. And we have all types of providers and users on the network to exchange health information and we were in Georgia one of the first statewide exchanges to take advantage of the national network the ehealth exchange by exchanging with bordering states. So we were an award-winning health Information Exchange network. And my role has been to work with providers across the state to get them to connect to the to the network, but also teaching them again, the value of exchanging information and making it available to get out of these silos of data sitting to be used for health purposes. So that’s, that’s what I’ve been doing that well,

Fred Goldstein  05:22

and how many Providers and Systems are in that network,

Denise Hines  05:26

we have over 13,000 plus providers across the state, including state agencies, for example, the Medicaid agency is a participant, public health, the state foster care agency is a participant. So we’ve been working with several of the state agencies around distributing data for public health purposes, such as a registry, I think one of our proudest moments here with the statewide exchange is our ability to provide alerts to the Department of children and family services to alert them when one of the children in their care in the Georgia families, 360  programs when when one of the children in their care presents to a health system, we can alert them that they need to reach out to the health system and check on that child. So we’ve been instrumental and providing what we like to call value-added services beyond basic health exchange that helped to improve communications data flow, not only between providers, but among providers, state agencies, ambulances are connected to the network, just all types of school clinics, we were able to help get connected and help exchange information that we had, I would say great success at talking about the value of health information exchange, but there’s still a lot of work to be done. So we’re still pushing forward there.

Fred Goldstein  06:55

Well, it’s fantastic to hear about that concept in which you actually put in place of notification to the Department of Children Family Services, that’s a great sort of as you add another value add to what’s typically Oh, we’re gonna exchange a bunch of healthcare information between people. But that’s really sort of stepping outside the box a bit from the healthcare system, and coming up with unique concepts. Are there others you’ve seen like that are similar, you’re looking at doing things similar to that between various organizations?

Denise Hines  07:20

I’ve talked a little bit about our query-based exchange. But I think our role with using direct messaging or secure messaging has been impressive as well, we were one of the early users of secure messaging. And where we found the need is, we’re always going to see some providers who may not adopt the advanced EHR systems who are still faxing. So we can go and offer secure messaging solutions to long-term care facilities, who traditionally at this point, have not adopted those systems to participate in health information exchange. So we can get them on secure messaging, and they can exchange information or submit information to a public health agency in ways that they would not have been able to waiting on the EHR implementation. We’ve implemented pharmacies, ambulances, and all of those segments of healthcare that we wouldn’t traditionally think was have access to participate in health information exchange. So I learned early on even in my throughout my career, the best way that we’re going to be successful at exchanging health information is to find solutions that meet providers where they are to bring them into the fold. So we’ve been very successful at that here in Georgia, too.

Fred Goldstein  08:41

So you’ve gone from the children’s to seniors, and does that include skilled nursing facilities, as well, or as part of that messaging exchange system?

Denise Hines  08:51

Yeah, we have we’ve exchanged over I think, to check my numbers before we get on this call been over a million messages last year, and we are headed toward that goal again. But what we found is we can find health care providers who are still faxing, we can get them on secure messaging within days and help them understand how to use it. And once they’re on their own, and they now can exchange within their referral patterns, they can exchange with the large health system to have secure messaging. And then we can also work with healthcare providers who have advanced EHR who also are regional exchanges in their own rights where they have connected health systems and hospitals and their own physician practices. So we’ve connected those large regional exchanges as well. So now you have this what we call the I like to call the last mile providers who seem to have been forgotten in some of the regulatory support early on, so we can now offer them solutions but also the most sophisticated, advanced health systems can also exchange within the statewide exchange. So that’s been our goal meet providers where they are bring them into the fold and help them electronically exchange information to make sure the data gets where it needs to go.

Fred Goldstein  10:14

What’s been the response from the providers to this, as they’ve connected up? What’s been the feedback you’ve received from them?

Denise Hines  10:20

I, most providers, or I would say early on, because the statewide exchange has been up. for a while now we’ve been successful with maintaining the statewide exchange growing it and remaining relevant, which is, you know, it’s been a challenge, I would say, in the HIE space for some organizations. The response initially, we have, of course, you know, you look at the technology adoption cycle, where you have those who are sitting at the table waiting on us to, you know, create a statewide exchange to allow them to exchange because they understand the value of it. And then you have those in the middle, if you show them the value, they will connect. And then you still have those that on the other side who still want to hold on to their data, who haven’t necessarily embraced releasing it for reasons of competition for they’re not certain whether data is going, privacy, security issues, concerns. So we work to make sure that we understand what those concerns are and create solutions, answers, whatever supporting documents we need or information we need we we seek that but there are still organizations who are not comfortable, still not comfortable exchanging their information and with others outside of their their health system. So hopefully, we’ll get there. And I know we have some new new leadership and policies and organizations who are very supportive of HIE that will continue to work work with and take advantage of those opportunities.

Fred Goldstein  11:59

Early on, you mentioned registries and connecting registries up for this, and obviously, you know, population health is built on data, it doesn’t exist without data flowing through the system and then doing all of the other services you need to do to improve the health of populations. What sorts of registries are you seeing on the system? And how are they being used?

 

Denise Hines  12:17

Yeah, so when we talk about population health, you know, it’s really going to be based on data, the best systems will require good data, data transformed into the right information. So I my personal opinion about what can be done with technology and population health is that technology and interoperability can be that equalizer to if it is designed and implemented and administered and used appropriately. So I think if we do IT and interoperability the right way, meaning whether we’re using an information exchange to move data, if we do it the right way, we have all providers, and stakeholders who are participating in a patient’s care contributing in and and moving the data, then we could have data exchange in the right way completely. The right information on the right patient at the right time for the right price, provider for the right treatment, and the right care plan. What we’re learning in the HIE space is we have to design to be able to move all types of information to have the right information, whether it’s medication information, whether it’s a care plan, whether it’s this is discharge information, admissions, and discharge transfer information. The Health Information Exchange has to be that place that can create these standards. And again, meet those providers where they are. So when it comes to registries and population health, of course, COVID is the most current registry that we heard of that’s being created as we speak every day from testing information to vaccination information to contact tracing. So creating that registry and being ready to create a registry as quickly as as was needed with COVID is going to be truly the test of an HIE, but also the registry of immunization information. We look at birth defects information, a newborn registry, and there are other registries such as tumor registry, cancer registry, so every diabetes registry so every type of chronic condition or disease state has a registry, and depending on the sophistication of the public health agency or the Health Information Exchange, we can get registries up and going. And using the data that comes from a provider we can take a data feed and scrub it with what I call scrub or parse it out. Contribute to those registries so that the public health agencies have, they will have complete information from a provider. But the important part about that Fred is that we don’t contain to burden these providers by adding a registry every month, which is what we’re seeing in industry. So that’s why the importance of an HIE.

Gregg Masters  15:21

And if you’re just tuning in to PopHealth Week, our guest is Dr. Denise Hines, Chief Americas officer for the Healthcare Information Management System Society, also known as HIMSS.

Fred Goldstein  15:32

Absolutely. It’s great Denise and the other area you talked about early was in, obviously doing a lot of thinking and work in this area, this whole thing of disparities. And you mentioned earlier, you know, certain providers may not want to connect, they may not be associated with a big system, things like that. Sometimes I hear that and think, rural, you know, individual providers tend to be the providers that are servicing the communities ee talked about where the health disparities are highest. Is that how do you see HHS and others beginning to handle that problem?

Denise Hines  16:05

Yeah, I mean, and the big problem is, when we think about health disparities, and trying to address them, if you have big gaps in the data, you can never really do the right analysis on the data to begin to create solutions that can address them. So what we’re seeing is, if we don’t have the information for, let’s say, there’s someone who has a chronic disease, and they’ve had it for a length of time, and if they’re all of their healthcare providers have the information they needed, then we wouldn’t have to be reliant upon a patient’s memory to talk about their healthcare journey, including what what services that they receive, or what what physicians that they visit, or what medications that they take. So we do know that some communities such as Rural Health communities, and underserved populations may not underserved communities may not have access to health care services. So over the last couple of I would say more importantly, the last couple of years, we started hearing the terminology, Social Determinants of Health. So what that told us is, if we take a look at a patient, population or patient community, I like to call it and began to understand whether or not that patient has access to basic services that they need to be successful in their healthcare journey. So the patient leaves a controlled environment such as a hospital and they’re sent home, a hospital may not know what exactly will happen when that patient goes home. And Fred when I talk about my my journey in healthcare, I come from home healthcare, started very early in undergrad working my way in-home healthcare. And what’s unique about home healthcare is we go to a patient’s home. So talk about really understanding of patient environment, patient’s environment, driving into a community, they physically seeing the patients, how are they doing, meeting the caregiver, talking to the patient and finding out if they have food? Are they able to do their activities of daily living? Did they take their meds today? Do they have access to meds? Do they have transportation power? Do they have water? What type of home do they live in? And those are what? Social Determinants of Health the same types of information we’re trying to collect using systems and ask asking patients, those questions. So we fast forward to today. You know, hospitals are really realizing now that they have to know about a patient’s home, their community, and whether or not what those social determinants are and what those responses are. So now we take in Social Determinants of Health and put on digital determinants of health to see if that same patient can participate in newly formed solutions and healthcare all around digital. So. So it gets even more complex when we start talking about that. That part of the space.

Fred Goldstein  19:14

Absolutely, you’re talking my language to that’s in-home stuff. I found a chronic disease management company 20 plus years ago, that was all in-home care management. And so looking through the shelves, oh my gosh, look at all these salty foods they’ve got in there. You’re right. It’s really about understanding what’s going on in that in those homes. The other point you raised, which is really fascinating. I don’t know why it hadn’t hit me in the head before was you talked about if the HIE has all of the information in it, then the doctor can know what’s going on, which also addresses another issue which might be the health literacy issue with the patient not being able to adequately explain their current situation, their current, their current medication, but if it’s all in there  in the language the provider understands that makes a ton of sense,

Denise Hines  20:03

Thats right Yeah. Yes.

Fred Goldstein  20:05

Tell me a little bit more about the digital divide. And you’re also some policy stuff. So what do we need to do to solve this digital divide, we see the disparities associated with access to these these technologies and services.

Denise Hines  20:18

Yeah, so this, you know, it’s going to be a tough one, because what we’ve seen over the last, with COVID, is really that introduction of needing to have a patient participate in their healthcare experience from their home. So now we saw the introduction of, or really the advanced use telehealth. And we’ll use that as a great example, I think most people can understand the use of telehealth in someone’s home. So what we ended up doing when we introduced telehealth to most patients, because COVID said, patients have to participate in care from their home and in most, in best cases that can be very convenient for patients to be able to participate in care from their home. But it also forced us to understand or ask those questions about the digital availability or digital literacy and digital literacy of a patient. So does that patient have access to internet? Do they have access? One is broadband available in their area? which is a big problem still, which is amazing. It’s still amazing to me that that is such a big problem. But also, do they understand how to use the system? Do they have a camera on either their laptop or phone? And if they have access to the system? Do they know how to log in and use the healthcare app or telehealth system that the provider has asked them to begin to use those we started designing the telehealth systems and asking patients to log in from their home, we have to ask those general questions. Do you have access? Do you know how to use this? Can you does your smartphone? Some people are using their smartphones for Internet access. And if they’re using it for Internet access, can they also use it for the app at the same time. So we’ve taken for granted in some cases that people can use healthcare app in a digital space today. And then we’ve also highlighted the broadband problem that exists across this nation.

Fred Goldstein  22:31

So from the perspective, I know there’s some some workout now to try and help individuals with the cost of their broadband and things like that. And it really is, you know, there’s a whole redlining issue that we saw neighborhoods and things. And it’s the same with broadband. It’s essentially redlining a new technology, you know, and, and so these communities don’t have it. And I think obviously, that’s a policy issue that needs to come down from DC or the states to ensure that we get access to these communities. Another area I know you’ve worked on in this is is maternity, and particularly an area I’ve been focused on for a while. So talk a little about what’s going on with technology, interconnectivity, and this issue of maternity, particularly high-risk maternity individuals from low, different socio-economic groups, etc.

Denise Hines  23:20

So our Well, in my work, Fred, with the Global Health Equity Network, we’ve been focused on maternal health, the Global Health Equity Network is something that is allows us to focus on policy, focus on opportunities to improve health care for underserved and underrepresented groups, but also figure out how we can apply technology to solve some of these issues. So when we talk about maternal health, you know, it’s it’s almost shocking, how dramatic of a problem this is in our in our country. And it’s not just a women’s issue, it’s a human issue. So we were able to find in our research that, according to the CDC, that more than 60% of pregnancy-related deaths are, in America, are preventable. I mean, preventable. And I’m saying that three times preventable its they can be prevented. And so we also know that because there are significant racial and ethnic disparities around maternal morbidity and mortality, black women are more than three to four times more likely to die from a pregnancy-related deaths as compared to white women. And so now we’re starting to see the focus on maternal health, not only from a technology perspective, but from a policy perspective. What we also know from using technology is that if we began to collect the data, it will help us understand what these challenges are. And if we understand what the challenges are, we can create more solutions that help prevent the death and problems related to maternal health. So what we’re doing at HIMSS is through the Global Health Equity Network, we’ve launched the global maternal health tech challenge. And that Tech Challenge is truly global, we started across the globe. And now we’re going to award a final winner at HIMSS 21. In Las Vegas. So we’ve asked these innovators to create solutions that can address these barriers and quit care coordination and behavioral health that can be implemented to improve maternal health outcomes. And so these solutions will pick up a winner in each region. And then each of those regional winners across the globe will be given an all-expense paid trip to HIMSS 21 in Las Vegas to present their solutions. And then we’re going to award a final winner at HIMSS 21. So this is that truly something that HIMSS is committed to that I’m committed to that the team is committed to at this point, finally getting the attention it needs to create some solutions

Fred Goldstein  26:06

Its really great. And obviously, we’re looking forward to seeing you at HIMSS. And getting out to HIMSS this year in Las Vegas. So I’m sorry, we sort of run out of time. But I’d love to thank you so much for being on the show, fantastic information, obviously your career has spanned a huge area of health tech and ID. Thank you again Denise.

Denise Hines  26:25

Well, thank you for having me, Fred, and I’ll be happy to come back anytime.

Fred Goldstein  26:29

Absolutely. We’ll have to get you back on. Back to you, Gregg.

Gregg Masters  26:32

And thank you, Fred. That is the last word for today’s broadcast. I want to thank Dr. Denise Hines HIMSS Chief Americas Officer for her time and very generous insights today. For more information on Dr. Hines work at HIMSS go to www.HIMSS. That’s H I M S S .org or follow their work on Twitter by @HIMSS . And finally, if you’re enjoying our work here at PopHealth Week, please subscribe to our channel on the podcast platform of your choice and do follow us on twitter by @PopHealthWeek. Bye now.