Insider Perspective: eHealth Exchange Dashboard

August 28, 2020

We met with Mike Lundie, Senior Director, Healthcare Interoperability, to learn how we are providing valuable insight into the operation of the nation’s largest patient data exchange.

1. What is the eHealth Exchange Hub, and why is it important? How does Cognosante support its work?

The eHealth exchange is the nation’s largest patient data exchange. It includes large provider networks, hospitals, pharmacies, regional health information exchanges and many federal agencies, representing 40% of all U.S. hospitals, tens of thousands of medical groups, more than 8,000 pharmacies, and 100 million patients, across all 50 states.
The eHealth Exchange Hub, hosted by InterSystems, allows for health information exchange network-to- network connectivity for the sharing of patient medical information on a nationwide level. In 2019, InterSystems contracted with Cognosante to develop and host a data analytics, dashboard and operational monitoring system of the eHealth exchange Hub utilizing eSante Insights.

2. What is eSante Insights? What is the value of that solution?

eSante Insights is an HIE accelerator, which means that it facilitates the adoption, utilization and efficiency of health information exchanges. By leveraging our eSante platform, we have created a data analytics solution that can ingest a massive amount of transactional data on a daily basis, and aggregate, report, and visualize the data in a meaningful way to the participants of the eHealth exchange Hub.

The value of this solution is that it helps our customers support their customers. In this case, we have taken a critical customer with a national footprint, and provided scalable, cost-effective dashboards. By providing the first real insight into participant activity and building a cloud-based infrastructure that will support future enhancements, we have increased the value of the EHX Hub, and provided a valuable use case for other health information exchanges.

3. What are the top three things employees should know about the project?

eSante Insights is a great example of how innovation solves real problems. Since its inception in 2010, the eHealth exchange had struggled to obtain operational metrics. The lack of data made it difficult to measure performance, determine capacity requirements, and measure adoption (an important indicator of the success of any health information exchange).

Using eSante Insights, Cognosante created scalable, cost-effective dashboards to provide secure operational monitoring for the eHealth exchange hub. Our solution allows eHealth exchange participating networks to monitor overall activity and performance as well as overall usage of the eHealth Exchange Hub, providing the first real insight into participant activity.

By leveraging the cloud, we minimized the operational cost of the solution while increasing its capacity to meet increased demand for analytics and support the Hub’s exponential growth. The EHX Hub currently processes upwards of 69 million transactions per day, from a starting point of zero at go-live twelve months ago. Compare that to Relay Health, one of the largest and oldest real-time pharmacy claims adjudication networks in the country, which processes over 49 million real-time pharmacy claims in a day. With eSante Insights ingesting the daily transactional data, the eHealth exchange hub has exceeded that number in just a year’s time.

4. Why is it so important to have concrete metrics to measure the performance of the eHealth Exchange?

Without operational data, the eHealth exchange had no reliable way of knowing who was sending or requesting data to and from whom, how the data was being used, whether it was being used as intended, or if information was being blocked by a participating HIE. This data was necessary to ensure the smooth day-to-day operation of the exchange and manage its growth.
More importantly, the data was needed to determine whether the nation’s flagship patient data exchange was effectively facilitating the flow of information for providers and patients.

5. What insights have we gained since the project began?

Our dashboards provide real-time insight into how the EHX Hub is being utilized. Technical and non-technical users can see the entire EHX network in one glance, with visualization tools that help them see data in exactly the way they need it. At an enterprise level, the eHealth exchange can see who is sending records to whom, where, and in what volume. They can see how effectively information is flowing among participants around the country. At an individual level, they can see which participants are using the exchange as intended, and who might be experiencing problems or engaging in data blocking.

Individual participants can monitor their own inbound and outbound requests, as well as responses for patient information from other eHealth exchange participants. They can also troubleshoot problems more easily.

None of these insights or capabilities existed prior to the dashboards. The best part is that, as the exchange grows and handles more transactions, the architecture can scale up accordingly.

6. What are you looking forward to the most in the next year? Do you have plans to deploy the solution anywhere else?

We just had a new release that went into production. In that release, we have redesigned the whole analytics system to process the millions of transactions we are now receiving each day. We are taking eSante Insights to the next level, currently processing up to 1,000 records per second.

This solution is directly applicable to the HIE work we do for Department of Defense (DoD) and the Department of Veterans Affairs, as well as for state HIEs. We are especially excited about the benefits to the DoD and VA health systems, because we are enabling them to track requests for patient clinical record retrievals from participating HIEs throughout the country when patients are scheduled for appointments. This is a tremendous step forward in improving the quality and efficiency of the health care that our service members and veterans receive.

Additionally, we look forward to working with Cognosante business units in adapting this in-house built capability to other settings and applications as opportunities arise.