After 4 Attempts and $43 Million, State’s Health Information Exchange Unfinished – CT Examiner

After nearly three years leading the state’s effort to build a health information exchange for Connecticut, Allan Hackney resigned on December 3, leaving an unfinished project in the hands of CONNIE, a newly formed nonprofit established to manage the exchange. 

If completed, the exchange could allow every health provider in the state to access a common set of patient records, in theory leading to better patient care and a better understanding of statewide public health concerns.

Already, the state has spent $23 million of federal grant funding between 2007 and 2018 on three prior attempts led by the Department of Social Services and the Department of Public Health at constructing a health information exchange with no product to show for the effort and money.

Now, three years — and another $20 million dollars later —  a fourth attempt under the direction of Hackney remains unfinished. 

This latest attempt employed two contractors — CedarBridge in 2016, and Velatura in 2018 — in an effort to reach agreements with the state’s healthcare providers and to develop a self-sustaining nonprofit to operate the exchange in the years ahead. But despite contractual deadlines in 2019, and a total of $1.3 and $2.09 million paid by the Office of Health Strategy to the companies, respectively, those tasks remain largely unfinished. 

A spokesman for the Office of Health Strategy said contract evaluations or reviews – records the CT Examiner requested on Nov. 11, 2020 – do not exist. Nevertheless, the contracts with these two companies have been extended. 

Spokesman Laurence Grotheer explained in an email that the business office and program managers review each contractor’s progress monthly as invoices come in. State procurement rules require a full evaluation at the end of each contract, and Grotheer said that Velatura’s evaluation should be completed in February.

The office did not provide those monthly reviews or progress reports in response to CT Examiner’s Freedom of Information request, nor is it clear why evaluations are being written now, for a contract that ended in 2019.

Rebuilding trust

When Hackney was hired in January 2017, the Health Information Exchange was expected to be functioning by the start of 2018.

An Aug. 8, 2017 story in CT Mirror reported that the exchange would begin sharing limited amounts of data between healthcare systems by the start of 2018 — three years ago.

The technology for the project, developed by UConn Analytics & Information Services and CRISP, is complete and available, but data cannot be shared within the system until agreements are finalized between the state and the state’s healthcare providers. 

In an October 2020 interview with CT Examiner, Hackney blamed the delayed work in part on organizational skepticism after a legacy of past failed efforts. The solution, he explained, would take time and rebuilding relationships.

“Credibility of execution is the main issue on people’s minds,” he said.

Hackney said in October that five healthcare providers had signed final agreements with CONNIE while 40 others were still at various stages of discussion. 

“There are a couple reasons why this hasn’t gotten off the ground earlier — we can’t ignore the skepticism in the health community,” said Hackney. “Attempts going back to 2007 that haven’t panned out, and that’s left a pretty high degree of skepticism in the eyes of many organizations that committed resources to the prior attempts that didn’t pan out. Overcoming that skepticism took a lot of relationship building and a lot of listening and outreach.”

The exchange “could have saved lives and prevented healthcare worker burnout during COVID,” Hackney told CT Mirror just weeks before deciding to leave the project — a statement that Hackney later told CT Examiner “caused all kinds of ruckus in certain corners.”

Hackney told CT Examiner, “I’m looking at the landscape in Connecticut beyond the pandemic, and the uses of a [Health Information Exchange] for solving gaps in care, locating gaps in care and giving caregivers insights to close the gap.”

Two goals and a September deadline  

Jenn Searls, the newly-appointed executive director of CONNIE, is now left with the task of completing the work — finalizing agreements with the state’s healthcare providers, and developing a sustainable business plan before grant funding expires this September.

According to Searls, 23 small to medium-sized healthcare providers had signed agreements by Jan. 21, and Searls said that the first agreement with a major healthcare system is nearly complete.

“The initial signers include ProHealth Physicians and the Connecticut State Medical Society,” said Searl. “But, if we are going to do good in the state we have to get a critical mass. Last night our board set a goal of 75 percent of our hospitals and labs exchanging data by the end of the calendar year.” 

Without at least three of the four major healthcare networks in the state — Yale-New Haven Health, Hartford Healthcare, Trinity Health of New England and Western Connecticut Health Network — that goal of 75 percent is unlikely or impossible. 

Searls said that her other goal for the coming year is to develop the sustainability plan for CONNIE that was contracted to be completed by Velatura in 2019.

That work was supposed to have started in April 2018, and included developing “innovative reimbursement options,” and engaging with sources of funding “such as Insurance Commission, Insurance Carriers etc.” 

According to Searls only “high level planning,” was done, despite a deadline of Sept. 2019. In response to queries by CT Examiner, the Office of Health Strategy said that no contract evaluation was ever completed, but that the work is “on track to be completed by the end of February.”

“There has been a high level sustainability plan and our very first task has been to update that,” Searls said. “We need to make it more specific and more targeted.” 

A plan needs to be in place before federal grant funding expires on Sept. 30.  CONNIE is again relying on Velatura to help them complete this work. 

The Office of Health Strategy Executive Director Vicki Veltri declined to be interviewed for this story.

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