PROVIDENCE – For all the moves in the corporate monopoly game that is focused on hospitals and health care delivery systems in Rhode Island, many of the biggest stories in the current health care landscape are the ones that always seem to fall under the radar screen, uncovered or ignored, by the local news media, where health care reporters remain a missing ingredient n the news cake mix.

Such was the case with the June 21 announcement of the new partnership created between HealthInfoNet in Maine, VITL in Vermont, and the Rhode Island Quality Institute in Rhode Island. The three statewide health information exchanges [HIEs] are building “a regional interoperable ecosystem” in order to collaborate and to facilitate the sharing of patient data, with the goals focused on enhancing patient care, improving clinical decision-making, and enabling better public health planning.

Translated, a new data highway is being built in New England, connecting patients and clinical providers in Rhode Island, Vermont, and Maine. The new data highway lays the groundwork for construction of a much larger data ecosystem that promises to change the way that health care decisions get made, who makes them, and leverages a patient's ability to interact with what happens to them with their care.

The new partnership comes at a time when the Rhode Island Quality Institute, which manages CurrentCare, the state’s health information exchange, is moving its physical location from the Foundry complex in Providence to East Providence – as well as moving forward with CurrentCare transitioning to an opt-out system.

Interoperable data systems are the true infrastructure that will under gird the delivery of health care in the 21st century, redefining the relationships between patients and providers and payers – and cost structures.

Translated, whatever changes may occur on the health care monopoly board, it will be the players that can best manage the flow of data who will have the greatest chance of success.

ConvergenceRI has regularly attempted to report on developments about the flow of the data around health care in Rhode Island, often through conversations with Neil Sarkar, the president and CEO of the Rhode Island Quality Institute.

Here is the latest conversation, talking about all things data in Rhode Island. The questions were conducted through an email exchange.

From ConvergenceRI’s perspective, the “conversation” was an opportunity to push the envelope on connecting the ongoing data challenges emerging from COVID pandemic and the opportunities to build new data libraries connecting chronic conditions and environmental factors.

ConvergenceRI: Did you get the funding you had hoped for CurrentCare in the budget?
SARKAR: I presume you are referencing the state budget. RIQI was not explicitly included into the budget for this year, nor are we in a typical year. Our core funding comes from a per-member-per-month contribution from insurance carriers and self-insured companies, supplemented with contract services from a range of partners, which does include the state.

ConvergenceRI: What is your view of the data landscape when it comes to health care delivery in Rhode Island?
SARKAR: The data associated with the health of an individual is very fragmented across our nation and our state. Our primary charge remains to ensure that the right data are available to the right person at the highest time of need.

With the transition of CurrentCare to opt-out, it does mean that care teams will have a more comprehensive view of data that can support an individual along their health journey.

Generally, health data are individual-specific and site-specific. As health information exchanges [like CurrentCare here in Rhode Island] embark on the role of health data utility, there will be increased opportunities for us to deliver the data in ways that support the highest quality of health care delivery.

There are many factors that make me very bullish on our future here in Rhode Island, starting with the Long Term Health Plan – which provides the scaffolding for improvement in health care delivery – and become the focus of regular conversations in the Health Information Technology Steering Committee – which provides the “what” [we need to do] to the “why” [improve the health of all Rhode Islanders].

ConvergenceRI: Given the increasing development of Long COVID as a chronic condition, what kinds of changes are needed in diagnostic coding, in data collection, in metrics around health outcomes?
SARKAR: In my opinion, it is too early to fully characterize or understand the impacts of Long COVID as a chronic condition.

Understanding the long-term impacts of SARS-CoV-2 infection will be important from a public health perspective. I expect that there will be increased attention to what types of symptomatology will collectively be used to provide more definitive direction in what kinds of health outcomes will need to be monitored from both clinical and public health perspectives.

This is a challenge with many complex and difficult-to-define chronic conditions, and I hope that this will lead to advancing approaches for identifying and supporting the treatment of such conditions.

ConvergenceRI: When it comes to research, what gaps do you see that need to be addressed in how the state is tracking behavioral health outcomes?
SARKAR: I am not in a position to know what data the state is currently or planning to collect with respect to behavioral health outcomes. I will note that there continues to be advances made in increasing the availability of behavioral health data alongside other health data to understand the impact of each on the other.

ConvergenceRI: There is increasing evidence about how toxics in the air, water, and food are functioning as endocrine disruptors: does the state need to invest in creating a database to track the evidence, correlated to health and education outcomes, i.e., asthma and air pollution, lead and behavioral conditions, PFAs and obesity in children, bladder cancer and benzene, breast cancer and DDT?
SARKAR: Again, I am not in a position to comment on what the state is currently or planning to collect on environmental or educational factors that may impact or be impacted by health data.

I expect that there will continue to be attention on the capture of behavioral, social, and environmental factors within electronic health record systems. The majority of these data are captured in unstructured from [e.g., in a note or free-text field], so there is a bit of work to do to look for opportunities for their incorporation into structured formalisms like databases.

I acknowledge the importance of identifying and validating correlations between risk factors and disease, but they are not the focus of CurrentCare at present.

ConvergenceRI: Are there specific improvements in patient dashboards that you are looking to create in CurrentCare?
SARKAR: The majority of our focus right now is on converting CurrentCare to an Opt-Out consent model. There are always improvements in the works, but nothing that I can comment on at this time.

ConvergenceRI: What questions haven’t I asked, should I have asked, that you would like to talk about?
SARKAR: As always, I always welcome the opportunity to share some thoughts with you and the readers of ConvergenceRI. Health care may very well be local, but successful innovation requires a broader view.

I am looking forward to increased dialogue with other health information exchange organizations in New England [Maine and Vermont], which was recently announced. [See link below to news release]

I believe that this collaboration will further strengthen the roles that we have to support our respective populations, and improve the overall healthcare experience across New England.