Q&A with Leanne Field, Director of UT Austin's New HIE Laboratory

By Jon Mertz
10:59 AM

The University of Texas at Austin formally launches its Health Information Exchange (HIE) laboratory this week. This laboratory simulates the national, state and local networks that are being developed to electronically exchange medical data. To provide more insights on this initiative, we caught up with Dr. Leanne Field, director of the nine-week Health IT certificate program at The University of Texas at Austin. She was kind enough to participate in the following Q&A.

How has the partnership between The University of Texas at Austin and the Office of the National Coordinator for Health IT worked in enabling this new certificate program? What are some of the key touch points?

Dr. Field: ”The program’s inception was the result of a University Based Training Grant awarded by the Office of National Coordinator for Health Information Technology (ONC) to the Professional University Resources for Education in Health Information Technology (PURE-HIT) Consortium, which is a collaboration of three Texas universities: Texas State University (the lead), The University of Texas at Austin, and The University of Texas Health Science Center at Houston School of Biomedical Informatics.  This funding made possible the rapid development and delivery of three certificate programs at the University of Texas at Austin which are designed to educate three distinct groups: computer science majors interested in gaining competencies in privacy and security; practicing public health professionals at city and state health departments, who are charged with implementing new processes to facilitate the interoperable movement of healthcare data within the State; and post-baccalaureate students who are seeking the knowledge and core competencies to enter the Health IT workforce for the first time.

“To date, more than 375 individuals have been educated in these programs since April 2010, and nearly 200 of these received 100% tuition support from the grant funding. Without the ONC funding, many of these individuals would not have been able to participate in this education.

“We are honored to have been visited and recognized by two national coordinators, who praised the Health IT Nine Week Certificate program as a successful implementation of the ONC for Health IT’s vision to equip a Health IT workforce. We also have collaborated with the Public Health Coordinator from the ONC for Health IT who has given several students the opportunity to participate in public health informatics research projects under his direction for their practicum experiences.

“The public health coordinator also is collaborating with our faculty to develop and teach a new ‘Methods in Public Health Informatics’ course. This course will give public health professionals in the Public Health Leader certificate program an opportunity to develop public health informatics problem-solving skills, and to gain hands-on experience with the tools and technologies in our learning center using a case-based approach.

“Being able to carry on meaningful dialog with the ONC for Health IT is an essential ingredient to the success of this program.”

In your HIE lab and health IT center, your students seem to get hands-on experience with HIE technology and EHR applications. This is a great way to engage in a practical way. How do the students find this experience? Do they enter data into the applications and track it through a simulated workflow and data exchange?

Dr. Field: “The Health IT Nine Week Certificate Program provides students with hands-on learning during the first five weeks of the program with multiple Electronic Health Records (EHRs) software systems. The sixth week, the students come into the HIE laboratory to transfer simulated patient data they have previously entered into two different EHRs between pairs of virtual practices utilizing two HIE software systems.

“Using guided exercises, they send and retrieve Continuity of Care Documents (CCDs) using the EHRs via the HIEs, view the simulated patient data in the portal of one of the HIEs, and test the patient-matching capabilities of the software. These exercises also allow students to see first-hand the implementation of privacy and security features built into the technology, including patient opt-in/opt-out and ‘breaking the privacy seal’ to access simulated patient data.

“In addition, students compare the contents of the physician ‘progress notes’ created during their EHR exercises with the CCDs generated by the EHRs, and with aggregated CCDs generated by one of the HIEs.”

Commentary by Students in the Fall 2012 Health IT Certificate Program:

    “Since I am a very hands-on person, I really enjoyed working in the UT HIE laboratory. I was able to see concepts we learned in class come to life in a real-world setting. I learned first-hand about breaking the privacy seal, using the electronic health record (EHR) to opt-in a patient, creating a Continuity of Care Document (CCD), and ultimately merging the test patient’s records together from different EHRs. It was an invaluable experience.” – A. Roberts

    “Working in the HIE laboratory has taught me how useful and easy it is to access patient’s important medical information through a Continuity of Care Document (CCD). I have also had the opportunity to learn where HIEs need to be improved to maximize quality of care.” – S. Standifer

    “The hands-on HIE experience helped me to gain a better understanding of what information can be transmitted between doctors and how useful that information can be. Now I really get why HIEs are so important and that they are key to the continuity of care of a patient” – S. Zimmerman

    “It was very beneficial to be able to get our hands on this exclusive technology after learning about health information exchanges in class. This one-of-a-kind lab at the University of Texas at Austin has allowed us to connect a concept from lecture to a real-world application.” – A. Ray

    “This software really allows you to experience health information exchange between two different cities and providers. You can see how valuable this will be for a patient’s continuity of care.” – A. Momin

How do the experiences in working with the Texas Health Services Authority (THSA) for the State of Texas help your students and how has it helped the THSA? What key lessons have the students learned by creating* a simulated Central Texas Regional HIE and North Texas Regional HIE?

Dr. Field: “The chief executive officer and the chief technology officer of the THSA were part of the advisory board to help plan the HIE Learning Laboratory. The THSA also has provided guest lectures to students in the Health IT Nine Week Certificate program on deployment of HIEs in Texas. These educational sessions have helped students better understand the governance, financial, technical, business and legal considerations in creating and implementing health information exchange.

“The HIE laboratory exercises allow students to see how simulated medical data is captured in the EHRs and transferred by the HIEs between virtual physician practices representing four cities in the state. In addition, students can evaluate the ways that the software systems accomplish health information exchange. They can gain insight about the trade-offs of various models for health information exchange such as the ‘store and forward’ model in the simulated ‘North Texas Regional HIE’ and a model which aggregates the Continuity of Care Documents (CCDs) in the simulated ‘Central Texas Regional HIE.’

“This fall, representatives from the THSA and other state Health IT policy-makers were invited to the HIE Laboratory to perform the same hands-on exercises as the students in Health IT Nine Week Certificate Program. This provided valuable insights to these policy makers about the state of the technology, its features and its current limitations.”

*Note: The students have not created simulated HIEs, but have carried out guided, hands-on exercises using the EHR and HIE software systems donated to the university.

With so many options and changes underway, what is your approach to teaching healthcare standards? Do your graduates enter the work force with a solid understanding of HL7 and Continuity of Care Document (CCD)?

Dr. Field: “We recognize that the ability to transfer not only data, but also to convey the meaning of the data is essential for healthcare. Therefore, we teach our students about several standards, including HL7 and standardized vocabularies such as SNOMED, ICD9/10, LOINC, CPT, and RxNorm. We compare and contrast nomenclatures, taxonomies, and ontologies, pre- and post-coordinated vocabularies, and discuss the challenges with achieving semantic interoperability.

“We also teach the structure and function of HL7 messages, and then introduce CCDs. We then reinforce these concepts with hands-on activities using EHR and HIE software systems in our HIE Laboratory.”

What is the biggest challenge you see in the adoption and use of technology within the healthcare?

Dr. Field: We believe the greatest challenge in the adoption and use of technology within the healthcare industry is the ever-changing nature of the healthcare delivery system itself. With payment reform, implementation of the Affordable Care Act and its accompanying insurance changes, and the focus on improving cost, quality and access in healthcare, the knowledge, skills and technology to accommodate these changes are a moving target. This presents a unique challenge to educational programs, such as ours, which are training and equipping the workforce with the needed competencies to meet these challenges.

It is our belief that by formally training students in both the theory and practice of health information technology and health informatics, that we are directly contributing to the successful transformation of the American healthcare delivery system.