Over the past six years, Jay Nakashima has led eHealth Exchange through several fundamental transformations, any of which would likely earn him the designation as Interop Hero. Taken together, however, his organization’s accomplishments are truly extraordinary. Under Nakashima’s leadership as president of the organization, eHealth Exchange has:

  • Adopted a new hub-and-spoke technology platform with eHealth Exchange at its center, increasing clinical data exchange from 20 million records annually five years ago to 20 billion annually today.
  • Pivoted during the early days of the pandemic to support electronic case reporting among the CDC, laboratories, and public health agencies in all 50 states.
  • Coordinated with the FDA to receive adverse vaccine notifications automatically using FHIR®.
  • Earned a designation as a qualified health information network (QHIN) under the Trusted Exchange Framework and Common Agreement (TEFCA).

“As an organization, we’ve really been able to double down and focus on ensuring that data can be exchanged at scale at the national level,” says Nakashima.

 Tracing its roots to federal interoperability project

Interoperability is a challenge in every industry, as Nakashima learned after college when he worked at IBM in Tokyo. After graduate school, he pivoted into healthcare, working for a healthcare payer, for two EHR vendors, and then for a national payer in charge of their clinical IT strategy. At each step, data interoperability and exchange with more partners — especially with clinical data — was a central aim of his work.

Nakashima had never worked for a nonprofit before joining eHealth Exchange, where he quickly learned it’s a business like any other. “You still have to bring in the revenue, add value, pay bills, and the other aspects of running a successful business,” Nakashima notes. “While we don’t have to worry about creating a profit to return to shareholders, we reinvest any excess funds to increase the public good.”

eHealth Exchange started as an Office of the National Coordinator of Health IT (ONC) project called the National Health Information Network. Despite the initiative’s success, the ONC wanted to sunset it, which caused an uproar among participants and healthcare organizations. Instead, the intellectual property was transferred to a nonprofit, and eHealth Exchange was born.

The exchange includes five federal agencies, 60 state and regional health information exchanges (HIEs), nearly 300 large health systems, and myriad other health providers and other organizations that agree to exchange data using the same trust agreement and technical specifications.

Tremendous progress under Nakashima’s guidance

eHealth Exchange’s centralized data platform laid the foundation for greater information sharing in a uniform, secure manner, says Nakashima, who notes that most exchanged data is used in direct patient care. The 10,000-fold increase in exchanged records points to the pent-up demand for data from disparate sources being used in care decisions.

During the pandemic, the utility of exchanging lab results and related data within the eHealth Exchange ecosystem became clear to federal agencies. “COVID was a big year. It really pushed us further into a public health exchange, which really fits great with our mission,” Nakashima says.

Submitting electronic Case Reports (eCR) took on increased focus in spring 2020. eHealth Exchange worked with the Association for Public Health Laboratories (APHL), the CDC, and public health agencies nationwide to speed the secure movement of eCRs to public health authorities. Approximately half of all reports are sent via Direct Secure Messaging, and the initiation of the project was completed in several weeks.

“Even though I’ve been in health IT for 30 years now, I was painfully ignorant and didn’t understand how completely starved for data public health agencies were and how rudimentary some of their data exchange processes were,” Nakashima says. “Some agencies were sending Excel files directly to the White House via email.”

Toward the summer of 2020, the Food and Drug Administration (FDA) joined eHealth Exchange and sought help collecting and distributing data on adverse events related to vaccines. The solution, which was deployed in weeks, uses FHIR R4 rather than consolidated-clinical data architecture to receive notifications and send follow-up questions. The FDA receives automatic notifications from 46 states.

Finally, eHealth Exchange was named one of the first five QHINs under TEFCA that will be used for data exchange, which is voluntary for now. Two more QHINs were named earlier this year. The QHIN designation has greatly increased visibility for eHealth Exchange.

“I think TEFCA is really going to move the needle, because it would be crazy for anyone to underestimate the government’s ability to implement change,” Nakashima says.

Even though TEFCA is voluntary, at least for now, it is absolutely spurring innovation.

“TEFCA is doing a really nice job of focusing on exchange for public health purposes and giving individuals the ability to retrieve their own personal data,” he adds. “We don’t have a final date when public health is going to be required for exchange under TEFCA, but it’s absolutely permitted now, and eHealth Exchange is spending a tremendous amount of time and effort focusing on that broadened public health exchange.”

Nakashima wraps up by encouraging those in the healthcare space to not wait for new regulations or standard operating procedures to be defined to move the interoperability needle.  “We can do a lot better with data exchange with what we have today. And as the technology, policies, and frameworks like TEFCA move forward, we can do more.”

Click here to watch the full Interop Hero interview with Jay Nakashima.