We introduced the Interoperability Hero Initiative in 2021, and we’re pleased to recognize the following individuals as part of our fifth class of Interoperability Heroes! Learn more about those selected as Interoperability Heroes below, including words from their nominators as to why they are deserving to be recognized as Interoperability Heroes.

If you know a Hero that you would like to nominate, contact us to be informed when we open the next round of nominations.  Learn more about the Interoperability Hero Initiative here.

Q3 2022 Interoperability Heroes

Courtney Baldridge (USAging)

Courtney became involved involved in a broad range of standards on behalf of USAging and the National Aging Network of Area Agencies on Aging (AAA). She has personally contributed to the Gravity Project’s Strategic Advisory Council (SAC), the Information Exchange for Human Services (IX4HS) Consensus Body, the DirectTrust Standards Board, the National Interoperability Collaborative’s Project Unify, and HL7’s Human and Social Service (HSS) WG.

Courtney then rallied representatives from multiple leading AAAs from across the nation to participate in each of these standards efforts. As recognition of her interop leadership, she has been voted Vice Chair of IX4HS, Co-Chair of HL7 HSS, and CBO Stakeholder Lead for the Gravity SAC. Courtney, and her AAA colleagues, have provided critical insights into the general processes of socialcare, the similarities and differences between healthcare and socialcare workflows, and the specific complex care services provided by AAAs in collaboration with social and clinical service providers.

In her own words:”1. Care is king, even in interoperability, and we must continue to focus on person-centered care as we work to standardize and exchange socialcare data. 2. Socialcare is its own expertise. 3. Properly assessing the social needs of clients is critical to the integrated landscape working. “

Susan Clark (Briljent)

In her day job, Susan has been instrumental in creating a Health IT Collaborative between 3 state agencies in Indiana as well as providing direct support on Health Information Exchange governance to the Indiana Governor’s Public Health Commission. She was nominated, and has interviewed for, this year’s class of HITAC by Briljent, AHIMA, Missouri Department of Social Services, and Indiana Family & Social Services Administration. Outside of consulting engagements she is the Chair of the AHIMA (American Health Information Management Association) Advocacy & Policy Council where she seeks to expand the organization’s aptitude and influence on the HIM workforce to create advocates for interoperability. She is sought out as a speaker on interoperability by AHIMA and its state affiliates, Indiana Security & Privacy Network, AAPC, and multiple health information management academic programs. She brings her passionate energy to the topic on multiple social media channels, garnering involvement from many.

Delaware Health Information Network

The post-acute care setting has long been a “black box” for clinicians who need healthcare data from the facilities to treat patients and for Accountable Care Organizations, whose pay-for-value measures require this data for outcome measurement. Skilled nursing facilities in Delaware historically did not use EMRs and couldn’t send the Admission, Discharge, Transfer (ADT) summary messages that drive alerts through Delaware Health Information Network (DHIN). While DHIN processes millions of these messages each year from healthcare systems, a very small fraction of these are from post-acute care facilities.

Over a fifteen month period, DHIN brokered a shared-cost agreement with two ACOs, the state’s largest skilled nursing facility provider and their EMR to enroll 34 facilities, currently sending and receiving messages with twenty-three so far. This collaboration brings significant closure to this data gap, ultimately allowing for up to 85% of post-acute care organizations in the state to deliver their ADTs through DHIN, correspondingly enabling the delivery of alerts to treating clinicians and making this data history available by query in DHIN’s Community Health Record.

Tim Ingram (Axxess)

Tim Ingram has led a worldwide team of engineers, product owners and managers, relationship managers and sales team members during his time at Axxess. In three years under his direction, the team has amplified the interoperability opportunities between technology vendors, such as pharmacy benefit managers (PBMs), document management companies, referral networks and others, to expand the ability for providers to operate safely across the healthcare spectrum with data and patient information. During this time, Axxess has made history in several ways: the first healthcare solution to become Community Healthcare Accreditation Partner (CHAP) Verified, the first healthcare solution to offer a free industry training program with education credits and the first standalone palliative care solution. Tim’s passion for collaboration and his unlimited idealism on what is possible has led to more than a dozen interoperability partners for in-home care providers to benefit from.

Steve Kohrs (CyncHealth)

Steve is invaluable to the organization. His attention to detail, dedication and innovations enables CyncHealth to do the work we do. He’s worked on several important projects, including the build of the patient portal (My CyncHealth) which will give individuals access to their entire longitudinal health record so they can see their care history, regardless of what physician, nurse, hospital, health system or clinic they visited. Steve built the portal’s integration with Apple Health, worked on the QR codes for COVID vaccines, and coordinated with several other third parties and technology partners to create a site where patient information can be hosted securely while allowing for patient access. The data sources for this portal are many and varied, requiring heavy data transformation through cloud services to run analytics on the raw data to speed up the process. CyncHealth was one of the first Health Information Exchanges in the nation to do this work and Steve was a vital part of this build. Throughout the project, Steve continually found new and easier ways to understand transformations of the data and modernize the data digestion for CyncHealth and the portal.

Lowell Community Health Center (Padma Sastry)

Lowell Community Health Center collaborated with other organizations to create greater efficiencies in their workflows in order to reduce their referral backlog by 92% and better support their traditionally underserved patient population.

Palliative Community Resources (Hospice Homecare)  (Kristi Kenslow and Kimberly Garlington)

Palliative Community Resources using Arkansas SHARE’s Encounter Notifications via Direct to Improve Strategies. At Palliative Community Resources they have recognized the need to better define patient centered Goals of Care and to differentiate the value-added benefit of Clinical Response Standards in community-based care delivery. With one primary aim at readmission prevention our team met with 2,884 families in 2021 to align care needs. Care management of these patients included after-hours response management resulting in  avoidable returns to acute care {Estimated >4 million in savings}.

Strategy for Change:

  • Established connection with Arkansas SHARE (State Health Alliance for Records Exchange) HIE for encounter notification services (ENS) via Direct allowing high-tech, high-touch care (notifications routed based on payer-derived attribution).
  • Triage Nurses leveraged daily ENS reports via Direct for near real-time care coordination Aligned Transitional Care Manager (TCM) within 48 hours of discharge to re-establish Goals of Care.
  • Implemented care management protocols aligned with discharge risk assessment
  • Developed proprietary Clinical Response Standards with ability to deploy rapid response nurses 24/7*
  • Credentialed associates to establish patient’s Goals of Care at point of engagement
  • Designed outcomes-based scorecard for care needs response and resolution
  • Integrated preferred providers to ensure a connected care continuum

Dave Pyke (Audacious Inquiry, a PointClickCare Company)

David is the primary architect of the TEFCA QHIN Technical Framework and supplemental technical documents.

David worked with the ONC and Sequoia project to create the QTF and create a new environment for interoperability for America.  He has consulted the top minds to ensure security and interoperability can be expressed through a technical framework.

David is an active member of the HL7 Technical Steering Committee, the HL7 Community-based Care and Privacy workgroup and the IHE IT Infrastructure workgroup. He is a FHIR Implementation Guide author and member of the HIMSS HIE & Interoperability workgroup and the CIVITAS standards workgroup, QHIN Technical Framework, Individual Access Services SOP, eLTSS FHIR IG, SANER FHIR IG, CREDS FHIR IG

Krystal Schramm (MiHIN)

Krystal has started a tribal initiative program at MiHIN aimed at establishing formal working relationships with tribes in Michigan, educating them on the value of health interoperability, and working with them to get onboarded to MiHIN’s use cases. This initiative has led to MiHIN actively working with over a third of the tribes in Michigan on current services and engagement. The Tribes need to trust that we will not abuse their data and they put that trust in our use cases and the legal sharing framework associated with them. The feedback from tribes overall has been positive, and they appreciate the value that MiHIN is providing them to work towards improving healthcare interoperability in their clinics.  Direct Secure Messaging is one of the 3 primary modalities that tribes can send and receive data through.

Travis White (Kno2)

Travis White has been instrumental in developing and implementing an interoperable and collaborative eSigning solution. Provider-to-provider, provider-to-patient and third-party-to-provider signing workflows remain some of the most burdensome processes in healthcare. They’re often managed through a combination of paper, broken fax workflows and proprietary signing portals.  Under Travis’s leadership, Kno2 is changing the process entirely. We have integrated eSigning technology directly into clinical workflows, removing the burden for administrative staff, clinicians and patients. Kno2 enables e-signing to occur within trusted and secured eSigning platforms (such as DocuSign) between two or more parties. What starts as a HISP-based communication in the EHR normalizes within the DocuSign signature workflow as a result of Kno2’s Connector.  The provider can now send a Direct Secure Message to request the signature and the patient doesn’t have to change their behavior at all – they receive notification via DocuSign’s traditional channels like email or SMS. Upon completion, we then automate delivery of completed documents back to the EHR, like admission packets, new patient onboarding forms, consents and others. As a result, Kno2 has equipped industry-leading e-signing workflows for nearly every EHR across U.S. healthcare with the Kno2 DocuSign EHR Connector, and the burdens of collecting signatures are a thing of the past. Customer reported benefits have ranged from less stress for the staff and the patients to complete their paperwork, even going as far as saying they are now able to provide care to more patients because of the reduction in paperwork and administrative overhead during clinic hours.