Idaho Dept. of Health and Welfare’s decision to part ways with data exchange is shortsighted

Maintaining the VCO system not only ensures Medicaid patients receive the right care at the right time, but it also encourages health care providers to focus on long-term wellness rather than just periodic or emergency care, writes guest columnist Greg Morrison. (Morsa Images/Getty Images)

For Idahoans, it’s unfortunate and shortsighted that the Idaho Department of Health and Welfare decided to terminate its contract with the Idaho Health Data Exchange. This decision disadvantages a state agency struggling to adapt to a modern technology framework for managing health care services for Idaho’s most vulnerable populations.

The department’s explanations for terminating the contract – citing transparency issues, information technology security concerns, compliance with federal laws, and failure to change leadership at the data exchange – appear weak and unsubstantiated. The data exchange, a nonprofit 501(c)(3) Idaho corporation, has navigated challenging times.

Idaho ends contract with Idaho Health Data Exchange

After a turbulent contracting period with Health and Welfare in 2020, the data exchange filed for bankruptcy protection, a process necessitating strict compliance with federal laws, in August 2022 and successfully reorganized by June 2023. The data exchange has since continued to serve 38 of Idaho’s 44 counties by securely exchanging over 75 million patient health messages annually for more than 175 health care organizations. These include three of Idaho’s largest hospital systems, all 15 of Idaho’s federally qualified health centers, and 10 critical access hospitals.

This extensive service network contradicts claims by Health and Welfare staff that “the exchange is predominantly used in rural areas to reduce additional phone calls and faxes … but didn’t live up to its promise.” And yes, we do also proudly serve rural Idaho, believing all Idahoans should receive the best possible care.

The reasons cited for terminating the contract do not hold up under scrutiny. The transparency and compliance concerns are particularly questionable, especially considering that Health and Welfare officials held positions on the data exchange’s board of directors from the company’s establishment in 2008 through 2020. Health and Welfare representatives also held key leadership positions, including board chairman.

If the department lacked visibility into the data exchange’s operations, it was because they weren’t paying attention, not because the information wasn’t available to them. This includes the audited financial statements and governance reports prepared annually by an external public accounting firm, meeting US GAAP standards. These measures ensured high levels of transparency and accountability and were continually available to Health and Welfare the entire time the department was represented on the board and continue to be available today.

Regarding technology security concerns, the data exchange has provided comprehensive documentation addressing multiple security evaluation approaches requested by Health and Welfare. The data exchange maintains a HITRUST-aligned security framework, routinely reviewed by its largest clients and insurance providers. This security framework is universally recognized as top-tier in the health care technology industry. The data exchange is also assessed under a SOC 2 Type II certification, an additional measure of security and compliance, by an independent third- party certifier. These efforts broadly reflect the data exchange’s strong commitment to security.

So much so that the data exchange is in fact counted on by health care systems across Idaho as a secure and reliable source for maintaining access to health care data during cyber outages, playing an ongoing and essential role in resiliency and security.

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The claim of an apparent failure to change leadership at the data exchange is also hard to understand. Simply put, the executive director from 2020 has been replaced. The new leadership is focused on serving Idahoans by maintaining a financially viable – even without the Health and Welfare contract – technologically sound, and highly secure health information exchange platform that enables efficient and quick information flow to properly credentialed health care providers, improving health outcomes and lowering the cost of care delivery.

Health and Welfare’s lack of understanding of the value and capability of the data exchange, an organization initially formed by a director of the department, is perplexing. With over $24 million invested in technology infrastructure since its formation, the data exchange has made substantial progress connecting health records with patients across Idaho to improve health outcomes and save money.

Seemingly, improving patient health and saving taxpayer funds would be an objective for Health and Welfare, especially considering the size and growth of its Medicaid program.

Given the necessity of health information exchange in a 21st-century health care system, it’s unclear how Health and Welfare plans to now fill this critical need. Developing an alternative platform would require tens of millions of dollars more in taxpayer money and years to complete. Does it make sense to do this again?

Health and Welfare’s decision to terminate the contract with the data exchange is a significant setback for Health and Welfare’s ability to better manage Idaho’s Medicaid program and public health initiatives. It overlooks the substantial progress and benefits provided by the data exchange, undermining years of investment and development. There has never been a time in the history of the data exchange when the data exchange provides more value to the state of Idaho than right now. It is crucial that Health and Welfare reconsider this decision and make available this practical solution that best serves Idahoans’ health care needs.

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