The transition from Health Information Exchanges (HIEs) to Health Data Utilities (HDUs) represents a critical evolution in public health data infrastructure. During her recent presentation at the American Public Health Association (APHA) Annual Meeting, Angie Bass, EVP & Chief Strategy Officer at Civitas member organization, Velatura Health Information Exchange Corporation, outlined the transformative potential of HDUs in enhancing public health through data integration and governance.
Before delving into the details of the presentation, it is important to level set on the types of organizations that can support public health infrastructure.
What Are Health Information Exchanges (HIEs)?
HIEs are organizations that facilitate the secure sharing of health data between different healthcare providers, payers, and public health agencies. Their primary goal is to ensure that the right information is available at the right time to support better clinical decision-making and improve patient outcomes across a region or state.
HIEs serve as a bridge between various health systems, allowing electronic health records (EHRs), lab results, imaging, and other vital health data to be accessed and exchanged seamlessly. By providing a centralized hub for health data, HIEs help reduce duplication of services, improve care coordination, and enhance the overall efficiency of healthcare delivery.
A Few Key Functions of HIEs:
- Data Integration: Aggregating data from diverse sources to create a comprehensive view of a patient’s health.
- Real-Time Data Sharing: Ensuring that healthcare providers have timely access to critical information.
- Care Coordination: Having access to real-time data supports better collaboration among care teams, especially for patients with complex medical needs.
- Public Health Reporting: Supporting disease surveillance, immunization tracking, and other public health initiatives by providing data to government health agencies.
While HIEs have made significant strides in improving healthcare interoperability, they may operate within limited scopes, primarily focusing on clinical data exchange. As the demand for additional data exchange use cases expands, there is an opportunity to build on HIE infrastructure. This is where the concept of HDUs comes in, building on the foundation of HIEs to deliver even broader benefits for public health and social care systems by offering more robust data sets and value-added services.
What Are Health Data Utilities (HDUs)?
HDUs aggregate, standardize, and govern data from diverse sources, including clinical providers, public health agencies, and social service organizations. This comprehensive approach allows HDUs to support secondary use cases such as population health initiatives, enabling real-time data sharing and advanced analytics that can produce critical insights.
One of the key benefits of HDUs is their ability to integrate, combine, and enhance health data. One use case being social determinants of health (SDOH) data; HDUs offer a holistic view of whole person health by weaving clinical, SDOH, behavioral health, and demographic data. Combining clinical health information with housing, education, and income data HDUs empower public health agencies, CBOs, Community Care Hubs, and other health improvement collaboratives to design targeted interventions that address the root causes of health inequities.
How Do HIEs and HDUs Differ?
While HIEs and HDUs share the common goal of facilitating data sharing to improve health outcomes, they differ in scope and functionality. HIEs primarily focus on exchanging clinical data between healthcare providers to enhance care coordination and decision-making for individual patients. In contrast, HDUs take a broader approach by aggregating, standardizing, and governing data from multiple sectors, including public health, social services, and community organizations.
This expanded role allows HDUs to address population health needs, integrate SDOH, and support public health initiatives. Despite these differences, HIEs often serve as foundational components of HDUs, providing critical infrastructure and expertise in health data interoperability. Together, they create a comprehensive data ecosystem that supports both individual and community health.
For other distinctions on HIEs and HDUs read through the HDU Framework.
Now that we have covered these fundamental basics, let us dig further into the HDU APHA presentation.
How Statewide HIEs Create Efficiency
Statewide HIEs streamline healthcare operations by eliminating duplication of effort, reducing waste, and lowering costs. Before statewide HIE implementation, providers and systems often had to build individual connections, leading to inefficiencies and higher expenses. Now, with a “connect once” model, organizations can access a shared network of services and data through a single connection, fostering seamless communication, improving care coordination, and optimizing resource use across the entire state.
Moving Beyond Traditional HIEs?
Traditional HIEs have long facilitated the exchange of clinical data, improving care coordination among providers for individual patients. However, they may face challenges, such as the ability to link fragmented data systems, to navigate inconsistent governance policies, and may have limitations in addressing broader public health issues such as providing eCase reporting, immunization records, and insights into health disparities and SDOH. These gaps underscore the need for a more comprehensive model to meet the demands of the evolving health data landscape—one that HDUs are designed to fill. To understand stakeholder’s readiness within a geography in becoming an HDU it is important to assess the current state and to consider the key characteristics of HDUs. There are necessary factors to make the transition and adopt an HDU model.
How HDUs Enhance Public Health
HDUs are transforming the public health landscape by creating a unified infrastructure for data collection, integration, and analysis. By leveraging data from a wide range of sources, HDUs empower public health agencies, healthcare providers, and community organizations to make more informed, data-driven decisions that improve health outcomes and equity.
Here’s how HDUs enhance public health:
- Strengthening Collaboration with Public Health Agencies: HDUs are designed to foster seamless collaboration between public health agencies (PHAs), healthcare providers, and community organizations. Through shared access to integrated and standardized data, PHAs can respond more effectively to challenges such as disease outbreaks, chronic conditions, and social crises. For instance, during a public health emergency like a pandemic, HDUs provide real-time insights on infection rates, healthcare system capacity, and resource availability. This infrastructure enables coordinated, data-driven decision-making, enhancing the ability to protect and promote population health at both local and national levels.
- Enabling Comprehensive Data Integration, Including SDOH: HDUs go beyond traditional clinical data by integrating a broader spectrum of information, including SDOH. SDOH data encompasses factors like income, education, housing, and access to transportation—key influencers of health outcomes and disparities. By combining clinical and social data, HDUs offer a more complete picture of individual and community health. This comprehensive view empowers public health agencies to design interventions that address not only medical needs but also the social and environmental factors impacting well-being, improving health equity.
- Strengthening Collaboration with Public Health Agencies: HDUs are designed to foster seamless collaboration between public health agencies, healthcare providers, and community organizations. Through shared access to integrated and standardized data, public health agencies can respond more effectively to challenges such as disease outbreaks, chronic conditions, and social crises. For instance, during a public health emergency like a pandemic, HDUs provide real-time insights on infection rates, healthcare system capacity, and resource availability. This infrastructure enables coordinated, data-driven decision-making, enhancing the ability to protect and promote population health at both local and national levels.
- Driving Data-Informed Strategies to Address Health Disparities: A core strength of HDUs is their ability to support data-driven approaches to reducing health disparities. By integrating diverse datasets across sectors such as healthcare, housing, and education, HDUs help identify vulnerable populations and uncover the root causes of inequities. Policymakers and public health professionals can use this data to target interventions where they are needed most—for example, connecting communities facing food insecurity with nutritional assistance programs or addressing housing instability through support services. By bridging the gap between health care and social care, HDUs play a critical role in driving more equitable health outcomes across populations.
Policy, Legislation, and Data Governance as Cornerstones for Nationwide HDU Infrastructure
The transition from HIEs to HDUs is gaining momentum, with policy and legislative efforts playing a critical role in shaping this transformation. On the federal front, the inclusion of HDU language in both House and Senate Labor-H appropriations bills represents a significant step forward. This legislative recognition not only defines HDUs but also establishes them as essential infrastructure for public health data management. Federal acknowledgment paves the way for increased funding opportunities and aligns HDU initiatives with national public health priorities set by agencies like the CDC and CMS. Such recognition will drive multi-state collaboration and position HDUs as a cornerstone of the nation’s health data strategy.
Securing Sustainable Funding
Robust and diversified funding mechanisms are essential for HDUs to thrive. States can leverage Medicaid funding to support HDU operations. While federal agencies may provide grants through existing public health data programs, it is important for HDUs to establish sustainable finance models. Beyond government funding, public-private partnerships offer an innovative approach to sharing costs and driving technological advancements. These partnerships and subscription-based models or value-based healthcare collaborations can ensure long-term financial sustainability, supporting the continuous improvement of HDU infrastructure, technology, and operations.
Establishing Strong Inclusive Data Governance
Data governance is a foundational element for the success of HDUs. As HDUs integrate more complex datasets—including clinical, social, and population health data—clear governance structures are essential to ensure data integrity, security, and ethical use. Key elements of data governance in the HDU framework include:
- Standardized Data Collection Protocols: Ensuring consistency and accuracy across diverse sources.
- Data Ownership and Access Rules: Defining who controls, manages, and can access sensitive health information.
- Regulatory Compliance: Adhering to HIPAA, state privacy laws, and other federal data protection regulations.
- Data Stewardship: Assigning trusted entities to manage and oversee the data lifecycle.
Without these governance policies, the potential for fragmentation and inefficiency increases, undermining the HDU’s ability to effectively serve public health needs. Strong governance not only safeguards data but also builds trust among stakeholders, enabling HDUs to operate as reliable and efficient public health data utilities.
Three Ways to Advocate for HDU Nationwide
As HDUs gain traction nationwide, the combined efforts of federal legislation, sustainable funding models, and robust data governance will be critical to realizing their full potential. By addressing these key factors, the HDU model can transform public health infrastructure, driving improved health outcomes and equity for communities across the country.
Here are three ways to advocate for HDU infrastructure:
- Policy Advocacy: Support the adoption of HDUs by advocating for state and federal policies incorporating HDU frameworks. Highlight their inclusion in legislative efforts, such as the Federal Labor H bills, and emphasize the long-term public health benefits of investing in HDU infrastructure.
- Securing Funding: Advocate for diverse and sustainable funding sources, including federal grants, state appropriations, and private sector partnerships. Highlight successful models like Velatura’s $50M recurring appropriation in Missouri to showcase the importance of long-term financial investment for HDU development and maintenance.
- Building Collaboration: Foster partnerships among public health agencies, healthcare providers, payers, and community organizations to drive HDU success. Emphasize aligning goals and building trust while engaging technology vendors to ensure seamless data integration and governance. Collaboration at every level—local, state, and federal—will strengthen and expand HDU networks.
To learn more about HDU infrastructure and support mechanisms, please contact the Civitas team at contact [at] civitasforhealth.org.
