Health Data Utility as Public Health Capability: Arkansas SHARE Case Study

By Alan Katz, Associate Director of Advocacy & Public Policy, Civitas Networks for Health  

ABSTRACT—Over the past decade, a combination of federal, state, and private-sector investment has rapidly transitioned Arkansas’ health data infrastructure from legacy paper formats to electronic health record (EHR) platforms now present in over 90% of outpatient physician practices and 96% of the acute care hospitals in the state. To help manage and further advance this transition in public interest, the Arkansas State Health Alliance for Records Exchange (SHARE) was established as the state’s official health information exchange (HIE) by a 2011 statute. Now under the Arkansas Department of Health, SHARE has steadily worked to broaden its statewide capabilities beyond point-to-point clinical data sharing to reduce barriers within and between public health agencies to maximize efficiency and improve outcomes. In doing so, it has become one of the nation’s leading functional examples of the health data utility (HDU) model.

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In 2011, the Arkansas legislature created the Arkansas Office of Health Information Technology (OHIT) with a mission to “obtain the maximum potential value from the investment of federal and state resources to increase the use of health information technology” and to further “the coordination of health information technology throughout Arkansas.”[1] The same legislation established Arkansas State Health Alliance for Records Exchange (SHARE) as the state’s official health information exchange for “effective communication…among hospitals, payers, employers, pharmacies, laboratories, and other health care entities” that creates “the ability to monitor community health status” and realize “efficiencies in health care costs.” [2] A year after the bill became law, SHARE launched the original version of its direct messaging service for providers, and a few months later, SHARE’s clinical records platform had its first major partner in North Arkansas Regional Medical Center (NARMC).

Today, NARMC is one of 118 hospitals statewide that participate in SHARE’s network alongside over 3,400 other clinical facilities contributing data and more than 900 facilities receiving data.[3] The information is contributed, processed, and received in the form of dozens of deliverables and analytic products across SHARE’s portfolio. The primary HIE platform incorporates a virtual health record (VHR), direct secure messaging, public health reporting to include (bi-directional immunization reporting, electronic lab reporting (ELR), syndromic surveillance reporting, cancer registry and electronic case reporting (eCR) health plan clinical data delivery, admission-discharge-transfer (ADT) and hospital readmission notifications, Foster Care custody change reports, and laboratory reports, among other functions. Hospitalization reports and continuity of care documentation (CCD) services also exist as independent options. From a baseline of just under a quarter of Arkansas’ office-based physicians who had adopted at least a simple EHR system in 2011[4], SHARE, in concert with the HITECH Act’s meaningful use incentive payments, has helped catalyze and consolidate a system in which over 90% of office-based physicians have done so.[5]

These services are developed and implemented through SHARE’s extensive technology partnerships with the private sector in Arkansas and beyond. This has created a unique and dynamic outlet for health IT innovation that ensures modern technologies and applications can be rapidly integrated into the state’s health system for the benefit of providers, patients, and other stakeholders. SHARE likewise works closely with public sector authorities outside OHIT to improve health IT access and efficiency for essential services, including a longstanding integration with Arkansas Medicaid. In addition SHARE works with Commercial Health Plans, Arkansas PASSE’s – Provider-Led Arkansas Shared Savings Entities, the University of Arkansas for Medical Sciences (UAMS), Arkansas Department of Corrections, and the Arkansas Department of Health (ADH), while having connections to all 94 of the state’s county-based Local Health Units.[6] Additionally, OHIT has partnered with the UUAMS Biomedical Informatics Department to allow fellows to rotate through SHARE to understand health information exchange and interoperability efforts happening statewide. Each fellow rotates for a four-week period and can select an additional rotation as an election in the fellowship.

SHARE has demonstrated considerable progress towards interoperability through its scale and scope of operations. As the network continues to grow and evolve, a key question is whether the HIE label is still the best structural paradigm for SHARE—or whether the complex, multi-layered and blended public-private infrastructure that SHARE maintains is better understood as something newer. How providers, payers, patients, and policymakers conceptualize the fundamental role of the statewide health data system is critical to how it operates and to whom it is ultimately responsible.

Consistent with nationwide trends in expanding public and nonprofit HIE capabilities, SHARE is best characterized as an emerging health data utility (HDU) by virtue of its central governance position for multiple overlapping health data use cases in the state and its role as an accessible resource at the community level across Arkansas.[7] The functional transformation from HIE to HDU is most evident in the broader public health space, where recent SHARE initiatives are focused on leveraging its broad reach and technical depth to keep driving systemic modernization at Arkansas’ public health authorities (PHAs) and strengthening their linkages to SHARE at the same time.

Several items within SHARE’s public health portfolio represent this functional transformation from HIE to HDU. Externally, SHARE provides ADH’s exclusive connection to the eHealth Exchange national network, which among other services gives SHARE access to the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS). Participation in a national network while maintaining local trust networks is just one of many key characteristics of emerging HDUs. AIMS is the nation’s premier information exchange network for public health labs, including ADH’s Baker Public Health Lab, and connects to the Centers for Disease Control and Prevention (CDC) and Arkansas hospitals on AIMS that also contribute data to SHARE. Operationally, this means that SHARE is interposed between these entities and AIMS and consequently has responsibility for ensuring the “data hygiene” and standards compliance of electronic lab reports that flow out from Arkansas to the AIMS network—and to the CDC’s National Syndromic Surveillance System.

SHARE’s position at this central nexus between providers and public health authorities has also made it the de factostate “utility” for ongoing digitization efforts and related systemic upgrades. No less than 70 different EMR platforms statewide currently exchange data with SHARE, each of which must be able to seamlessly connect to the network for their respective facilities and organizations to reap the benefits of interoperability. Lack of fully-standardized data elements and diverse technical specifications are persistent barriers—but in many cases (especially public sector use cases), the SHARE team starts from a lack of any data elements whatsoever. Newborn screening at the hospital (the “heel spot” blood test) is a foundational public health service for identifying a wide range of congenital conditions early, and by 2021 ADH had achieved a 98% screening rate for the 31 conditions tested.[8] The problem to date is that all those lab results have been transmitted via fax, limiting their integration with the rest of ADH’s health information, the national networks, and SHARE’s own systems. Similarly, prior to 2023, a large segment of the agency’s 26 disease registries[9] and associated information were partially or fully running on paper or otherwise unconnected, requiring providers to fax or call in required disease reporting information. For EMS responders seeking to collect and upload data to a central HIE platform, no mechanism exists at all.

Since the end of the COVID-19 pandemic, SHARE has moved quickly and intently to address each of these significant gaps in the system. Working in close collaboration with ADH as well as several of the state’s leading hospital systems[10], registries for infectious disease, maternal mortality, birth defects, traumatic brain injury, and other conditions have been digitized and linked to core components of SHARE’s virtual health record (VHR) and HIE platform infrastructure. Other registries that are already electronic—those for electronic laboratory reporting (ELR), cancer registry, syndromic surveillance, and immunization reporting—are being streamlined through SHARE integration with an emphasis on reducing interfaces which in turn saves the healthcare entities money and time.  Applying best practices that were scaled rapidly during the COVID-19 pandemic, the system allows state epidemiologists and Local Health Unit staff to seamlessly access data that includes real-time tracking, demographic information, and monthly updates.

In late 2024, SHARE began piloting the transition from fax machines to electronic lab reports for newborn screening with Arkansas Children’s Hospital, its Epic EHR provider, and the Arkansas Public Health Lab. The initiative is currently finishing its “test monitoring phase” and preparing to go live this year; shortly thereafter, the SHARE team expects to expand the work to other hospitals on the Epic system followed by hospitals contracting with other vendors. At the same time, SHARE is building the state’s first digital platform for real-time EMS data integration with providers through its own infrastructure. The new service has begun in the trial stage as a partnership between ADH, SHARE, and several private ambulance providers to combine alerts, access to continuity of care documents (CCDs), and other parts of the SHARE portfolio centered on its MPI and eCR capabilities. Enabling consolidated reports on patients who were transported and treated in EDs or as inpatients vs those who were not transported after an EMS call will be particularly valuable for primary care follow-up and coordination—which will also be facilitated by SHARE’s HIE platform.

SHARE has also made a priority of continuing to deepen connections between state agencies and sub-agencies that manage health and health-related data as a matter of government and network efficiency, modeling HDUs’ role as key arbiters within the public health enterprise. Among the foremost recent examples of this imperative is its project to integrate beneficiary data from the Special Supplemental Nutrition Program for Women, Infants, & Children (WIC) into other clinical and non-clinical data streams under different divisions of ADH, particularly Medicaid. WIC is administered at the federal level by the USDA’s Food and Nutrition Service, while ADH manages the funding for the state and county Local Health Units deliver the program benefits (healthy food, breastfeeding and nutrition support, and care referrals). Pregnant and postpartum women and young children are automatically eligible if they are already enrolled in Medicaid or SNAP.[11]

Despite this large pool of potential beneficiaries, only 53.5% of eligible people nationwide are enrolled in WIC[12] and Arkansas total utilization rate of 35% in late 2021 placed it lowest in the country, below neighboring Mississippi (46.6%), Texas (49.6%), and Oklahoma (51.7%).[13] In response, SHARE led an effort to maximize value and the impact of WIC dollars for the highest-need Arkansans by cross-referencing data on Medicaid enrollment and relevant clinical-demographic indicators (postpartum status, children under age 5, A1C level, BMI) from its master patient index to identify potential WIC beneficiaries. Building on secure data flagging and patient matching processes that it used to connect ARHOME to providers and patients during the 2023 Medicaid redetermination process,[14] SHARE has successfully assisted ADH and Local Health Units with targeted outreach to eligible Medicaid beneficiaries and allow ADH staff to expedite their WIC enrollment.

Conclusion

The transformation of SHARE from a traditional Health Information Exchange (HIE) to a fully operational Health Data Utility (HDU) marks a watershed moment in Arkansas’ journey toward modernizing its public health infrastructure. This evolution is not merely a technological upgrade—it represents a strategic overhaul aimed at creating a dynamic, data-centric ecosystem that connects healthcare providers, public health agencies, and community services in unprecedented ways.

At its core, SHARE’s transition underscores the power of statewide interoperability. By linking diverse data systems and fostering public-private partnerships, Arkansas has built a robust framework that ensures critical health information is accessible and actionable. This seamless integration supports real-time data sharing across multiple sectors, allowing for rapid responses to public health emergencies and enhancing day-to-day care coordination. In practical terms, the digitization of registries and the enhanced integration of EMS data have filled longstanding gaps in data accessibility, resulting in more coordinated and efficient public health responses.

Moreover, SHARE’s forward-thinking approach extends beyond technical enhancements. Strategic initiatives, such as modernizing newborn screening protocols and streamlining disease surveillance, illustrate commitment to proactive, data-driven public health measures. By leveraging sophisticated analytics and targeted outreach strategies—such as those supporting WIC enrollments, SHARE is not only improving operational efficiency but also driving tangible improvements in population health outcomes and the health of Arkansans. These efforts underscore how advanced health data utilities can transform raw information into strategic insights that guide policy decisions and clinical practices.

Looking ahead, as SHARE continues to expand its capabilities and integrate even more deeply with public health and social services, it is setting a national benchmark for systemic modernization. Its holistic approach—combining advanced technology, strategic partnerships, and targeted public health initiatives—demonstrates the potential for HDU functionality to drive systemic change. By harnessing comprehensive data to inform decision-making, SHARE is helping to create a more resilient and responsive healthcare ecosystem, one that not only addresses immediate public health needs but also lays the groundwork for long-term improvements in care coordination and community well-being.

Learn more by visiting the SHARE website.

References:

[1] Arkansas Code Annotated. § 25-43-809. Office of Health Information Technology—Creation—Purpose—Policy. Available: A.C.A. § 25-43-809

[2] Arkansas Code Annotated. § 25-43-812. State Health Alliance for Records Exchange—Duties. Available: https://law.justia.com/codes/arkansas/title-25/chapter-43/subchapter-8/section-25-43-812/

[3] SHARE: State Health Alliance for Records Exchange. Available: https://sharearkansas.com/

[4] Office of the National Coordinator for Health IT. “Health IT State Summary—Arkansas.” 20 February 2015. Available: https://dashboard.healthit.gov/quickstats/widget/state-summaries/AR.pdf

[5] SHARE: State Health Alliance for Records Exchange. “What is SHARE.” Available: https://sharearkansas.com/about/about-share/

[6] SHARE: State Health Alliance for Records Exchange. “Which Providers are Using SHARE.” https://sharearkansas.com/our-progress/who-shares/

[7] SHARE: State Health Alliance for Records Exchange. “The Value of SHARE-ing Health Information.” 26 June 2024. Available: https://sharearkansas.com/2024/06/26/the-value-of-share-ing-health-information/

[8] Arkansas Department of Health. “Newborn Screening.” Available: https://healthy.arkansas.gov/programs-services/community-family-child-health/newborn-screening/

[9] Arkansas Department of Health. Data, Statistics, and Registries. Available: https://healthy.arkansas.gov/programs-services/data-statistics-registries/

[10] SHARE: State Health Alliance for Records Exchange. “UAMS IDHI Brain Injury Program Emphasizes Value of SHARE Hospitalization Alerts: Raising the Quality of Care While Providing Long-Term Care.” Available: https://sharearkansas.com/2024/05/20/uams-idhi-brain-injury-program-emphasize-value-of-share-hospitalization-alerts-raising-the-quality-of-care-while-providing-long-term-care/

[11] USDA Food and Nutrition Service. “WIC Eligibility Requirements—Am I Eligible.” Available: https://www.fns.usda.gov/wic/applicant-participant/eligibility#:~:text

[12] Neuberger, Zoe. “WIC Coordination with Medicaid and SNAP.” Center on Budget and Policy Priorities. 8 October 2024. Available: https://www.cbpp.org/research/food-assistance/wic-coordination-with-medicaid-and-snap-1

[13] USDA Food and Nutrition Service. “National and State-Level Estimates of WIC Eligibility and Program Reach in 2021.” Available: https://www.fns.usda.gov/research/wic/eligibility-and-program-reach-estimates-2021

[14] SHARE: State Health Alliance for Records Exchange. “A Newsletter from SHARE—Spring 2023.” Available: https://sharearkansas.com/wp-content/uploads/Spring-2023-SHARE-Newsletter.pdf

by Communications Team

Civitas at HIMSS25

Civitas Networks for Health is proud to collaborate with HIMSS for their highly anticipated #HIMSS25 Global Health Conference in Las Vegas. Taking place from March 3-6, 2025, this event is the epicenter of health care innovation, bringing together industry leaders, innovators, and professionals from across the digital health ecosystem to advance health IT and interoperability. 

What Makes HIMSS25 Unique? 

• Cutting-Edge Educational Opportunities: Delve into a diverse array of sessions led by expert speakers, covering key topics such as digital health transformation, data governance, health equity, AI-driven patient care, and more. Attendees can also earn CE credits to stay ahead of industry trends. 

• Innovative Pavilions and Forums: Experience groundbreaking exhibits like the AI Pavilion, Interop+Smart Experience Pavilion, and First-Time Exhibitors Pavilion. New preconference forums, including the Health Equity and Smart Health Transformation forums, will provide actionable strategies to tackle pressing challenges in health IT. 

• Showcasing Emerging Talent: The Emerge Innovation Experience offers a platform for startups and innovators to showcase breakthrough ideas, making it a must-visit for investors and early adopters. 

• Emerging Healthcare Leaders Reception – HIMSS Health Conference & Exhibition: The HIMSS team is hosting an exciting evening reception where you can mix and mingle with other vibrant young professionals. Enjoy awesome music, delicious food, creative dessert drinks, and great company! Learn more. 

• Exclusive Networking Opportunities: Engage with health care professionals, including Civitas members, to discuss how local networks fuel national transformation. Civitas is hosting a member meetup on March 4 at 4:00 PM, co-hosted with InterSystems. 

Want to learn more? Check out everything new at HIMSS25 by visiting the HIMSS website. 

 Civitas members can access exclusive discounts. For details, email contact@civitasforhealth.org and ask about your HIMSS registration discount code.  

Civitas Involvement at HIMSS25 and Interesting Conversations We're Looking Forward To

Civitas Networks for Health is proud to have a role in shaping conversations at HIMSS25. From moderating dynamic discussions on interoperability to hosting a dedicated member meetup, Civitas is fostering collaboration and furthering the national dialogue on how we are using data to drive health system transformation. 

Here are a few things to look forward to at the conference: 

Real Discussions on Advanced Interoperability – Breakthroughs & Barriers 

"The State of Interoperability & HIE Today" opening keynote will set the stage for a day of deep discussions on the breakthroughs and barriers in healthcare data exchange. Taking place on Monday, March 3, at 8:30 AM (PT) as part of the Interoperability & HIE Preconference Forum, this keynote will provide a high-level overview of the current interoperability landscape, highlighting both progress and persistent challenges. Brendan Keeler, Interoperability and Data Liquidity Practice Lead at HTD Health, will explore evolving standards, policy impacts such as the 21st Century Cures Act and Information Blocking Rules, and the role of HIEs in improving care coordination and patient outcomes. This session will offer valuable insights for health IT leaders, policymakers, and interoperability advocates navigating the complex and ever-changing health data ecosystem. Additional registration is required to attend this exclusive forum, making it a must-attend event for those driving forward interoperability efforts in 2025 and beyond.

Additionally, Civitas CEO Lisa Bari will moderate two sessions as part of the Interoperability and HIE Forum (preconference) on March 3, 2025, at the Venetian Hotel. The Forum sessions will tackle critical topics, including privacy, regulatory frameworks, and the evolving landscape of the Trusted Exchange Framework and Common Agreement (TEFCA). Civitas is proud to have served on the HIE and Interoperability Forum Committee helping to bring attention to pressing topics and in designing meaningful programming. 

Forum highlights included: 

• Opening Keynote: A powerful overview of the current state of interoperability, featuring recent advancements, persistent barriers, and the opportunities ahead. 

• Fireside Chat: Industry leaders discuss real-world success stories, lessons learned, and policy impacts on interoperability efforts.

• Audience Reactor Roundtable: An interactive session encouraging audience dialogue on strategies to advance interoperability initiatives. 

Here are the details for the two sessions Lisa will moderate – mark your calendars: 

Fireside Chat - The State of Interoperability & HIE Today: Breakthroughs & Barriers 

• Monday, March 3, 2025, 9:05 AM to 9:50 AM · 45 min. (US/Pacific) 

• Venetian | Level 3 | Lido 3101 

Crowd Pulse: The Audience Reactor Roundtable - The State of Interoperability & HIE Today 

• Monday, March 3, 2025, 9:50 AM to 10:15 AM · 25 min. (US/Pacific) 

• Venetian | Level 3 | Lido 3101 

Civitas Member Meetup at HIMSS 2025

Join Civitas and our member co-hosts, InterSystems, for an exclusive member meetup on Tuesday, March 4, from 4:00 –5:30 PM. This is your chance to connect with peers, share insights, and deepen relationships with other Civitas members .  

For event details, email contact@civitasforhealth.org. 

Civitas Member and Partner Sessions at HIMSS 2025 

If we missed your organization in the lineup, let us know so we can add you! 

Civitas’ Commitment to Health and Health Care Transformation 

Civitas proudly represents a diverse network of organizations—including Health Information Exchanges (HIEs), Community Information Exchanges (CIEs), Health Data Utilities (HDUs), All Payer Claims Databases (APCDs), Regional Health Improvement Collaboratives (RHICs), and Quality Improvement Organizations (QIOs) among other strategic business and technology partners—working together to transform health care through data-led collaboration. HIMSS25 offers a platform to highlight how these partnerships and local networks drive national impact, from enhancing care coordination to advancing interoperability. 

Civitas is excited to be at the event and encourages you to join us in Las Vegas as we build a more sustainable, equitable, and connected health system. 

For more information on HIMSS25 and Civitas events, visit HIMSS25 Website or contact us at contact@civitasforhealth.org. 

by Communications Team

How to Make the Most of Your Civitas Membership

As a Civitas Networks for Health member, you’re part of a vibrant and diverse network working together to advance health improvement, data sharing, and collaboration across communities. Civitas offers a wealth of resources, opportunities, and connections to help you make an impact in your region and beyond.

Here’s a guide to help you maximize your membership benefits with specific examples to illustrate the value available to you:

Join Workgroups and Councils 

Workgroups and councils are a fantastic way to collaborate with peers and tackle shared challenges and areas of interest. These groups are designed for members to roll up their sleeves and dive deep into critical issues that impact daily work.

Getting involved is easy—just sign up when you’re ready, and our team will make sure you’re connected to the right resources.

Our workgroup offerings include:

• Equity and Quality
• Executive Leaders Forum (designated for full and affiliate member executive leaders/by invitation only)
• Emerging Leaders Council (nominations open once a year for full and affiliate members)
• Social Determinants of Health and Interoperability
• Health Data Utility (invitation only/or by request)
• Marketing and Communications
• Public Health
• Standards and Technology
• Learning Health Systems

Civitas members can sign up for workgroups anytime through the interest form – available in the Member Area – or email contact@civitasforhealth.org for assistance.

Leverage Tailored Resources and Tools 

At Civitas education and training is core to what we do. 

We develop and provide a wealth of resources to help you excel in your daily work and make meaningful connections across the network. From practical toolkits and case studies to guidance on navigating emerging health data standards, these materials are designed to meet the needs of members across different sectors.

These resources most often come from collaborative efforts within our workgroups and with input from our Civitas members, reflecting the collective expertise of our members. Additionally, Civitas regularly publishes authoritative blogs featuring member’s and tailored topics, papers, and reports that highlight best practices, share actionable insights, and showcase success stories from across the network.

Here are a few key public resources you can explore to start:

• All about Health Data Utilities
• Civitas program information
• Public comments and advocacy resources

Please note that more is available in the Member Area.

Members also have access to educational events and technical support, helping you implement cutting-edge solutions without starting from scratch. Whether you’re modernizing data-sharing practices or addressing social determinants of health, Civitas equips you with the knowledge and tools to advance your work effectively.

By taking advantage of these tailored resources and learning opportunities, you’re not only strengthening your organization’s capabilities but also contributing to a shared vision of using data to improve care.

Explore what’s available through the Civitas Member Area and our website. If you are not finding what you are looking for, let the Civitas team know how we can support you further.

Attend Events and Webinars 

Civitas hosts a variety of events that offer learning and networking opportunities throughout the year. Whether it’s the Network News all-member monthly series, which keeps members informed about the latest Civitas updates and partner developments, or specialized webinars like the FHIR Deep Dive Webinar Series, there’s always something happening to expand your knowledge and connect with peers.

Don’t miss the Civitas Annual Conference, “Bridging Data and Doing”, hosted this year in Anaheim from September 28-30. It’s the perfect chance to showcase your work, meet 800+ Civitas members and health industry professionals from across the country, and gain fresh perspectives and actionable insights to take back to your work.

Amplify Your Work 

Your success is our success, and we’re committed to highlighting the incredible work of our members. 

Civitas regularly promotes member achievements through social media, blogs, newsletters, case studies, and even public-facing reports and whitepapers. If you have a story or project to share, let us know. Whether it’s a case study, an innovative program, or a recent achievement, Civitas wants to amplify your voice and showcase the impact you’re making. If you’re interested in learning about ways Civitas supports this, or tips to improve your organization’s communication strategies, please join the Civitas Marketing and Communications (MarComm) Workgroup by emailing contact@civitasforhealth.org.  You can also always email your news and updates to contact@civitasforhealth.org for inclusion in our newsletter and other communication platforms.

Explore Partnerships and Civitas Programs 

Civitas is much more than just a network—it’s a bridge to powerful partnerships. Our programs and initiatives like the Patient Centered Data Home bring members together to enhance data sharing across regions and the Demographic Data Element Modernization (DEMo) initiative where we are shaping the future of health equity by refining how demographic data is collected and used. By participating, you’ll not only contribute to these transformative projects but also gain access to tools and insights that can directly benefit your organization.

Stay Engaged and Informed 

Your Civitas membership is your gateway to impactful connections, innovative resources, and the tools needed to address pressing challenges in health care, health data exchange, community, and public health.

The more you engage—through networking opportunities, participation in workgroups, or leveraging exclusive resources—the more value you’ll gain in advancing impactful solutions for your community.

Civitas’ communications channels are your key to staying up to date – Network News Webinars provide monthly updates on Civitas initiatives and industry developments. Additionally, follow Civitas on LinkedIn and X to see member highlights, industry news, and event announcements. You can also subscribe to the Civitas newsletter for updates on events, resources, and opportunities tailored to your interests.

For questions or to learn more about how to maximize your membership, visit the Civitas website or email us at contact@civitasforhealth.org. Our team is here to help!

Together, we can drive meaningful change and build healthier communities nationwide.

by Communications Team