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
