Hello my name is Dr. Sarah Walker and I'm honored to serve as the 2025 president of the El Paso County Medical Society.

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Thank you again and we hope you enjoy this program presented by the El Paso County Medical Society and hosted by Kathrin Berg.

When you're being treated for a medical condition, your health care information is vitally important and these days it's getting and easier, easier for doctors to have it all at their fingertips when they need it.

We all know the feeling of filling out medical forms, and you have noticed over the last several years that this practice has become a bit easier, especially if you're going to the same health care provider.

There has been collaboration and technology in our community that is advancing so much that your providers have now the information together all in one central place.

This is especially important when there is an emergency and they need your information.

Today, we're going to talk about how health care information is being shared in our community and how it can help you and our community and also your kids and grandkids.

This evening's program is underwritten by Paso del Norte Health Information Exchange and we also want to thank the El Paso County Medical Society for bringing this program to you.

I'm Kathrin Berg and you're watching the El Paso physician.

Thanks again for joining us this evening.

We're going to be talking about the understanding of the importance of community health data, as well as improving patient care through data sharing.

And we have with us Dr. Joel Hendryx, who is the chief medical officer of University Medical Center and also a board member of PHIX.

And I'll explain what that is in just a moment.

And then we have Dr. Hector Ocaranza, who is the health authority.

And I always think of what.

But no, you're the health authority, also the medical director of the Department of Public Health and also a board member of PHIX.

And then we have Emily Hartman, who has been with us several times.

Even when we were putting all of this together years ago, I feel like it's been about a decade.

And that's why it's so interesting to have this show today of what things are different.

But you were the executive director of PHI and that spelled P H I X .

Physicians Health Information Exchange.

And that's what we're going to be talking about this evening.

And what I'd like to do, Dr. Hendricks, if we can sort of stop for a minute.

So in your role of Chief Medical Officer and then also as a board member of PHIX, explain your role here today, because I know you've got a thousand different roles out there, but for today and for tonight's discussion, explain those two roles.

Well certainly, as a representative of El Paso County Medical Society My role is to be able to present to the board and to work with Emily and other physicians.

We have a physician advisory group, and it's there to be able to help advise, to listen to feedback and give them feedback, try to help them with their initiatives, saying, you know, this makes sense, makes sense from a medical point of view, or it makes sense from a patient perspective and try to encourage other members and our our community, physicians, to be able to participate.

We've been very fortunate that the different health care systems have all joined together and now have information given to PHIX.

And that kind of coalesce during the pandemic, which has been was very vital.

Very vital is how we managed to get through that.

And El Paso was a leader in that.

And so that that is my role is to be able to help communicate back to the county medical society, to our physicians in El Paso, and also to help give initiatives and work with Emily on those initiatives as we move forward.

And I feel like it's just been speedy over the last several years because when we talked about this originally, it was just about getting one system on board and then two systems on board.

And I want to say our first program with you and I, Emily, and I don't remember who else is on there.

I believe you were as well, is about seven, eight years ago.

And we were looking at just getting one hospital system on and now all of them are on.

So I would love for you, Emily, if you could again, as the executive director and you're the founding executive director, if I understand the right and if not, I. I saw you go like this, so you're not.

My experience----- - -but talk about the the startup of all of this.

Sure.

So in the beginning it's talking about the potential value and working with folks like Dr. Hendryx and Dr. Ocoranza and other peers in the physician committee to talk about what could we do if we had all of a patient's medical records in one place.

Theoretically, when they go into the emergency department, that'll benefit their care.

And now it is almost a decade later.

I think I've been at PHIX for about eight years now, so it's been a long time.

Now have those real stories from providers talking about their patients.

When it was actually at University Medical Center, one of the emergency department physicians from Texas Tech was telling me that their workflow is that when the patient comes into the emergency department, they'll pull the patient's driver's license and look up what's happened with that patient.

What if they're having a cardiac issue?

What medications are they on and what procedures have they had so that they can best direct that individual's care?

And so we're really fortunate now with really broad participation.

We have all the hospitals in El Paso, we have Texas Tech, we have Emergence Health Network, we work with the VA, we work with the Department of Defense and William Beaumont.

So having all of those partners data flowing through the system, it really allows it to be beneficial to the physicians in the ways we were dreaming of, you know, eight, ten years ago.

So here's an odd question, and it's not something we talked about earlier, but say you have an issue, you're in El Paso and you're in the system here in El Paso, but now you're in Montana on vacation.

You talked about being able to have a driver's license.

Is that a system that is nationwide, becoming nationwide?

You said Dr. Hendricks at El Paso was really great about getting this all together.

Where are we in America with that?

Dispersity I guess.

Sure.

So we are a regional organization.

We're a local nonprofit to El Paso, and we work into southern New Mexico and West Texas as well.

But we connect with peers at a national level and we connect with other types of national networks so that that information can flow from an organization like ours to others across across the country.

Very nice.

I love hearing that.

Dr. Ocaranza.

So through the years, goodness gracious, we've done all kinds of stuff.

Definitely.

So in your role here this evening, again, you're a board member of PHIX and I know we're going to talk in a little bit to what broad benefits that fix is to the community.

But in your role here, what is it that you're doing with PHIX with the health department as the health authority, etc.?

Well, in this day in time, data is so important to be able to objectively respond to anything.

And the COVID pandemic Was the best example PHIX was instrumental in being able to people get appointments to get the vaccine, to get the results on the COVID test, because the health department was the only one that was doing COVID testing at that time, and people needed to have the results, PHIX made it possible So bringing all the data together and basically all the providers sending the data to PHIX and PHIX being able to distribute to whoever needs that data was pivotal to have a better response.

And it continues to evolve because now we're able to see what's been going on in the community that is called the syndromic surveillance, when a lot of people get sick from the stomach, whether it is a virus, whether it is food poisoning, we will be able to see the effects of this because people are going to be buying medications for diarrhea, buying medications for colds, especially now that is the cold season.

And if people after buying the cold medications end up in the emergency room now, we're going to be seeing a lot of those patients coming to UMC, coming to any of the hospitals.

And together that information gives us an idea of what is happening.

And we can start having education, vaccination or other countermeasures to keep the community safe and healthy.

So here's a question.

I mean, think about it then.

You remember when we were kids are our children.

We have to provide the vaccination, the sheets before they go to school, before they go to college.

Is PHIX a place that adults have their information, their vaccination information?

I'm just thinking this right now as a mom, for example, somebody asked me when was the last COVID vaccine you had?

And I had to go in my desk, find my little card to see which one it was.

And I feel like a knucklehead.

I'm thinking, I'm sure that's listed somewhere.

Is it?

I don't know.

I'm just kind of throwing that out there is PHIX part of that, to where, yes, it's your medical information, but it also shows if you did get the flu shot, if you've had your shingles vaccine, I'm just thinking about the, you know, the different things that are optional right now.

So we do receive vaccination history, whether it's pediatric or adult, if it's part of the medical record that shared with us by our partners, we do receive it.

We do not, however, have a patient facing ability at the moment.

Right.

Right now we're limited to providers being able to access data for their patients through the system.

Okay, that makes sense.

And so on that this is me just coming up with questions as you're talking about it.

I know you provided questions, but for example, if I am with a specific hospital system and you know, there's several in town, but when I go to register for my upcoming appointment, check in, and then a lot of my information is already in there, which is so fabulous because the last time we did the show seven years ago, that was kind of the thing.

Its like, you know, every time you go to the doctor, you sign the same things, you fill it all out.

Now it's all there.

And for the most part you just change something here or there.

When that is the case, when you said it's not a patients entering the information, that information that you're giving to the provider, the patient giving to the provider, then that information is shared.

Is that correct?

Is that how I'm hearing that?

So, yes.

Do you want to get that?

I think that so if you go to a hospital, depending on which hospital you go to, you've been to another hospital, you've had another lab test, the that institution has to access facts.

Oh, it's not a it's not a pop up.

It just says, oh, you've got this.

And that's something they are working on.

So it's not pushed to the hospital.

They have to actually access it internally with time.

And as people get more used to it and the benefit, the value of that information, whether it's your private doctor or an institution, they have to access it.

And that's something that Emily and her team are working on, looking at a new platform, making it easier to find that patient and to be able to access it in a in a meaningful manner so that you don't spend a lot of extra time.

Exactly.

And therefore, that information.

So while we're there, whether it's an X-ray test or whether it's a medication or, you know, all the things you were in the hospital two weeks ago.

Well, you know, when I was in private practice, it took me a month sometimes to get information from the hospitals.

Right.

Because it had to go through manually.

And now it's just a matter of looking on PHIX and being able to say, Yeah, that's you.

I can verify that.

And and yes, well, you did have that.

Okay, I don't have to repeat that test, but you know, I need to do it in two months.

I need to be able to follow you up or in the medications that you receive from the hospital.

You know, I, I can I can access that and be able to help tailor your care based upon that current information.

Wow the convenience and accuracy of that, I think was fantastic.

We talked a little bit right before we went on air about each hospital system having a mandate by CMS and I in and was like, you know, it seems isn't like, no, I don't but it's the Centers for Medicare and Medicaid.

But there's a mandate to have a plan and come up with a plan and who is best to describe that of the three of you, I'm throwing that out there.

I think Dr. Hendricks brought it up earlier.

Well, certainly so.

So CMS, which is the they are the ones who help pay for Medicare and Medicaid.

Right?

It's Medicaid.

It's a state program, but it is funded to through that the federal government.

And with that, they come up with guidelines and they come up with suggestions.

And part of that is that we have to at this point start documenting social determinants of health and be able to start analyzing the needs of our of the patients within our system.

Then with that, then in the coming years, there is going to we have to have an action plan.

So each hospital system will have to do that right or so, which is important, which is good, good for the patients.

So if I live in a certain zip code and certainly there are certain social determinants of health or it's food insecurities, whether it's transportation, whatever that is, that has to be we have to understand that and be able to put the resources that we need, that our community needs to be able to address those so that on an individual effort to that patient going to a clinic, whether it's our clinic, whether it's a private doctor.

Right.

That they have, they will be able to understand, you know, what, this this person really needs some extra care and extra questions on what are the barriers to them getting care.

Mm hmm.

Mm hmm.

Why do more women get better care than men?

Because they don't go to the doctor, Right?

Exactly.

Exactly.

Emily had brought some things here, and I think this is a perfect transition to that.

So access, let's talk about it's going to be form B, So we're going to put up a form on the air for you.

And this is the relationship between food access and health.

And this is specifically about diabetes that we're talking about here.

And Emily, if you can kind of explain to the audience here what we are looking at.

The example is type two diabetes prevalence and food access and just having this kind of information and how is this beneficial to the community?

Yeah, sure.

So what you're seeing there is the purple is showing you access to food.

So the darker purple areas, there are areas of our region that are greater than one mile away from a grocery store, and that is the definition that's commonly used for a food desert.

And so what we've overlaid that information with here is the prevalence of type two diabetes, which these guys are both far better qualified than me to describe type two diabetes, but it's related in part to lifestyle.

So your diet and exercise, so not living in an area where there is easy access to healthy food could have an impact on on the prevalence of type two diabetes, which is what this is a first step that we've taken to try to understand that relationship in our community as part of planning with all of our partners about when you're thinking about patients not just within the health care setting, but as a whole person and their whole environment, understanding both the prevalence of type two diabetes but also other drivers that might be contributing to that, like food access is important.

And so how is this information?

I see this is part of the bigger picture.

How is this information gathered put together into this kind of a format?

Yeah.

So we're from the health care side.

What we're doing is we're taking the records that we're receiving from all of our partners, and we are identifying them, meaning that no individual's information is available.

So it's that private way of aggregating data at a community level.

So we have statisticians and informatics who are doing that work in our offices and partnering with Epidemiologists to help do this type of analysis.

And then looking at the food access data that you're seeing is from this the U.S. Census.

Okay.

I'm sorry.

No, it's not.

It's from a different resource that my team is using to understand grocery stores where they are and then applying the US census definition of what a food desert is to that.

And we were completely separate in my my other life.

So I'm with the El Paso Community Foundation and we operate downtown and there really isn't a grocery store downtown.

And so this issue comes up quite a bit when we're talking about downtown and securities.

What I'd like to do, Dr. Carranza, because it's kind of your turn to talk with this same information.

So we're looking at some of the initiatives for vaccinations around town, and this is the form number.

See if we can talk about this, too, and what folks are seeing.

Yes, there.

So there's a lot of things that we can see on this graphic, which initially, if you see you have peaks, you have colors, you can different things.

But what it helps us to determine is, okay, how much influence are we seeing in the merchants roles in the doctor's office?

So those are the big peaks that we see in the lower right corner of the graph.

And with that, we need to think, well, what can we do to avoid having these people go to the emergency room, getting hospitalized and making other people sick as well?

And now we put it in perspective.

As far as the map of El Paso, where are all these people that are sick coming from here in El Paso?

And if we see the zip codes, we can we know that vaccination is extremely poor and education as far as prevention, is extremely important.

So our teams of educator can go to the specific zip codes to talk to them about washing your hands, covering your cough.

Don't leave your mocos everywhere.

- I'm going to walk away with that today: Don't leave your mocos everywhere!

We're we're parents.

You know how we're always after our kids - I do.

Also bringing the vaccination to all these places.

Perhaps they don't have a right to go and get their vaccine.

That's the nonmedical drivers of health That's part of the social determinants of health.

Other aspects that can influence either positively or negatively to the health of somebody.

So look, in a more holistic view of the health of the community, the health of the family, the health of each individual, there's many factors that can affect and we can modify those factors.

And we as public health look at those and see how we can modify those factors or eliminate barriers so that people can access the care that they need.

In this way, we will see in the presence of the disease, in this case specifically the influenza, how can we modify to make it better?

How can we avoid this?

People end up sicker than we normally would see somebody with influenza.

So that is extremely important when you put together data and analyze it in a way that it comes to the health of somebody, whether it's is the individual, the family, the community.

That's what faith is doing, putting everything together.

So each one of us in the panel in the medical community can see and address those issues to make that person better.

I kind of like that because it's helping to predict the future so you can help prevent some of the things that may be coming about.

I thought I heard a little star start from you, Dr. Hendryx Well, I just to add on to what he was saying.

So certainly in we have perceptions right?

My my learning is that you have to validate, right.

We don't have that data.

But the data that they're bringing to us now helps validate what we suspect.

When you when you have that validated data, right, then you're able to really marshal your resources, go get grants, go get, you know, talk to your government, talk to talk to city leaders and say, you know, this is the data, this is what it's showing.

This is our community and let's work together with this data that we validated to be able to help take care of our a healthy community.

And what I love hearing about, again, us going on air, I feel like El Paso.

You said El Paso has been really great about this and the city actually gave a grant to help with this information as well.

So it really is.

We're all in it together, all health care systems, which again, kudos to El Paso.

Cause I know, many cities do not operate that way.

So very much so fantastic for El Paso on that.

Emily, I'd like to bring this up because it made me raise an eyebrow when you talked about this.

So also in this study you were talking about climates and how climate and air pollution actually affects the likelihood of having a heart attack.

And as you were saying to you, we have suspicions.

And when we have studies and we're looking at information, it helps validate some of the things that we're thinking about.

So with this study, this is fascinating to me.

Environmental factors and health.

If you'd like to kind of go through this one, too.

Yeah, of course I'll be out there.

So this is work that we did both with El Paso County and with the city of El Paso to look at exposure to different types of pollutants.

So we pulled publicly available data on different types of air pollutants in El Paso and overlaid that with respiratory encounters that individuals have in the community as well as heart attacks, myocardial infarctions, and found that there is a statistically significant relationship with with both.

And I personally did not know that air pollutants could cause myocardial infarctions because I'm not wearing a white coat.

I wouldn't have known that at all.

As you said earlier.

Yes.

So it's been to Dr. Hendryx' point an opportunity to validate what what the medical community knows.

And then I think once we have that information, there's an opportunity for public health messaging so that others can be aware of of risk and understand, you know, the public health things that they can do to help mitigate that risk as well.

If i'm a pulmonologist, And I know that my patients being exposed to high levels of nitrous oxide, then, you know, what am I going to do?

I need to talk to I need to help instruct them on these are not going out or wearing the mask or doing something different so that they don't have an exacerbation or that it's over.

You end up with a chronic disease, right?

This is what I think that data and validation does.

And then we're looking to a different areas of town that are higher and lower, etc., etc..

Yes, that's not shown on this diagram, but we can also do this geographically so that you can understand your your risk by by where you live as well.

So going on that question, because I feel like we're so associated with New Mexico, at least, you know, going back and forth.

But I know that the hospital systems are different.

And I think I asked this earlier about I may not have asked it in the proper way.

People who are traveling back and forth with Las Cruces because I feel like there's a lot of families that live between the two cities.

Does Las Cruces have its own information exchange now.

I think I know the answer with that that face.

So not yet.

And I'm going to use the word yet.

Would that be something that Are we working with anyone in Las Cruces?

I know it's a different state.

There are different policies, procedures in place.

I respect all that.

We do have partners in Las Cruces.

We don't have any of the major hospital systems, but we do have partners, some rehab hospitals, some outpatient clinics and specialists there.

And then we work with a hospital in Silver City, New Mexico, Hilo Regional Medical Center as well.

So we're working on growing in southern New Mexico, and it's all one big health care community across two states.

So so that's our goal.

And I'm just going to ask this question, and I don't even know if there is an answer for it.

So, again, with people going back and forth of Las Cruces, we also have a very large population that goes back and forth between Mexico.

Is that even anything that is on the for site or because I know the pace of day, I know everybody works with everyone else is always the desire.

I know you work a lot with Juarez.

What is the situation there, if any?

We have it in our strategic plan over the next three years to explore what that could look like.

There's a lot of complications from a..an aligning legal from both sides of the border, aligning how everything works from a consent perspective for patients to allow the data to go across the international border.

But but it is on our radar because we know it's an important aspect of of health in our communities that that patients do cross the border from a public health perspective, I know that's a desire as well.

Dr. Ocaranza Yeah, definitely.

And we continue to reach out and be partners, hence the name Paso del Norte and Health Information Exchange in which we hopefully one day can have that bidirectional communication with our partners from Mexico and Juarez, because many people come from Juarez to receive medical care here and vice versa.

A lot of the people go back and forth.

So having a way to look at medications, to look at procedures is going to make things a lot easier for those health care providers that are rendering the service to that individual patient without having to duplicate many of the studies, many of the medications which can pose a risk to each patient.

So in in the public health perspective, we know that diseases know no borders.

So both those political borders either between states or between countries, we need to see what is happening and what is affecting to the whole community, the whole region.

And we're breaking ground, as Dr. Hendryx said, where we've done so much more than the rest of the state of Texas or New Mexico.

And we will continue doing that.

We want to continue to putting in those building blocks --And tell me why and how is it I feel like when we talked about this was vaccination several years back, El Paso was boom, front and center.

We were ahead.

We are ahead with this, too.

Why is that?

Why is El Paso such a special community?

Well, that likes to work with each other.

I say that because we are also this program is aired in other states around the country on different PBS stations.

And so this is a way to brag about ourselves and very confidently say that is because of the special people that we have.

I know.

Great.

And Dr. Hendryx and Emily are very, very good special people that we have, and many othe that are leading this effort.

So I think in that regards, kudos to the whole community because we have the will, and we want to continue doing something good.

Mhm.

I like that.

Dr. Hendryx Yeah.

I think kind of adding on to what Dr. Ocaranza said is that the relationship between physicians and their patients is very good and they listen to their patients and not Dr. Google I mean the patients listen to the doctor.

And so I think that that helps if you have a belief in what they're saying, if you trust what they're saying because they've been with you for a long time, right, then I think that helps then.

And to you, it's not universal, but it certainly does help as we we move forward.

I agree.

I agree completely, completely.

There are and I just have this here actually from a question is I still have all my questions from the last time we did a program about five years ago.

And at that time, one of the questions was, are there any patients who are concerned about privacy?

And this may be another thing we all hear about HIPAA.

I don't know what I don't know what the acronym HIPAA stands for any more I used to I remember what it stood for in the past.

But there's HIPAA If we know the acronym, Great.

Let it go.

Let it throw out there.

But is there any is there a notion ---- Say it again.

Health Information Portabilitiy Act You can't you can't give out information without the consent of the patient.

Okay.

So anyone that has any concerns about their information out there, is that even a concern any more at all?

Yes.

So whenever you go to the hospital, you can opt out of sending information to PHIX.

Okay.

There is a box.

You can check it.

You just don't have to send it when you go to your doctor.

If they're a member of PHIX that they don't have this.

If you say no, you don't have to send it.

Okay.

And percentage wise, you think there's a lot of people that do do that.

I would think it's so super informative and good to have all the medical systems that you're dealing with, have your health information.

And again, if you're in a car accident, if you have emergency surgery for something, they can look you up and boom, she's allergic to these drugs.

She's you know, that's it's such a beautiful thing.

And that would beg the question of who would not want to have that.

Do you find that that's really an issue here?

It's not common.

It's less than 1% of the patients we have a less than 1% opt out rate.

But but we certainly respect it when patients do want to opt out.

That's obviously their choice.

And we help them through that process or their providers help them through that process if if that's their preference.

But you're absolutely right.

I mean, being part of PHIX we've seen it save lives.

We've seen the impact of when PHIX is accessed after a hospital visit by a primary care physician.

We we published a study in 2023 that showed that after that hospital visit, when PHIX accessed by primary care, there is a 61% decrease in rehospitalization for those patients and a 53% return decrease in return to the emergency department.

So there's a huge impact on having your information shared across your network of providers, but not everybody wants that and certainly we respect that as well with the opt out process.

So for the information of everybody that's listening and watching right now, so the 61% decrease of actually returning, explain.

I mean, I think we here at the table understand why.

But explain to the audience who's not familiar with this.

Why is that?

It's because your physician is able to see exactly what happened to you in the hospital in detail.

All of the labs that you had were there, all of the notes that were written, any radiology studies that were done, they're all there at their fingertips.

And so they're able to to see exactly what they need in order to best direct your care, do a medication, reconciliations and you for follow up studies, make sure that they're they have all the information they need to do that most effectively.

So you are helping me here with further questions when you're doing a medication reconciliation.

And this is, again, in the old days when we used to joke, it's like, Mom, put all of your medications in a plastic bag and bring them with us.

Now that is all in one place.

And here's the question, too.

There are times when it's okay, it's time to go off this medication and start that medication.

And is that something that PHIX again- You were talking, Dr. Hendrix that the health care system is what puts that information in.

So is that always kept up to date?

How does that usually work?

Again, when I check in your what medications are you still taking?

And sometimes I'm like, I remember what that one was for, and then I'll just kind of skip it.

Is that relooked at every time there's a medical appointments or how is that usually done?

Dr. Hendryx Well, from the hospital side, we have to do a medical reconciliation.

Every time you come in, you're admitted to the hospital.

We okay.

When you're admitted, we are mandated to do a medical reconciliation.

So we take if if you're in the system, then that really helps.

And if there's some question about if we can get information from PHIX, then that's even better, right?

Whenever your discharge, there has to be a medical and medicine reconciliation of your discharge medications that is once again posted to PHIX as a provider.

If I'm out, if I'm a part of PHIX, then I can go to that that PHIX and I can say, okay, well, these are the medications.

They were discharge.

What are they going to interact with?

What I want to do, do I want to change them?

Do I want to say, yeah, no, that's a great thing?

Or you know what?

We need to get you a consult with somebody else because this is a medication that determined you need a console for heart or for kidneys or whatever it is.

So medical reconciliation is a big is a big factor within the hospital system.

Now, if I'm a private doctor and I don't necessarily do a medical reconciliation and upload it to PHIX, I should sometimes most of the time they do, but it may not be 100% okay.

But when they do go to a hospital system, it didn't matter whether it's a tenant hospital, HCA hospital, UMC, any of those hospitals have to do a med record consolidation.

So you hit on a great point.

That was my next question.

Will private practice physicians be part of PHIX?

Again, this is from years ago.

So we were talking about hospital systems.

We were talking about a mandate with Medicaid and Medicare.

What are the rules, if any?

And again, we're in El Paso, so everybody wants to help each other out, which is awesome.

But with private physicians and whoever would like to take that, take that, what is the are there any mandates there or any rules to follow?

No.

Okay.

So El Paso County Medical Society working with PHIX, for their members, they we came up with a special deal with them to be able to have them join PHIX Okay.

And Emily was very good about working with the physicians, training them, training their staff on how that works.

And it is a value.

So if I'm a physician, I've got all these extra if it's an extra fee and if it's minimal, but I get a lot of value from it, then that makes it that's good.

So but not everybody sees it as a value.

And so therefore, what we want to do is try to introduce to them this idea that it is a big they and that that value is to your patient.

Absolutely.

And so if if you're able to have the information that communication and you're able to sit there in your mind, come up with a plan for your patient with that information, that's a value, right?

But how you translate that into everybody's seeing it that way is a little more of a challenge because it's not done.

And once they get to do something new here, once they get to do it, then, you know, we've we've had good success.

And I think Emily can talk to, you know, to some of the success stories she's had with private groups, small groups, private doctors, community clinics.

You see talk about that.

Let's take that, because we've kind of covered all the big stuff here.

So this is where I like getting into the weeds a little bit because I think it helps people understand why it's important to share that information and what it is that aside from this, what you and your staff are doing to bring on as many participants as possible.

Yeah, absolutely.

So right now we have about 350 and growing number of outpatient clinics that are part of our system and we love our partnership with the El Paso County Medical Society because it allows us to reach out to folks who may be interested in the system and talk about value.

I think, of course, there's no mandates, so it's about us explaining the value and talking to them, not just us talking to them, but telling the stories of their peers and how they use it to create efficiencies within their clinic and how they use it to benefit patient care as well.

And always taking their feedback.

I don't know if you want to add to that.

- Sure, and I'll put it in perspective.

If we see it in the patient's eyes, if I'm a patient, I go to the physician's office and I'm going to be waiting.

And you brought up the point that before we used to sign papers, the release of information, let me fax it to the other physician.

Let me fax it to the hospital and we go to the patient like, do you remember where you got those studies done?

Do you remember where you got the procedure to go?

I believe it's here.

Maybe it's there right?

So in the meantime, you're still waiting.

And we as physicians, we want to have the results so we can start putting everything together so we can develop a plan for you and not duplicate the services.

And we're not going to be prescribing a medication that you're really taking or you take something that is very similar and now you're doubling in the medication.

So all that is the value that PHIX brings in.

Because now that I have your name, your authorization to access the records, it's going to be populating into your health record.

And that's how we build that record in a more comprehensive way so we can deliver better care for you.

So doest this bring value, Of course, it brings a lot of value because I don't have to be having two three girls calling each hospital to fax me that information.

Now I can have it in the electronic health record.

And now as a physician, I'm not going to be spending that much time waiting for those, but I'm going to be spending time looking at you.

Right.

Checking you, providing that care that you need - That true one on one time.

Exactly.

And that's what we all want.

We want that one on one time with you.

So and I don't know and this is a question that in my head I'm thinking and I keep hearing the word mandate.

So, so far it's not a mandate for all physicians.

Do any of the three of you on this table foresee that being a mandate in the future for anyone who is truly practicing medicine, health care?

And I go, you know.

A clinic Sometimes it's not necessarily a doctor, but maybe a physician's assistant.

Is that something that you see is it's so I think, you know, from a if you look at it from a political structure.

So El Paso is so far advanced over most I've had the fortunate opportunity deal with a lot of the big Texas teaching hospitals and we are so far ahead of them in many ways.

But you're saying that.

Yes.

And and with that saying that, you know, there certainly there's a state mandate trying to create an umbrella thing so that everybody can exchange everything.

But it's not near as good as what we it is my in my opinion.

And and that's only by the fact that you're stating that all house along wrong that way we have a better system and we want to make sure that we're not smothered by that system.

Hopefully that we're able to so the value that we do and be a leader in and how you exchange information, because I think everybody wants the same thing.

Everybody.

It's why we had electronic medical records.

Why?

Because we were wanting to share that information.

But the mandate or if it comes, will come to potentially political.

Yeah.

And that we don't know.

We don't we have no idea in the future what that is.

Emily's given she has testified and she's been giving lectures and everything to the state and even nationally on on our system.

And she's done a great job.

So that's a great point there.

So the reception of you coming to meet with different legislators, what what, if any, are arguments?

Is it?

I always feel like everything comes down to money.

You know, it's funding the funding this and the funding that.

And I don't know if that's the case, but what are you being met with when you go and have these meetings?

I think for us, because we're fortunate that our partners fund our organization, our funding comes from our members.

And so we are not going necessarily for a funding ask to the legislature.

It's more educating them on the work that we do and trying to make sure that we're represented in conversations about data sharing at the state level and that we can contribute as appropriate, you know, to those conversations and to being a a pilot site really like an innovator in the state that others can look to for what they might be able to do in their communities, because we really are doing some great work with our partners here.

And we just want to make sure folks recognize that.

And that to Dr. Hendryx' point, we we get to continue to do the great work that that we're doing here locally.

So when you're looking at different systems in Texas, trying to get them up to speed like El Paso is how that how is that working now?

And how does that how do you see that working in the next five years?

It's not the same depth of information that we have and we're able to exchange within our local network of partners, but it's at least some information so that they can even know who is providers are in El Paso.

To your point, Dr. Ocaranza, even knowing who to call in high level diagnoses and medical history gives you a long way to knowing how to how to approach care for somebody when they're in a different community.

Right.

Is there a certain state that is kind of on the forefront, like El Paso is now as a city, but or is there certain areas of the country that see this more as an importance than than others?

It varies.

Every state and every regional model of health information exchange nationally has a different focus.

We're really heavy into use cases with our public health department and with our providers and working on analytics.

There's others that do and emphasize different types of of work, maybe working with nonmedical drivers of health.

San Diego is really good at that.

They were at the forefront of looking at folks across different sectors, looking at emergency department utilization among those who are receiving housing services and are just as involved just as an example, and using that information to drive kind of community of thought leadership around where should we really be investing dollars in our community to truly benefit in wraparound services for these folks?

So we try to look to those examples nationally, but we also have folks that are looking to us and we talk with folks from New York.

Actually, we have a regular call with them to collaborate on the analytics work that we're doing and share the work we're doing to help advance what what they're working on.

So it's and I'm a cheater because Dr. Hendricks wrote something down in his paper and I can see it from here, and he wrote down the word research.

So why did you write that down?

And I'm thinking this is somehow affiliated with everything that we're looking at here.

And I'd like to know, too, with this information exchange with these studies.

And you guys were talking about the grants, too, that the has given to you.

But in the area of research, what do you see going forward with that?

Well, certainly we Emily talked about de-identified identified debt.

And when you identify that, so whenever there's no names attached, any data, you're able to aggregate that data and analyze that data.

Dr. Carranza has done an job within our county of looking at that started certainly from a research point of view, whether it's a private research, whether it's say for example, Texas Tech, they have a lot of research.

And you know, there was a study on COVID and certain medications that were desired, effective for treating COVID as far as readmissions, as far as comorbidities, etc..

So that is that is one of the really interesting aspects of all this data, because you're able to utilize that in such an interesting way.

There was a doctor from Washington know well, Brigham Young, Brigham Young who you know with and we don't I don't think PHIX gives out data just to anybody it goes to the board it has to be approved.

It has to be specific for that.

It's not commercial.

It's it is specifically for a research project.

And with that, you're able to look at some data I think they're looking at from University of Houston, of looking at things.

They're doing stuff.

We're doing things.

Can you compare the data?

Can you say this data is comparable?

These are the things that we're seeing.

What are you saying?

Research is important and, you know, it doesn't necessarily treat your diabetes, but it may give you an idea of where you're going to go to treat that diabetes.

And, you know, once again, it's validating your assumptions or not.

Maybe we are wrong in our assumption.

You brought up a point, too.

And Dr. Ocaranza, I'm going to ask you about this.

So you said there is there is a lot of information being put in during the time of COVID because there are just people that were going to see the doctors that may not have seen them in years.

I remember when we were doing some of our programs during the time of COVID, we said to ourselves, you know, ten years from now, it would be very, very interesting what the data that has been gathered over this last decade will show is about, yes, what happened and what was going on during COVID.

But then there's that big question of long COVID.

You know, I think it's is it still called long COVID and the data that is being gathered there.

So I'd love for you to just maybe take that tangent a little bit with a lot of information that was gathered during COVID.

If there's long COVID now we're looking at four or five years out, where are we going to be five years from then with people that did have COVID, etc.?

All I guess I want to say like three years ago, we talk specifically about this during one of the programs and here were three years out and we know a lot more now.

Right?

Exactly.

In in if we talk about COVID, there was many factors that we didn't know.

Right.

In looking at the data.

Now we know who can get a long career.

What were the effects of the vaccination?

What are the effects of COVID initially compared to now?

But there's a lot of data that we collect that we're like, okay, what happens if we put this in?

We can analyze the effects of X into the health of Y, and that's what Emily and the group did with environmental factors in heart attacks.

So in there's a lot of success stories in public health when we look at data, meaning vaccination, meaning the use of seatbelts, we have to be jumping in the back seat with no with no seat belts!

How are we still right, I'm with you and we're still alive and many of them are not.

And those that data definitely gave us the chance to go to the legislative leaders in in promote some new laws.

And that's what also is been helpful in which we're creating laws to make things safer.

Is it because of the pollution that the cars are giving us?

So that's what we were right.

And Emily just talked about that with pollution.

Yeah, exactly.

Yeah.

Now the cars need to have specific anti pollutants, so things like that are extremely important and that's how we we want to collect data and we want to do that research.

We want to apply in into making things better.

And here's another point of that study, too, which I think is interesting.

The relationship between income and health so underserved communities in health.

And Emily, I may have passed this your way to to see wants to show people what we have on this map.

And Diego I'll tell you, Diego is the guy that does all the magic and puts all the charts in.

So I'm letting them know what charts we're using.

But on this chart here, when you're looking at our community and the different areas of what the income is and compared to health, explain why that's important and why it's good for the health community and providers to understand that.

Sure.

So this particular example is looking at type two diabetes prevalence across the community and overlaying it with the income level of certain census tracts, which are really small geographic areas to understand the relationship between type two diabetes and income.

And so you can see that there's areas with both low income and and high prevalence of type two diabetes, and that's a challenge for our health care community because type two diabetes is related to lifestyle and impacted by things like healthy eating and exercising.

And that's all far more difficult to do if you have low income.

And so it's providing that information back to our health care community to inform different strategies and programs that may be able to benefit those communities in a unique way, given both the prevalence of the disease but also the income of the community.

And there's one here too, which I think is super important, is senior falls know people who are elderly and where they may.

Yes, we were talking about the blues, whose couch earlier, we were all sitting in that couch like, Man, it's hard to get out of this couch.

But when I was 12, it wasn't that hard.

But in general, we do have areas of the population that are more aged and other areas of the city.

So talk a little bit about that too, and how that is helpful for the knowledge.

Sure.

Absolutely.

So this is looking at again, at vulnerable groups, so seniors who are falling, what is their impact in terms of other conditions that they may have that may be contributing to the risk to fall?

How many falls you're seeing per senior?

Because once you fall, once there's a higher likelihood that you'll have a subsequent fall, that could lead to a longer length of stay in the hospital and worse health outcomes.

And so what this is also showing is an increase in senior falls over time.

And so it's an important public health issue for our for our community.

Very nice.

And so, Dr. Ocaranza, I feel like you, the public health authority or the health authority excuse me.

Yes, there is the health authority.

That's it.

And a pediatrician, which is great, right?

You want to ask every pediatrician about the future?

And that is my next question.

So in the area of data exchange and again, I foresee hopefully that the nation will be on this system pretty soon and there is more and more talking.

But what do you see?

And Dr. Hendryx I'm going to ask you the same question a moment to what do you see in the future with everything that we're speaking about today?

Well, I see that we will be able to predict a little bit better, although that's one of the new frontiers that we're trying to explore.

How can we predict what's happening, Weather ladies are great at predicting what's going to happen in the weather a week from now.

But unfortunately, we don't know what's going to happen with influenza in a month or two, but we're getting close to know, okay, where are the trends taking us within a week?

Are we going to see a spike?

Are we going to see a decrease?

And, That's where the historical data help us make that assumption so we can very safely say, well, we're going to be within these parameters and therefore we may expect to see something happening with a specific virus.

If we're doing this with infectious diseases a little bit more in with infectious diseases that are that we have some history that are giving us that comfort zone to be able to say what might happen.

So we see that in public health, which help us say, well, you know, El Paso now historically, all these years, we see that their flu season runs from October to April, and we see that the peak is going to be between the middle of December till the end of January.

Everybody get ready.

Let's start doing activities before that happens so we can see if we can modify that disease in such a way that we don't see those peaks there.

Everybody will see in or even worse, to see a pandemic that is going to be killing people by making them more vulnerable.

And that's our job.

So we were I always think to one of my favorite shows is when you're looking at ancestral type information, I'm thinking to with this, if their-cancer seems to be what we talk about a lot when you're doing gene testing.

- Just don't invite us to that program We're not the ancestors yet!

I'm happy to an ancestor any time.

But when we're looking at bracket genes, for example, and you've got a grandmother and a mother and a granddaughter, and I'm thinking, too, that maybe the future this could be very helpful when you're looking at lineage and trying to tie people together.

I could be wrong, but it's just something that I think are going off in one way.

They're doing that now.

And is that in these systems again, El Paso.

But if I've got grandma in Montana and an aunt in Hawaii, not yet, but do you see, you see that.

So when you say we're doing that now, explain what's current and what you see going forward.

So if I take care of a patient, then I notice that there's cancer history.

And once again, it has to be a good history.

And it can either come from facts, it can come from just talking to the patient.

So once you know that, then you then a light goes off, right?

So, okay, well, there's breast cancer, there's ovarian cancer, there's something going on here.

And then that may trigger going tested for.

So and you have to ask the patient, because some people don't want to know.

Yeah.

Having said that.

So though.

So in a sense, it's already within the medical community.

It's not to to her point, it's not patient facing.

In other words, a patient can go and say, okay, I've got that.

This is a communication between you and the physician.

And, you know, you bring your concerns whether you've researched it or, you know, you've talked to your, you know, relative.

And that that is that conversation that they you get to have with your doctor on on what you need to do to protect yourself, to be knowledgeable about it or not, because that is a choice that that individuals get to make.

And I do respect that.

Some people don't want to know.

I want to know.

But but I get that that's that as a talk.

And I'm just thinking, you know the 23 me tests out there and yeah, it can get so convoluted and I think that's a topic for another day on another program.

So I want to thank you all so much for being here.

Is there anything else that we want to talk about before we get off the air?

Dr. Hendryx?

Yeah, I want to that, you know, certainly being a part of the proud El Paso community, I've really touted, you know, PHIX and all the different things that they're doing.

I want to emphasize that other people are doing great things, too, within the state of Texas.

They may be doing it a little bit different.

And, you know, and they are doing they're trying their best to get that information, to be able to share that information because they want the best for their patients, too.

They may go about it a little differently, but they are trying that here.

It not only in Texas, but across across the nation.

You know, once again, I'm so proud of what what Emily and her group You have everything going on.

But I just I just can't say enough about it.

But I don't want to I don't want to-- there are other people doing a lot of great work.

That was me.

You did say that.

But I'm like, you know, some.

Oh, I just always try to be as good as we do.

And the other part of it is, you know, certainly we always talk about A.I., and that is going to be a factor as we go forward, because that's going to be a part of that information exchange.

We don't know where that's going at this point, and it will flesh itself out as we go further.

Right.

But I think that's going to be a big part of of some of these graphs of being able to analyze those graphs and how is that going to leverage the information, the exchange of of that we are able to help us guide, right.

The care and the emphasis on on that care.

Agreed.

And again, leveraging, it's all about the leveraging.

Thank you so much.

Thats Dr. Joel Hendryx, who again is chief medical officer over the University Medical Center.

Also on the PHIX board, we have Dr. Hector Ocaranza, who is the health authority, also on the PHIX board, and Emily Hartman, who is the executive director of PHIX And again, PHIX stands for Paso del Norte Health Information Exchange.

But thank you so much for watching.

This is the El Paso Physician.

I'm Kathrin Berg and good evening.