Colorado Health IT Roadmap - Leading Change Today for a Healthier Tomorrow November 2021
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Colorado
Health IT
Roadmap
Leading Change Today
for a Healthier Tomorrow
November 2021
November 2021 1
Acknowledgements
The 2021 refresh of the Colorado Health IT Roadmap was a
collaborative effort led by the Office of eHealth Innovation and
the eHealth Commission that involved state agency partners,
community organizations, and individual Coloradans. Appendix 1
includes a list of participating organizations and individuals.
Special thanks to members of the eHealth Commission Planning
Group who provided oversight and guidance throughout the
refresh process: Michael Archuleta, Mona Baset, Arthur Davidson,
Rachel Dixon, Kevin Stansbury, and KP Yelpaala.
2 Colorado Health IT Roadmap
November 2021
Fellow Coloradans,
The Polis-Primavera administration is committed to providing equitable, affordable, and
accessible high quality care for all Coloradans. As stewards of the state’s health information
technology (IT) strategy, the Office of eHealth Innovation (OeHI) and the eHealth
Commission have been working diligently over the last several months to refresh the
Colorado Health IT Roadmap through extensive input from Coloradans and stakeholders from
communities across the state.
From the first day in office, our team has engaged state and local leaders, Tribal members,
and community members from all across the state to utilize innovation, policy, and
technology in pursuit of our bold healthcare reform goals. By partnering with public,
private, and non-profit organizations from all corners of the state, we have re-imagined the
state’s health IT strategy through an equity lens. The goals of this 2021 Health IT Roadmap
reflect our commitment to a Colorado for All.
Despite rapid advancements in technology and ambitious policy changes, there are still
opportunities to provide more coordinated care. Trusted information, shared infrastructure,
policy, and innovation must continue to be harnessed to address these challenges and
opportunities. The goals and potential recommendations outlined in the 2021 Colorado
Health IT Roadmap accelerate this important work.
The 2021 Health IT Roadmap offers a series of potential recommendations to be considered
in pursuit of our commitment to ensuring equitable, affordable, and accessible high-quality
health care for all Coloradans. The administration appreciates the work of all those who
have invested their time and ideas. Community leadership, collaboration, and innovation
play a critical role in the achievement of our health care priorities.
Sincerely,
Dianne Primavera
Lt. Governor of Colorado
136 State Capitol, Denver, CO 80203 | P 303.866.2471 | www.colorado.gov/ltgovernor
November 2021 3
Contents
5 The Opportunity
6 Acting on a Shared Vision
7 Figure 1: The 2021 Colorado Health Information Technology Roadmap
8 Learning from the Past
9 Refreshing the Roadmap
10 Table 1. Aligning Colorado’s Health IT Roadmap Initiatives with 2021 Roadmap Goals and
Outcomes
11 Harnessing Health IT to Drive Change: Roadmap Goals
11 Roadmap Goal 1: Coloradans, providers, payers, community partners, state, local, and Tribal
agencies share data and have equitable access to needed health and social information.
13 Figure 2: Colorado Health Information Technology Ecosystem
15 Roadmap Goal 2: Coloradans access high-quality in-person, virtual, and remote health services
that are coordinated through information and technology systems.
19 Roadmap Goal 3: Colorado improves health equity through the inclusive and innovative use of
trusted health IT and digital health solutions.
22 Building from a Strong Foundation: Colorado’s 2019 Health IT Roadmap
23 Core Values and Objectives for the Work
24 Achieving the Goals
24 Policy
25 Federal Requirements and National Trends in Exchanging Information
28 Services
32 Beyond 2024: Getting to a Single On-Ramp in Colorado
33 Funding
37 Stewarding the Work
37 Aligning Policy, Funding, and Services Decisions
38 Community Engagement
40 Governance
40 Operationalizing Policy, Funding, and Services Decisions
41 Monitoring for Accountability
42 Evolving the Work to Meet Future Needs
43 Appendix 1: Participating Organizations and Individuals
44 Appendix 2: Health Information Exchange in Colorado
45 Appendix 3: Developing Social-Health Information Exchange
46 Appendix 4: National Best Practices and Examples: Policy Solutions
48 Appendix 5: National Best Practices and Examples: Services
49 Appendix 6: National Best Practices and Potential Resources: Funding
50 Table 2. Potential Federal Funding Opportunities That Could Be Leveraged for Health IT and
Infrastructure, 2021
4 Colorado Health IT Roadmap
The Opportunity
The 2021 Colorado Health Information Technology Roadmap charts
a path for harnessing and expanding the digital tools and services
that support the health of all Coloradans.
Known as health information technology (IT), across a broad range of stakeholders to achieve
these tools have the potential to significantly three shared goals by 2024.
expand affordability, access, and equity in
● Roadmap Goal 1: Coloradans, providers,
health care. Health IT offers an opportunity
payers, community partners, state,
to advance these goals by creating inclusive
local, and Tribal agencies share data and
and equitable access to information and
have equitable access to needed health
resources while improving the quality and
and social information.
value of care that individuals receive. Its
widespread availability and use can support ● Roadmap Goal 2: Coloradans access high-
the coordination of whole-person care, public quality in-person, virtual, and remote
health response, and population health health services that are coordinated
improvement. through information and technology
systems.
However, development and adoption must
occur in a systematic, aligned, and intentional ● Roadmap Goal 3: Colorado improves
way. health equity through inclusive and
innovative use of trusted health IT and
This Roadmap sets a course for aligning efforts digital health solutions.
November 2021 5
Achieving the 2021 Roadmap goals will advance responsible for leading and collaborating on
the priorities identified by stakeholders these activities, including the Office of eHealth
engaged through this process and Governor Innovation, the eHealth Commission, state
Jared Polis and Lieutenant Governor Dianne agencies, and community partners.
Primavera’s vision of affordable, accessible,
and high-quality health care and promoting a Lastly, the 2021 Roadmap defines a vision for
Colorado for All. transforming the state’s current infrastructure
into a more cohesive and integrated system
Success ensures that individuals are that enables inclusion and equitable access to
connected to needed services and supports data and information that can better serve all
through coordinated and integrated whole- Coloradans. Accomplishing the activities set
person care, and that providers and payers forth within this Roadmap will set Colorado
can electronically share standard clinical on a path for success in achieving this vision.
and financial data to support the delivery Figure 1 on page 7 shows an overview of the
and payment of value-based, high-quality 2021 Colorado Health IT Roadmap.
care. Activities supporting these goals will
establish or solidify digital connections among Acting on a Shared Vision
Coloradans, their providers, and state, local,
The 2021 Roadmap’s three goals support a
and Tribal agencies so that needed information
shared vision of affordability, accessibility,
is available for population health improvement
and equity for all Coloradans. Creating health
as well as public health emergency response.
equity requires eliminating barriers that
Colorado will work with Tribes to develop
limit opportunities to thrive. Creating digital
a data sharing strategy that respects data
health equity using health IT and digital health
sovereignty and meets the needs of the
solutions requires intentional efforts to build
state, Tribes and, overall, Tribal members.
digital inclusion. This means ensuring that all
Additionally, equitable, inclusive use of health
individuals and communities have access to
IT and adequate broadband coverage statewide
technologies and the support and skills to use
brings Colorado one step closer to closing the
them.
digital divide for all residents.
Achieving digital inclusion and digital health
The 2021 Roadmap identifies common values
equity also require intentional strategies
that guided its development and will be used to
and investments that reduce and eliminate
prioritize and implement necessary strategies
historical, institutional, and structural barriers
to achieve its three overarching goals. It lays
to the access and use of health IT. The 2021
out recommendations for policies, technology
Roadmap calls for these needed strategies and
services, and funding. Some of these efforts
investments.
are already underway and require continued
support to bring to scale. Others, while new to This document also builds on the successes
Colorado, have proven effective in other states achieved in Colorado’s 2019 Health IT
and are opportunities for Colorado to explore. Roadmap1 as well as the work still in progress,
These recommendations will be implemented under the direction of the eHealth Commission
using modern and secure technology that is and the Office of eHealth Innovation, in
governed by data sharing agreements, which collaboration with state agencies and
protect individual privacy and comply with
applicable laws and regulations.
1 Office of eHealth Innovation. Colorado s Health IT
The 2021 Roadmap highlights the activities Roadmap. 2019. https://oehi.colorado.gov/sites/
needed to steward these efforts over the oehi/files/documents/Colorado%20Health%20IT%2
next three years and identifies partners Roadmap-19_Web%20%281%29.pdf Accessed July 11,
2021.
6 Colorado Health IT Roadmap
Figure 1: The 2021 Colorado Health Information Technology Roadmap
ULTIMATE IMPACT FOR ALL COLORADANS
Access • Affordability • Equity
CORE VALUES AND OBJECTIVES FOR THE WORK
Accountability • Alignment • Equity • Innovation • Reusability • Sustainability
STATEWIDE INITIATIVES
Care Coordination • Patient Access to Information • Public Health Response
Virtual and Remote Services • Value-Based Programs • Population Health
GOALS
Access to Information • Digital Health Equity
Coordinated In-Person, Virtual, and Remote Services
STRATEGIES
Policy Services Funding
• Data sharing and consent • Core information services • Provider, community
agreements • Identity management health IT adoption
• Standardized processes • Provider directory • Provider
and data standards • Community resource inventory participation in
• Consent management health information
• Access, availability exchange
of virtual and remote • Data-sharing management
services • State agency
• Scalable data-sharing platform investments
• Clarification of Office of
eHealth Innovation and • Colorado Innovation Resource • Non-governmental
eHealth Commission roles Center funding
STEWARDING THE WORK
Community State and Local Office of eHealth eHealth
Partners Agencies Innovation Commission
Alignment • Community Engagement • Governance • Operationalizing • Monitoring
November 2021 7
community partners. These initiatives and public health emergency maximized the use
those from the 2021 Roadmap, featured in of existing health IT infrastructure and policy
Table 1 (see page 10), advance statewide and inspired collaborations where available and
priorities and leverage existing investments to appropriate.
advance affordability, access, and equity for
Coloradans. The COVID-19 pandemic highlighted
opportunities for enhancements and
The 2021 Roadmap comes at a time of innovations to better serve residents,
unprecedented opportunity for Colorado to providers, state agencies, and community
strategically invest in health IT solutions. organizations and to strengthen partnership
Colorado can potentially utilize a portion of with Tribes. Colorado’s broadband
federal funds for health IT across the state. infrastructure was stretched to meet the high
Potential opportunities include investment in volume of health care, behavioral health,
development, expansion, and modernization and social services operating in virtual
of Colorado’s health IT ecosystem, including environments. Some communities, especially
public health and behavioral health information in rural and frontier areas, lacked broadband
systems, and expanded broadband connectivity. access and affordable health IT infrastructure.
Many Coloradans started and continued using
Learning from the Past virtual options to access health care, services,
The COVID-19 pandemic brought together both and supports.
the public and private sector to quickly respond
to community needs. This unprecedented However, not all Coloradans had the
technology tools, skills, or awareness needed
8 Colorado Health IT Roadmap
to adequately connect with their providers
nor fully trusted in the technology available to
them. Providers who were already connected
Refreshing the
to health information exchanges and analytic
organizations were able to monitor the health
Roadmap
of their patients through notifications of The Office of eHealth Innovation and the
events such as the admission to hospitals to eHealth Commission partnered with the
better coordinate care for patients related to Colorado Health Institute in May 2021 to
COVID-19. Other providers, however, could not refresh Colorado’s Health IT Roadmap.
easily share information with one another nor Under the leadership and guidance of the
access population-level data and information to eHealth Commission, the Office of eHealth
support public health decision-making. Innovation and the Colorado Health
Institute engaged with public and private
Despite these challenges, Coloradans came
partners from June 2021 to September
together to address community issues and
2021 to assess current and future needs in
needs. The eHealth Commission and the Office
policy, funding, and technology, and solicit
of eHealth Innovation leveraged emergency
feedback on strategies for sustaining these
funding for onboarding providers to the health
efforts in the future.
information exchanges, expanding access to
population analytics and technical assistance Activities included more than 50
targeted to rural safety-net providers, and stakeholder meetings; virtual regional
advanced the use of virtual health. learning collaborative telemedicine
meetings; community meetings in Haxtun
But much work remains to leverage existing
and Trinidad; two virtual listening sessions
infrastructure for public health emergencies
open to the public; an online survey; the
and ongoing care coordination efforts. Public
Annual Innovation Summit in September
health information such as immunization
2021; and posting the last draft of the
records and testing results — most urgently
Roadmap online for public comment.
needed during pandemic response — is
See Appendix 1 for a list of participating
available electronically to Coloradans
organizations and individuals.
through the myColorado Digital Application,
myColorado.gov, and electronically available The 2021 Roadmap synthesizes and
to providers but difficult to routinely access. reflects the priorities of the many
Opportunities exist to refine and scale the participants in this process.
availability of immunization information for
population health and care delivery needs.
Continuing to enhance health IT infrastructure
and connectivity will reduce inequities and Coloradans identified many lessons learned
improve health and financial outcomes. from the COVID-19 pandemic that inform
the 2021 Roadmap, including the need to act
The 2021 Roadmap reflects the feedback with purpose and urgency when addressing
of hundreds of Coloradans across the state important issues facing local communities and
who engaged in this process through regional the state. Stakeholders at all levels of the
learning collaboratives, interviews, surveys, Roadmap refresh process expressed a similarly
listening sessions, and workgroups. A diverse urgent desire for Colorado to accelerate its
group of Coloradans from all levels of health pace to meet these goals. The 2021 Roadmap
and health care, representing a broad calls for the important work needed now for
cross-section of the state’s geographic and Colorado to lead in the future.
demographic population, provided feedback.
November 2021 9
Table 1. Aligning Colorado’s Health IT Roadmap Initiatives with 2021 Roadmap Goals and Outcomes
Polis-Primavera
2021 Roadmap Goal Alignment Outcome Alignment
New, Coordinated
Updated, In-Person,
Virtual and Creating Affordable Access to
eHealth Commission or Access to Remote Health High-Quality Whole- Equity for
Initiative or Work Group Existing Information Services Equity Care Person Care All
Accessible and Affordable
Health Analytics and Population Updated X X X X
Health
Accessible and Affordable
Health IT and Information Existing X X X X X
Sharing
Best Practices for Health
Information Cybersecurity Existing X X X X
Threats and Incidents
Broadband and Virtual Care
Existing X X X X X
Access
Consent Management Existing X X X X
Digital Health Equity Updated X X X X X
Harmonize and Advance Data
Sharing and Health Information
Existing X X X X
Exchange Capabilities Across
Colorado
Health IT Portfolio/Program
Existing X X X
Management
Innovation Resource Center New X X X X X X
Integrate Behavioral, Physical,
Claims, Social, and Other Existing X X X X X X
Health Data
Patient Access to Health
New X X X X
Information
Promote and Enable Consumer
Engagement, Empowerment, Existing X X X X X
and Health Literacy
Promote Value-Based Programs Updated X X X X
Public Health Response New X X X X X
Scalable Data-Sharing Platform New X X X X X X
Statewide Health Information
Existing X X X X
Governance
Statewide Health Information
Existing X X X X
Technical Architecture
Support Care Coordination in
Existing X X X X X X
Communities Statewide
Unique Provider Identification
Existing X X X X
and Organizational Affiliation
Uniquely Identify a Person
Existing X X X X
Across Systems
10 Colorado Health IT RoadmapHarnessing Health IT to Drive
Change: Roadmap Goals
A top priority of Gov. Polis and Lt. Gov.
Primavera is to ensure all Coloradans have “Our staff spends a lot of
access to affordable and high quality health time calling patients and
care.2 The Administration has identified
providers on the phone
affordability, access, and equity as priorities,
which inform the 2021 Roadmap. to complete registry information.
It would be much more efficient
Health IT creates opportunities to meet to connect to electronic registries
people’s needs. It offers pathways to solutions to get health status information of
that meet shared goals and priorities. It can
our patients.”
be a powerful tool that identifies health
disparities and informs solutions to resolve A rural Federally Qualified
them. And it must be used and implemented Health Center administrator
within the boundaries of legal rules with
needed authorization and consent.
community organizations, payers, and agencies
The Roadmap’s goals are informed by the to access and share their data.
gaps in today’s health IT infrastructure that
were identified by stakeholders throughout Providers interviewed for the Roadmap refresh
the refresh process. Addressing these gaps is process shared that they want to treat their
important to advancing affordability, access, patients as whole persons but cannot access
and equity for all Coloradans. holistic information to quickly understand each
patient’s health needs.
Roadmap Goal 1: Coloradans,
Although the majority of hospitals are
providers, payers, community connected to health information exchange,
partners, state, local, and Tribal many providers — in particular rural safety net
agencies share data and have providers, behavioral health, oral health, long-
term services and supports, and social supports
equitable access to needed like food and housing providers — are not
health and social information. able to share information broadly through the
health information exchanges. Affordability,
Improving equity requires removing barriers
lack of technical workforce, and outdated
that make it difficult for Coloradans to access,
electronic health records affect providers’
receive, and use their own health information.
ability to connect and share. Colorado’s
Coloradans also want to be able to securely
Rural Connectivity Program, led by the
share their data with and among trusted
Office of eHealth Innovation and the eHealth
providers and organizations that support
Commission, is focused on prioritizing rural
their health. Coloradans should be able to
safety-net and behavioral health providers to
give — and deny — consent to allow providers,
connect to the health information exchanges.
However, providers are not consistently
2 Colorado Governor Jared Polis. Health: Saving Coloradans incentivized or required to participate in the
Money on Healthcare. https://www.colorado.gov/governor/ health information exchanges in Colorado.
health. Accessed July 9, 2021.
November 2021 11promotion. Small and rural providers, however,
“Today’s technology is typically do not have the financial resources
not developed with the or expertise to establish such connections
end user in mind.” and use relevant analytics to support quality
improvements.
A behavioral health provider
in metro Denver Opening equitable, secure, and affordable IT
pathways for patients, their providers, payers,
community partners, and state agencies to
Three nonprofit organizations, Colorado connect with and share health and social
Regional Health Information Organization services, information, and data would create
(CORHIO), Quality Health Network (QHN), and an IT ecosystem that provides a more holistic
Colorado Community Managed Care Network look at health (see Figure 2 on page 13).
(CCMCN), play unique roles stewarding
Colorado’s health information exchange and Addressing this need puts Colorado
analytic infrastructure (see Appendix 2 for stakeholders in prime position for advancing
more information from the 2019 Colorado Colorado’s goals of affordability, access,
Health IT Roadmap about health information and equity and provides opportunities for
exchange). Providers and organizations supporting existing activities and initiatives.
registered with CORHIO and QHN can
electronically share data and information
with one another to support patient care. Interoperability is the ability
CORHIO is the largest health information of two or more systems to
exchange in Colorado and provides critical exchange information and use the
infrastructure to providers, payers, and state information, without any human
and local organizations including identity
resolution services and event notifications.
intervention, once it is received.
QHN covers the Western Slope and focuses on
provider-driven solutions and services. This
includes tools and processes for whole-person Affordability
care coordination. CCMCN, the technology
• For patients and consumers, sharing data
organization for the Federally Qualified Health
and information across providers that
Centers and other community partners,
is relevant and permissible can reduce
is leading efforts statewide to establish
duplicative and unnecessary services,
interoperable technical systems focused on
lower costs, reduce time spent completing
health outcomes and critical analytics that
duplicative paperwork, and minimize
inform the coordination of care for whole-
unnecessary in-person visits.3
person and population health needs.
• For providers, organizations, payers,
Providers in Colorado benefit from being
and patients, sharing quality data and
electronically connected to one another and
information across a shared infrastructure
to statewide health information repositories
leads to better health outcomes and
and networks such as health information
lower costs. This information can be
exchanges. Such connections can allow
used to reduce administrative burden
hospitals, providers, and payers to access
patients’ complete health records as well 3 Menachemi, N., Rahurkar, S., Harle, C., Vest, J. (2018).
as aggregate datasets that support their The benefits of health information exchange: an updated
systematic review. Journal of the American Medical
participation in value-based quality reporting, Informatics Association. 25 (9). https://doi.org/10.1093/
reimbursement, and population health jamia/ocy035
12 Colorado Health IT RoadmapFigure 2
13with quality measure reporting, which
lowers costs and incentivizes high-quality, What’s the diference between
coordinated care. Metrics and reporting health IT, digital health
for current and planned payment reform
initiatives in the Office of Saving eople
solutions, and virtual and
Money on Health Care, the Behavioral remote health services?
Health Administration, Health First
Colorado (including Alternative Payment Health information technology includes
Models for Primary Care and the Hospital things like computer hardware, electronic
Transformation Program), and commercial health records, computer programs, and
payers could be facilitated through information exchanges and systems that
improved data and information sharing. record, store, protect, retrieve, and
share clinical, administrative, social,
or financial information. Digital health
Access solutions include tools and technologies
• For providers, payers, community ranging from patient portals and remote
organizations, state and local agencies monitoring devices to mobile health
and Tribal health centers, sharing quality applications (apps) for a smartphone or
data and information will inform a better tablet that are used to improve health.
understanding of patients’ and consumers’ Virtual and remote health services include
needs and ultimately whole-person care.4 a broad range of supports for patients,
Coordinated, whole-person care also consumers, and providers to interact from
ensures that Coloradans receive the care different locations, from video telehealth
and support they need to remain healthy, visits to email chats. Virtual and remote
from a referral to a counselor or a dentist, health services can include medical, oral,
to housing support or a prescription for and behavioral health.
fresh fruits and vegetables.
• Many health systems, communities and with behavioral health, housing, food,
state agencies are actively working on and transportation supports securely
sharing information to improve whole- and efficientl .5 Additionally, the Office
person care. This includes efforts on of Behavioral Health is tasked with
Colorado’s Eastern Plains through and has been funded to implement a
the Regional Accountable Entity and comprehensive plan to strengthen and
Colorado Community Managed Care expand the behavioral health safety
Network. It also involves the Colorado net system that calls for a coordinated
Department of Human Services and technology and information infrastructure
the Colorado Department of Health to increase access to behavioral health
Care Policy & Financing’s Joint Agency services for all Coloradans.6 This step
Interoperability efforts that will enable is critical for the Behavioral Health
cross-agency information sharing through Administration, established through House
standardization or Quality Health
Network’s Community Resource Network
that enables providers on Colorado’s
5 Community Resource Network. https://
Western Slope to connect their patients communityresourcenet.org/. Accessed August 12, 2021.
6 Colorado Department of Human Services. Office of
4 Office of eHealth Innovation. Advancing a Coordinated
Behavioral Health. Senate Bill 19-222: Comprehensive Plan
Ecosystem for a Social-Health Information Exchange (S-HIE)
to Strengthen and Expand the Behavioral Health Safety Net.
in Colorado. 2021. https://oehi.colorado.gov/sites/oehi/
Senate Bill 21-137. Behavioral Health Recovery Act. https://
files/documents/SHIE%20White%20 aper%20%281%29.pdf
leg.colorado.gov/bills/sb21-137.
14 Colorado Health IT RoadmapBill 21-10977, which will align, coordinate,
and integrate state mental health and
substance use programs and funding to
“I did not go out for
streamline access and lower barriers to a year during the
services for patients. pandemic; telehealth was
very important to me. These are
Equity things we should have had and
• For patients and consumers, access now that we have them, we need
to timely and easily understandable, to keep them because (telehealth)
culturally appropriate information that works for people like me. What
is in their native language, on affordable
would have taken me a half-day
devices and services, and through reliable
infrastructure not only improves health with coordinating transportation is
outcomes and reduces costs but begins now a 15-minute visit.”
to address long standing inequities and
A Health First Colorado
structural barriers. member living with a disability
in Southern Colorado
• To advance health equity, the Offic
of eHealth Innovation and the eHealth
Commission have refocused the 2021 Adequate broadband service provides the
Roadmap through an equity lens and is needed speed for providers to connect with
elevating equity goals through diverse their patients, for patients to send information
representation on the eHealth Commission like blood pressure readings back to their
as well as funding projects across Colorado providers, and for patients to securely access
that advance equity and whole-person their health information online. The current
health. recommended federal standards for broadband
upload and download speeds (3 Mbps and 25
Roadmap Goal 2: Coloradans Mbps, respectively) are not sufficient to meet
access high-quality in-person, the needs of Coloradans.8 The U.S. Treasury
requires any broadband infrastructure projects
virtual, and remote health to be funded by the American Rescue Plan to
services that are coordinated meet or exceed symmetrical download and
through information and upload speeds of 100 Mbps.9
technology systems. Analyses using data from the Colorado Health
Coloradans want options for how and when Observation Regional Data Service (CHORDS)
they access care and supports. Virtual health found that the amount of care delivered by
services, including telehealth, have proven telemedicine by a select group of Front Range
to be convenient and reliable solutions for providers during the COVID-19 pandemic
whole-person care. Virtual care ranges from increased dramatically, from an average of 39
video visits with a behavioral health specialist encounters per week before the pandemic to
or an oral health hygiene instruction visit
with a registered dental hygienist to at-home 8 U.S. Government Accountability Office. Broadband: FCC
Should Analyze Small Business Speed Needs. GAO-21-494.
monitoring and management of diabetes or July 8, 2021.
high blood pressure.
9 U.S. Department of the Treasury. Guidance for the
Coronavirus Capital Projects Fund for States, Territories
& Freely Associated States. https://home.treasury.gov/
7 Colorado General Assembly. House Bill 2021-1097. https:// system/files/136/Capital- rojects-Fund-Guidance-States-
leg.colorado.gov/sites/default/files/2021a_1097_signed.pd Territories-and-Freely-Associated-States.pdf.
November 2021 1524,600 weekly encounters during the mid-2020
analysis period. The most significant use was by
community mental health centers and patients
“I want to help my
seeking behavioral health care for conditions parents age in place
such as anxiety and depression.10 Nearly all safely, but they need
(86.5%) of Colorado providers surveyed as better internet to be connected
part of the 2021 Regional Telehealth Learning with their medical providers.”
Collaborative began offering telehealth for
the first time in 2020. And out of safety-net A Coloradan with parents
providers surveyed, most (93%) provided some living in the San Luis Valley
form of virtual health for their patients.11, 12
Recommendations from the 2021 Regional tools or platforms readily or easily, from
Telehealth Learning Collaboratives, hosted by a virtual provider’s notes to readings from
the Office of eHealth Innovation and rime telemonitoring of blood pressure or blood
Health, suggest starting with telebehavioral glucose. And some virtual or remote-only
health as the service to expand upon providers, especially those delivering care to
and support continued adoption. This Coloradans but located outside of the state,
recommendation is in response to the need for are not sharing data and information through
this type of service and availability of digital health information exchanges, limiting the
solutions for both patients and providers but data and information available to Coloradans’
also strengthens alignment across state agencies other providers and creating the potential
with the development of Colorado’s Behavioral for duplicated effort and uncoordinated care
Health Administration. Virtual health services during in-person visits.
are here to stay and are important resources for
Whole-person care coordination across in-
advancing the state’s goals.
person, virtual, and remote services for
Providing whole-person care requires personal health and social needs is only
information from virtual and remote visits possible with a connected and interoperable
to be available, accessible, and shared with ecosystem and infrastructure (see Appendix
providers, organizations, consumers, patients, 3 for more information about social-health
and agencies through health information information exchange).
exchange and available when and where
needed. Electronic medical record systems Affordability
do not always incorporate virtual and remote • Convenient, efficient, and accessibl
services support Coloradans in getting
10 Office of eHealth Innovation and Colorado Health Institute. the right care at the right time, avoiding
The Value of Telemedicine During the COVID-19 Pandemic costly visits to the emergency department.
Response: Insights from Patient Care Utilization in Colorado. Consumers can save time and money by
September 2020. https://oehi.colorado.gov/sites/oehi/
files/documents/Insights%20From%20 atient%20Care%20 not having to leave work for appointments.
Utilization%20in%20Colorado_0.pdf. CHORDS covers a When asked about their experiences using
portion of the Front Range, so statewide numbers are telemedicine, about 70% of Coloradans
presumed to be higher.
interviewed in 2020 reported being
11 The Regional Telehealth Learning Collaborative are
convenings of diverse cross-sector and industry stakeholders
satisfied, relieved, or appreciative of th
from across Colorado to advance statewide adoption and
coordination of telehealth strategies.
12 Office of eHealth Innovation and rime Health.
Regional Telehealth Learning Collaboratives. 2021.
https://docs.google.com/document/d/1SEvX0k-
9npj3JxkeaL2iHLNNmQJeD8kQ6I6M_plGLI8/edit
16 Colorado Health IT Roadmappatient would need if seen over a video for
triage by a physician rather than an audio
“Our work is to ensure
call alone or an immediate ER visit.16
good patient experiences
and build the tools to Access
support good health outcomes. If • Virtual and remote health services
we cannot get patients the things reduce barriers that many Coloradans
they need and help them be more face when trying to access care, such
efficient then we are failing.” as finding child care, arranging reliabl
transportation, and securing time off
A hospital executive to attend appointments. Outpatient
in rural Colorado
telehealth consultations improve access
by reducing wait and treatment times
and by increasing the number of patients
service.13 A study of a California university
receiving tests or treatment.17
health system’s outpatient telemedicine
program found positive, measurable • The Department of Health Care Policy &
impacts on patient travel time, travel Financing is supporting efforts to expand
costs, and environmental pollutants.14 econsults for Health First Colorado
members to facilitate access to specialty
• Telehealth has shown promise in reducing
care. These efforts could be leveraged for
costs. Remote monitoring for patients
other types of consults such as psychiatry
with chronic conditions, for example, has
and by other providers and payers
reduced hospitalizations and emergency
statewide. And legislation establishing the
room visits and saved patients’ travel
Behavioral Health Administration cites the
costs.15 With the ability to triage patients
“imperative that an improved behavioral
more accurately with the assistance of
health system in Colorado … provides
video, the Denver Health NurseLine was
access to quality and affordable services in
able to increase cost avoidance by patients
a variety of methods, including in-person
and decrease unnecessary emergency
and virtual services.”18 The Department of
department use. With support from the
Human Services implemented telephonic
Office of eHealth Innovation s COVID-19
signature processes to allow Coloradans
telemedicine project funding, this program
to sign up for public benefits, such a
found a 76% reduction in level of care a
Supplemental Nutrition Assistance Program
13 Office of eHealth Innovation and Colorado Health (SNAP) food benefits, in the comfort o
Institute. The Value of Telemedicine During the COVID-19
Pandemic Response: Insights from Patients in Colorado. 16 Denver Health NurseLine Program Information submitted to
September 2020. https://oehi.colorado.gov/sites/oehi/ the Office of eHealth Innovation. 2021.
files/documents/Insights%20From%20 atients%20in%20
17 Totten AM, Hansen RN, Wagner J, Stillman L, Ivlev I,
Colorado_0.pdf.
Davis-O’Reilly C, Towle C, Erickson JM, Erten-Lyons D,
14 Dullet, N., et. al. Impact of a University-based Outpatient Fu R, Fann J, Babigumira JB, Palm-Cruz KJ, Avery M,
Telemedicine Program on Time Savings, Travel Costs, and McDonagh MS. Telehealth for Acute and Chronic Care
Environmental Pollutants. 2017. Value in Health. V. 20 (4). Consultations. Comparative Effectiveness Review No. 216.
https://www.valueinhealthjournal.com/article/S1098- (Prepared by Pacific Northwest Evidence-based ractice
3015(17)30083-9/fulltext. Center under Contract No. 290-2015-00009-I.) AHRQ
Publication No. 19-EHC012-EF. Rockville, MD: Agency for
15 Totten AM, Womack DM, Eden KB, et al. Telehealth:
Healthcare Research and Quality; April 2019. https://
Mapping the Evidence for Patient Outcomes From Systematic
effectivehealthcare.ahrq.gov/sites/default/files/pdf/ce -
Reviews [Internet]. Rockville (MD): Agency for Healthcare
216-telehealth-final-report.pd
Research and Quality (US); 2016 Jun. (Technical Briefs, No.
26.) Table 7, Telehealth cost and utilization: Findings from 18 Colorado General Assembly. House Bill 2021-1097.https://
systematic reviews. https://www.ncbi.nlm.nih.gov/books/ leg.colorado.gov/sites/default/files/2021a_1097_signed
NBK379312/table/findings.t9 pdf.
November 2021 17their own homes. This virtual approach,
implemented in response to COVID-19, “I want to increase access
is being reviewed and evaluated in
partnership with the counties for longer-
to care for my patients
term operations. and I want everyone on
the care team to know what care
Equity has been provided.”
• Around one in 10 households in rural A hospital provider in metro Denver
Colorado lacks broadband.19 Federal
investments in connecting rural
community anchor institutions gave many
providers adequate internet speeds, but “It’s the patient’s
households have not benefited from information. They should
similar broadband boost. Approximately be able to access it.”
130,000 households in Colorado have no
computer or access to a digital device like Leader of a Critical Access Hospital
a smartphone or tablet, according to 2019
data from the U.S. Census Bureau. Limited
connectivity in rural communities reduces virtual health in their communities and $20
options for accessing health care as well as million for Colorado’s federally recognized
other social supports. It increases health Tribes to support broadband and virtual
disparities and widens equity gaps for health efforts. From a rural perspective,
residents in these communities. health disparities and inequities exist
due to limited workforce, geographic
• Access to care can be made more distances, and increased costs. Colorado
equitable by prioritizing infrastructure legislators appropriated $6.4 million to
investments and policies that close the Office of eHealth Innovation in 2021
disparity gaps such as improving access to begin to address this inequity as part of
to affordable broadband, user-friendly a larger investment to fund connections
tech tools, and live translation services; to health information exchanges and
continuing to pay providers at the same provide analytics and technical assistance
rate for audio and video visits; and in rural safety net facilities such Critical
supporting patients and providers when Access Hospitals and certified ural Health
needed. The Colorado Broadband Offic Clinics.20 Still, larger ongoing investments
is focused on expanding connections for and policies are needed to ensure both
Coloradans who need access to virtual rural and urban providers have access to
care. modern, trusted, and secure systems that
can easily connect and share information
• Colorado House Bill 21-1289 establishes the statewide.
Colorado Broadband Office in statute an
creates the digital inclusion grant program
to award money to broadband projects
that include $15 million toward broadband
enhancements and devices for safety-
net rural providers to enable and sustain
19 Colorado Broadband Office. (2021). Telehealth Funding
Opportunities & Resources. https://docs.google.com/ 20 Colorado General Assembly. House Bill 21-1289. https://
presentation/d/1WYJw_OVoubf8-X7rx6tW7yxRsjU6-icc/ leg.colorado.gov/sites/default/files/2021a_1289_signed
edit#slide=id.p1 pdf.
18 Colorado Health IT RoadmapRoadmap Goal 3: Colorado
improves health equity through “It is important to have
the inclusive and innovative use demographic data to
of trusted health IT and digital understand Colorado’s
disease burden ... but clinics that
health solutions. serve those who lack documents …
Not all Coloradans have equitable access we sometimes feel we are asking
to health IT and digital health solutions.
them to undermine their trust in
Analyses using data from CHORDS found
that telemedicine use during the COVID-19 the community by asking for that
pandemic decreased as patient age increased, information.”
with the lowest rate among those ages 65
A state agency representative
and older, and that individuals identifying as
and provider in Colorado
Black and Asian had lower rates of adoption
than those identifying as white.21 Several
studies have found that non or limited English
on self-reported race, ethnicity, preferred
speakers have lower rates of telemedicine
language, geography, and gender can illustrate
use, strengthening the need to consider
disparities and other structural causes of
how systems can better integrate live
health inequities and inform approaches to
interpretation and digital translation services
address them. Tools and solutions must be
into their infrastructure to promote greater
developed and evaluated with input from
communication and digital equity.
individuals and communities who will use them
According to the Colorado Rural Health to promote participation, collaboration, and
Center’s 2021 Snapshot of Rural Health, it value.
costs one rural health care facility $162,000
Coloradans want to easily access their
to implement an electronic medical record
information, find resources, connect with their
system, with $85,000 going to first-year
providers, and control decision-making about
maintenance costs alone.22 An initial survey
their care and their loved ones’ health and
recently conducted by the Colorado Rural
well-being. Colorado will not achieve its shared
Health Center and supported by the Office of
goals unless all Coloradans can live, work,
eHealth Innovation found that connecting to
learn, play, and thrive in healthy, inclusive, and
the state’s health information exchanges is a
equitable environments. Health IT and digital
challenge to rural providers due to the cost of
health can help if equity is prioritized in its
service and labor costs to maintain connectivity
development and use.
and staff training. Due to fiscal challenges,
health information exchange connectivity is
Access
limited in rural Colorado.
• Digital accessibility is not the same for
Colorado needs more from these tools and all Coloradans. It could include screen
solutions to close equity gaps. Accurate data readers for individuals with vision
limitations, readability for individuals
21 Office of eHealth Innovation and Colorado Health Institute. of different literacy levels, language
The Value of Telemedicine During the COVID-19 Pandemic
Response: Insights from Patient Care Utilization in Colorado. options with one click, and images that
September 2020. https://oehi.colorado.gov/sites/oehi/ require limited bandwidth. Technology can
files/documents/Insights%20From%20 atient%20Care%20 reinforce or further entrench inequities
Utilization%20in%20Colorado_0.pdf.
if not developed intentionally so that all
22 Colorado Rural Health Center. Snapshot of Rural Health in
Colorado, 2021. Accessed August 12, 2021.
individuals can participate.
19• Governor Polis issued Executive Order D
2020 175 in August 2020 calling on state “Every portal is different,
agencies to advance diversity, equity, and which is annoying and
inclusion efforts across Colorado.23 This
frustrating. I need to
includes creating “statewide standards of
accessibility to guide agencies in ensuring constantly remind myself which
State buildings, systems, vital documents, provider I am trying to connect
community meetings, and other with. It is time consuming. I really
communications and resources, including wish there was one front door that
websites, are accessible to all Coloradans, looked good and was easy to use.”
regardless of ability or language. Where
applicable, these standards shall be at A person living in southern Colorado
or above the standards required in the
Americans with Disabilities Act and the
Colorado Anti-Discrimination Act.” traditional health care settings.26
• Colorado’s Broadband Advisory Board • Text messaging during the COVID-19
created the Subcommittee on Digital pandemic assisted many Coloradans in
Literacy and Inclusion to “discuss, research, accessing preventive care and support.
analyze, and draw conclusions concerning The Colorado Department of Public Health
digital literacy and inclusion” and has and Environment used text messaging in
developed three working groups to support English and Spanish to notify Coloradans
policy, data, and promising practices.24 who were overdue for their second
COVID-19 vaccine. Youth leaders with
Affordability Colorado’s Below the Surface developed
• Disparities account for approximately new messages for young people accessing
$93 billion in excess medical care Colorado’s Crisis Services text line during
costs nationally and $42 billion in lost the pandemic to reduce isolation and
productivity each year, not accounting for encourage people to ask for help.27
premature death.25 Digital health offers
individuals more control over their bodies Equity
and minds. It can support Coloradans in • Digital health equity requires all
making better-informed decisions through individuals to have access to at least one
greater access to data and information. device such as a laptop or cell phone;
It can also provide new options for adequate and affordable cellular service
facilitating preventive services, early and internet to connect; and relevant
diagnosis of life-threatening diseases, and digital health tools, resources, and
management of chronic conditions outside supports. This can include, for example,
translating digital resources into additional
23 Governor Jared Polis. Executive Order D 2020 175 Equity,
languages and engaging patients and
Diversity, and Inclusion for the State of Colorado. https://
www.colorado.gov/governor/sites/default/files/inlin -
files/D%202020%20175%20Equity%2C%20Diversity%2C%2 26 U.S. Food & Drug Administration. What is Digital Health?
and%20Inclusion%20for%20the%20State%20of%20Colorado. https://www.fda.gov/medical-devices/digital-health-
pdf. Accessed August 29, 2021. center-excellence/what-digital-health. Accessed August 13,
2021.
24 Colorado Department of Labor and Employment. Digital
Literacy and Inclusion Initiative. https://cdle.colorado.gov/ 27 Colorado Department of Human Services. Youth leaders
digitalinclusion. Accessed August 8, 2021. to develop messaging for Colorado Crisis Services during
COVID-19 emergency. https://cdhs.colorado.gov/press-
25 Turner, A. The Business Case for Racial Equity. https:// release/youth-leaders-to-develop-messaging-for-colorado-
altarum.org/RacialEquity2018. Accessed August 11, 2021. crisis-services-during-covid-19. Accessed August 13, 2021.
20 Colorado Health IT Roadmap• Colorado’s “Health at Home” website
“The multiple Medicaid (healthathome.colorado.gov) developed by
and provider websites are the Office of eHealth Innovation provide
challenging to navigate, one-stop access to information to assist
especially for a person who is deaf Coloradans seeking virtual care regardless
of their insurance status. The Department
or hearing-impaired.”
of Health Care Policy & Financing has
A Coloradan who identifies begun a significant effort to improve th
as deaf and is enrolled in usability of Colorado’s Program Eligibility
Health First Colorado and Application Kit (PEAK), the state’s
online service for Coloradans to apply
for health, food, cash, early childhood
consumers directly in the development of assistance programs, and more. This effort
these tools. It can also include synchronous is in response to Health First Colorado
interpretation services needed for live client feedback around challenges and
telehealth visits. Human-centered design needs.29 These modifications, which include
is an effective approach to meaningfully updated client-friendly language and
co-create with users, remove accessibility redesigned, mobile-friendly pages, remove
barriers, and prioritize people’s needs and barriers to access the services and supports
concrete experiences.28 Coloradans need when they need them.
29 Colorado Department of Health Care Policy & Financing.
28 Isaac Holeman & Dianna Kane (2020) Human-centered 2021 COVID-19, RRR Revamp, and PEAK Modernization
design for global health equity, Information Technology for RMC/RRR Projects. https://hcpf.colorado.gov/sites/hcpf/
Development, 26:3, 477-505. https://www.tandfonline. files/Accountable%20Care%20Collaborative%20 rogram%20
com/doi/full/10.1080/02681102.2019.1667289. Accessed Improvement%20Advisory%20Committee%20Public%20
August 11, 2021. Health%20Emergency%20Update%20June%202021.pdf
21Building from a Strong Foundation:
Colorado’s 2019 Health IT Roadmap
Colorado’s Health IT Roadmap guided the • Implementing essential virtual health
transformation of the state’s health IT and remote service programs and policies
landscape over the past five years. It was to ensure Coloradans had access to
originally published in 2017 with input needed care during the pandemic and
from over 1,000-plus stakeholders and beyond and to inform state
updated in 2019. It included 16 high-level recommendations on future telehealth
actionable initiatives to support Colorado’s and broadband infrastructure and policy
Triple Aim of better care, lower costs, and decisions.
improved health for all Coloradans. Some
key accomplishments of the 2019 Roadmap • Advancing state health priorities using
include: reusable health information exchange
and analytics in Colorado through efforts
• Establishing a strategy and governance to increase access and connectivity
that secured and prioritized more than among rural and safety net providers in a
$50 million in federal, state, and private way that is sustainable.
sector funds to advance health IT.
• Coordinating the development of a
• Refocusing technical, governance, and framework and technical sandbox
innovation efforts through a health (Colorado.Developer.Gov) for health
equity lens. information governance in Colorado.
• Creating a business case for developing • Developing sustainability and agile
a social-health information exchange business plans with extensive community
to support coordinated whole-person input in preparation for the end of the
care across the physical, social, and federal Health Information Technology
behavioral health domains. for Economic and Clinical Health Act.
• Developing a nimble, flexible proces These successes — as well as other important
to support a rapid pivot in priorities insights within the 2019 Roadmap — provide
and activities to support the COVID-19 a strong foundation upon which this 2021
pandemic response. Roadmap is built.
“Colorado needs a streamlined approach for getting communications
going between patients and providers. There are so many different
ways to connect right now, it is frustrating.”
An advocate for people with disabilities who is vision-impaired
22 Colorado Health IT RoadmapCore Values and Objectives
for the Work
Colorado’s health IT policies, investments,
and activities over the next three years
will be guided by values that support state
and Roadmap goals. The Office of eHealth
Innovation and the eHealth Commission,
which steer the Roadmap in collaboration
with stakeholders and communities across the
state that participated in the Roadmap refresh
process, identified the values that will drive
this work. Below is a list of these core values
and objectives.
Accountability: Invest in initiatives and quality,
affordable solutions that address the needs
of patients, providers, communities, payers,
state, local, and Tribal agencies.
Alignment: Engage and coordinate across state
and local agencies, providers, payers, and
community partners to strategically leverage
efforts, establish shared solutions that meet
the business needs of multiple stakeholders,
and maximize impact to all Coloradans.
Equity: Facilitate individual-, community-, and
systems-level solutions that measure, address,
and reduce disparities and advance equity.
Innovation: Accelerate creative ideas and
easy-to-use solutions that generate value and Commission are developing a tool and decision-
have potential for scale. making process for assessing projects and
solutions for new or continued funding. The
Reusability: Leverage existing, affordable tool includes a series of questions that the
solutions that support end users’ needs when project sponsor, vendor, or manager must
feasible and appropriate. respond to, including how the approach
addresses equity, reduces costs, promotes
Sustainability: Promote solutions that provide coordination, and increases access, especially
value and encourage and justify long-term for underserved communities. If these priority
financial support. issues are addressed, Commissioners assess
and prioritize based on how the project solves
These values and objectives will be codified an unmet need, reduces provider and patient
in governance structures as well as guide administrative burden, especially among rural
transparent decision-making. The Office and safety net providers, and drives future
of eHealth Innovation and the eHealth innovation.
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