The Oklahoma Health Care Authority has approved a contract with a global software company for its new health information exchange despite a protest from a local nonprofit that bid nearly $30 million less, as well as federal misgivings that the decision might adversely affect health care in the state.
Tulsa-based MyHealth Access Network filed a protest Jan. 11, calling the agency’s bid process “heavily flawed” and “arbitrary” after its final updated $19.9 million bid lost to Orion Health’s price of $49.8 million.
In an effort initiated by Gov. Kevin Stitt, the Oklahoma Health Care Authority ultimately awarded the contract to the global software company in December through a bid process to become the new state-operated health information exchange — or HIE.
The Office of the National Coordinator for Health Information Technology expressed concern in a Jan. 6 email to state officials about the apparent shift to scrap MyHealth — a “quite impressive” and “exemplar” nonprofit HIE that has existed for a decade — in favor of starting from scratch.
“As we learned more about the Oklahoma HealthCare Authority’s new health information exchange strategy we grew concerned that its apparent effect would be to shut down MyHealth’s extraordinary work (through a state required use mandate) and start from scratch to build a new state-run HIE,” wrote Donald Rucker, national coordinator of the federal office. “We see the non-profit HIEs such as MyHealth as a central strategy for more accountable healthcare.”
On the Oklahoma level, the state’s selection of Orion Health is unpopular in health care and business circles.
A letter of opposition to state officials dated Tuesday asks them to “reconsider their current course and work to support Oklahoma’s successful statewide HIE, MyHealth,” which securely shares more than 80% of medical records generated in Oklahoma.
Thirteen major entities are listed in support of the letter: Tulsa Regional Chamber; Oklahoma City Chamber; State Chamber of Oklahoma; Hillcrest HealthCare System; Ascension St. John; Integris Health; Blue Cross Blue Shield of Oklahoma; Cherokee Nation Health Services; Choctaw Nation; Chickasaw Nation; Red Rock Behavioral Health; Oklahoma State Medical Association; and Oklahoma Association of Optometric Physicians.
“If this change does occur, it will diminish the existing private sector HIE success, incur significant and unnecessary costs to taxpayers, and negatively impact the state’s HIE infrastructure, which could pose significant health and safety risks to patients,” according to the letter.
The Oklahoma Health Care Authority’s Wednesday afternoon meeting agenda lists an item for approval of the Orion contract. A spokesperson said the board already approved the HIE contract and that the agenda item is merging it with an existing contract.
Agenda documents note that approvals are still pending from the state Office of Management and Enterprise Services and federal Centers for Medicare & Medicaid Services.
Health Care Authority officials declined an interview, saying in an agency statement that lawyers for the state advised against making comments until the protest process is complete.
“The HIE vendor was selected after an extensive competitive process wherein numerous vendors were evaluated resulting in one that provided the overall best value to the state,” according to an OHCA statement. “We respect the media and public’s right to know the basis and details encompassing the selection of the HIE vendor. We would be happy to entertain an interview and comment when the protest process is complete.”
In a follow-up email about Rucker’s letter, spokeswoman Melissa Richey said the Health Care Authority is greatly concerned that his understanding is that the state wants to “shut down” MyHealth.
Richey wrote that OHCA wants to clarify the state’s strategy with the federal government after the protest concludes, “which does not include tampering down any HIE activity that exists in the state.”
MyHealth points to lower bid price
Potentially at stake for Oklahoma are tens of millions of dollars in federal funding at a 90/10 match with state funds, MyHealth officials say, which reduce to a 75/25 or 50/50 match if a functioning state HIE doesn’t secure them by September.
MyHealth wants the contract to be rescinded and for the Office of Management and Enterprise Services to award it to MyHealth either directly or by reopening the bid process. OMES has until Jan. 26 to render a decision.
The preeminent concern in MyHealth’s protest is a contention that the contract evaluators didn’t consider the nonprofit’s final revised bid of $19.9 million, almost $30 million less than Orion’s $49.8 million bid.
The nonprofit’s initial bid, on Dec. 30, 2019, was $106.6 million. It lowered the price nine months later, on Sept. 23, to $41.7 million after OMES asked for MyHealth’s best and final offer, according to documents.
When the process was delayed beyond the bid timeline, OMES requested an extension of that price, which MyHealth said it granted on Oct. 22. But at the same time, the nonprofit also submitted its $19.9 million offer.
Two months later, the Health Care Authority announced on Dec. 23 that it had awarded the contract to Orion Health for $49.8 million.
MyHealth says it made significant progress with each revised bid toward achieving first-year deliverables and milestones to cut the price without reducing services offered in its original proposal.
Its protest takes issue with several aspects of the state’s evaluation criteria, including alleging that the evaluators “essentially ignored” its existing relationships and how far ahead it already is compared to the software company.
The nonprofit also alleges that it was “arbitrarily” penalized for having fewer transactions, connections and utilizations because it operates predominantly in Oklahoma, while Orion has a global reach.
MyHealth an ‘exemplar’ for public good
Rucker’s office is under the U.S. Department of Health and Human Services.
His email extolled MyHealth as a standout model, including applauding recent key work the nonprofit performed analyzing COVID-19 data.
“In many ways MyHealth is an exemplar in the United States of using information for the public good,” Rucker wrote. “We recently highlighted MyHealth’s critical work to analyze key parts of COVID pathology and transmission in live demos to the heads of the Centers for Disease Control and Prevention, the Office of the U.S. Asst. Secretary of Health charged with COVID testing, and the Deputy Secretary of the Department of Health and Human Services.”
Stitt’s office didn’t offer a comment for this story Tuesday.
In November, the state publicly announced that it was designing a statewide health information exchange and would soon award the contract.
“Oklahoma has struggled for a decade to establish statewide interoperability with this data,” Stitt said in a prepared statement that day. “My business background has taught me the importance of accurate data to inform organizations how they can provide the best services to their customers.
“When I took office, we started the process to look for a single vendor to come in with an established service line and proven track record to achieve this for Oklahomans, and we are in the final stages of awarding the contract.”
MyHealth has operated in Oklahoma since 2009. The Tulsa nonprofit received a $12 million Beacon Community Program grant from the Office of the National Coordinator for Health Information Technology in 2010 to develop one of 17 local health information technology efforts in the U.S.
The ‘speed of trust’
A health information exchange allows medical records to flow efficiently in a secure manner among hospitals, providers, health agencies and patients to improve health outcomes and lessen costs.
A person’s medical information follows them electronically via a central hub, allowing caregivers access to a person’s history to offer individualized care at a moment’s notice — like an unexpected trip to an emergency room after a car crash.
Dr. David Kendrick, CEO of MyHealth, said he and his nonprofit have spent more than a decade demonstrating above-board operations and transparency to attract more and more members to the point of now holding 80% of medical records generated in Oklahoma.
So when he found out nearly a month ago that his group had lost the bid to be Oklahoma’s health information exchange, Kendrick felt like the state was rewinding 10 years of work to start over.
“Health care data moves at the speed of trust. Until trust exists, who would share their records?” Kendrick asked. “Who would be willing to have someone act as an intermediary until that trust is built? That’s the reason MyHealth didn’t happen (instantaneously); that’s the reason it took 10 years to get to this point.”
In a prepared statement for the bid award announcement, Orion Health said it was delighted to be selected to create Oklahoma’s new HIE platform.
“Storing and aggregating vast volumes of different clinical data, and surfacing it in data analytics, will bring the State of Oklahoma a step closer to delivering the right care for the right patient — at the right time and in the right place,” said Ian McCrae, founder and CEO of Orion.
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What Oklahomans need to know about the COVID-19 vaccine while signing up in Phase 2
Who is eligible currently?
On Feb. 11, Gov. Kevin Stitt announced teachers and school staff would become eligible Feb. 22 for COVID-19 vaccines, as well as Oklahomans of all ages with co-morbidities. The comorbidities, or medical conditions that denote high risk of death from COVID-19, include but are not limited to hypertension, diabetes, chronic vascular disease and other heart- and liver-related conditions
Officials have assured pre-K-12 school staff who are not classified as teachers, such as bus drivers, that they will be covered due to their high-risk positions; about 89,000 individuals are estimated to be eligible in this category.
Still eligible to make appointments: health care workers and those 65 and older
I have comorbidities - what do I need to do?
Beginning Feb. 22, residents under 65 with comorbidities will be eligible for a vaccine, estimated at 1 million Oklahomans.
The state plan include lists of issues that put people at increased risk of severe illness if they were to contract COVID-19. Those include asthma, cancers, cardiovascular disease, chronic kidney disease, chronic liver or renal disease, chronic lung disease, diabetes, Down syndrome, heart disease, high blood pressure (hypertension), obesity, suppressed immune system.
No documentation is required by the state to prove a comorbidity. Patients being vaccinated through pandemic providers including doctor's offices and pharmacies may have their records checked to confirm eligibility.
What determines how many appointments are available?
The state is reliant on COVID-19 vaccines supplied by the federal government; officials reportedly are notified of shipments one week at a time. The limited supplies make it logistically impossible to schedule vaccinations weeks in advance. Oklahoma officials hope for a policy change that resupplies be based on states' “burn rate,” of how many shipped doses are distributed promptly.
States and tribal leaders are receiving federal shipments of vaccines based on population, OSDH leaders have said. Oklahomans with a CDIB card would go to a tribal health care center for vaccines.
I signed up at vaccinate.oklahoma.gov but never got an email confirmation of any kind — what should I do?
Confirmation emails are sent out in batches; users should receive one within 24-48 business hours of registering. “Emails are sent out over a span of time in the order in which registrations occurred,” the state said. “As a result, some emails may be delayed.” If you've waited at least 48 hours without having gotten a response, it could mean a data-entry error was made by the user during registration.
State and county health officials also have said most of these issues are resolved when the user checks their junk mail folder for messages flagged as spam.
I’ve been told I can make an appointment, but I went to the portal and there were none available within 100 miles — what do I do now?
First, if the portal has a link that says "No appointments available," click anyway. Possible glitches in the system might result in that message showing up even when appointments might be open outside the user's immediate area.
If you're still coming up empty, bookmark and keep checking the “Click here” link emailed to you, says deputy OSDH commissioner Keith Reed. The link does not expire and is the only method to check for appointment availability. No further emails will be sent.
When will new appointments be added to the online portal as the state is updated on the supply of vaccines expected to ship from the federal government?
A new round of scheduling should be available on the portal every Thursday. Starting 5 p.m. Wednesday through Thursday morning, new appointments are uploaded for distribution pods, said Mindy Spohn, OSDH vaccine facilitator.
Tulsa Health Department did not add appointments Feb. 10-11 for the coming week due to inclement weather.
Someone I know is unable to go online to access the vaccination portal — how can they make sure to get an appointment?
The state recommends that those unable to access the online portal ask a family member or friend with internet capabilities to assist them with the registration process.
Some churches have stepped up to help people without internet access register on the portal, as well as those who need a foreign-language interpreter. State officials have said a Spanish translation is forthcoming for the online vaccine portal.
How are 211 and LIFE Senior Services trying to help?
Call center staff at 211 can help Oklahomans connect to resources they may need to physically access the vaccine distribution sites, but they cannot schedule appointments. OSDH helped add to 211 staff, who can collect patients' contact info to pass on to local health departments for phone scheduling.
LIFE Senior Services is helping callers get scheduled by signing them up on the portal and receiving emails for the patient. Pictured: LIFE Senior Services activities director Amberly Villegas and Geneva Boling.
Who else is trying to help people book appointments?
Josh Wright, software developer from Norman, developed a text-alert system for Oklahomans as a companion site for the state's COVID-19 vaccine portal.
The vaccine-alerts.com site has 41,000 users, who have received 1.25 million text alerts, as of Feb. 5.
Can I show up at a vaccination site without an appointment to wait for someone to miss their scheduled time?
No, Tulsa Health Department and other sites say those without appointments are not welcome at known vaccination sites. THD says if someone does miss their appointment, those shots may be offered to first-responders in the area who have not been able to get vaccinated yet.
What happens if I am unable to make my scheduled appointment? Can it be changed?
Asking that residents strive to keep their bookings as time slots are in high demand, the state has said that those who miss their scheduled time will need to make a new appointment. Cancellations or scheduling changes can be made through the portal. “There’s been some difficulty with that,” Spohn said. “Sometimes you have to wait 24 hours to be able to get back in and redirect your appointment because it locks up. … That’s among fixes we’re working on on our end.”
At what point do I schedule my second dose or "booster shot"?
The answer seems to change depending on which site a patient received their first dose.
Second-dose appointments may be scheduled at the time of the first shot. It is not required to schedule booster doses through the portal. “Follow the instructions given when you got your first shot,” OSDH Deputy Commissioner Keith Reed said.
Second-dose appointments may also be made via the state portal, and users will be asked whether they need the Pfizer or Moderna shot. Some clinics have had scheduling issues for second doses, Spohn said, so officials are working to ensure those sites aren’t filling up with only first-dose appointments.
Tulsa Health Department says: “You are able to walk in for your second dose without an appt, provided you come at the same time as your first dose. Must bring your vaccination card with you.” Director Bruce Dart said those who got a Pfizer vaccine through Tulsa Health Department should try to come back to the same site 21 days after the prime dose; those who got Moderna should walk back into the same site 28 days after.
In Wagoner County, second-dose appointments cannot be made until one week before the patient is due for the booster shot.
I can't get an appointment for my booster dose when I am supposed to — is it OK to take it any later?
Those concerned about getting appointments exactly 21 or 28 days after their first dose don’t need to worry; if you’re a little late, it doesn’t cause you to have to restart the shots. You may just take a few more days to reach 95% immunity.
The state says it may take longer for second-dose appointments to show up in the system as those cannot be entered into the system weeks in advance. Because the timing of booster doses means a three- or four-week delay, those scheduling their booster dose via the online portal are told not expect to set the schedule right after the prime dose.
Can I choose whether I receive a Moderna or Pfizer shot?
Some clinics have both Pfizer and Moderna available, but basically it’s whatever is available at the time of the appointment at the site.
Will I be able to drive-through to get my vaccination or will I have to go inside a facility?
Mindy Spohn said the state is trying at each location to help patients with accessibility issues to be able to drive-through. “The problem with drive-throughs … it does limit our throughput because you have a 15-minute observation period.” She said some sites may have found ways to offer drive-through with observation, "but their ability to reach large numbers is limited because of that."
If I have already had COVID-19, do I still need to consider getting the vaccine?
The short answer is yes. Dr. Jennifer Clark, who leads Project ECHO’s COVID-19 data sessions, said the human body’s natural immunity isn’t fully reliable and can be erratic. She said the response a person’s body will have from the vaccine will be more reliable and robust relative to the body’s natural immune response. Monks recommends waiting 90 days after recovering, especially if those who received monoclonal antibodies or convalescent plasma.
Do I still need to practice the three W’s after getting my vaccination?
Yes, it is vital for Oklahomans to continue to wear masks, wash their hands and watch their distance even after being vaccinated. The vaccine effectively protects recipients, but recipients may still be able to spread the virus to others. The CDC has not yet determined if or when it will stop recommending that people wear masks and avoid close contact with others to help prevent community spread.
Can you be a carrier of the virus after receiving a vaccination?
"We have to assume the answer is yes, you can. In other infectious diseases, this happens pretty commonly, though in others it does not. It won’t be known for another few months as we’ve gotten lots of people vaccinated and then tested with viral swabs," Oklahoma Medical Research Foundation President Dr. Stephen Prescott said.
Why do I have to wait 15 minutes before being able to leave after my vaccination, and what side effects are common?
Any adverse reaction that could endanger the patient's health should be evident within 15 minutes, so those receiving the vaccine must agree to observation during that time. Dr. George Monks, president of the Oklahoma State Medical Association, said possible side effects include mild pain or swelling at the injection site, true of any medicine injected into skin. Other possible side effects include mild fever, chills, tiredness and headache. Monks said side effects are almost always mild and are more common in younger people or when receiving the boost dose. Monks said one can think of the symptoms as a sign that the vaccine is working.
How many vaccine doses have gone to waste in Oklahoma?
State officials say there is no problem with expiring vaccines; doses arriving each week are already scheduled to be distributed the following week. “We don’t have any vaccine that’s sitting on the shelf,” says deputy OSDH commissioner Keith Reed. On Feb. 9, he said only 247 cumulative doses had been wasted due to broken or leading needles and vials.
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Kendrick
Corey Jones
Staff Writer
I am a general assignment reporter who predominately writes about public health, public safety and justice reform. I'm in journalism to help make this community, state, country and, ultimately, world a better place.
