Hawaii Doesn't Need Another Data Feed. It Needs a Health Data Utility
By Brian Oliger, HI Resolution Consulting
Picture a patient who gets a CT scan on Maui and is flown to Honolulu that night. The receiving team often can't see the images, so they scan again. The patient fills out the same history on a clipboard. And the next week, the hospital that sent them is building yet another data feed because a different state program asked for one.
None of this is anyone's fault. It's the result of a system where each hospital connects separately to each partner, each state program asks for its own feed, and the patient is the only thing that travels between them.
Hawaii is in a good position to fix that. Federal Rural Health Transformation funding is flowing through 2030, national exchange rules have matured, and other states have already shown what works. The question is whether we build one more feed or build something that replaces them.
Other states have already done this
The idea has a name: a Health Data Utility. It means one state hub that serves clinicians, public health, Medicaid and patients, instead of a dozen separate connections.
Maryland made its exchange, CRISP, the official state Health Data Utility by law in 2022. This year it is using rural transformation funds to pay rural providers to connect, one milestone at a time.
Nebraska passed a 2021 law that brought near-universal participation in CyncHealth, which also runs the state's prescription monitoring program.
California now requires 4,400+ organizations to share data under its Data Exchange Framework.
Indiana has built one of the largest clinical repositories in the country, covering more than 20 million patients, and uses it for public health reporting and research.
Nationally, the plumbing has caught up too. TEFCA, the federal framework for exchange between networks, went from about 10 million shared documents before 2025 to more than 460 million by the end of that year. CMS's new Interoperability Framework is pushing patient-facing apps that let people pull their records with one verified login.
What a Hawaii Health Data Utility could look like
We already have a strong starting point in HHIE. The goal is to build on it, not around it, in phases that each pay off on their own:
One pipe for state reporting. Hospitals send data once. Registries, public health and Med-QUEST draw from the utility instead of asking each hospital for a new feed.
Connect once, nationally. HHIE joins TEFCA through a single national network, so Hawaii providers can reach records from the mainland and vice versa. A statewide patient index matches records reliably, with de-duplication.
Images that travel. Start with neighbor island emergency transfers to Oahu, where repeat scans cost the most time and money.
Patients in control. A Hawaii-branded app, built on the national CMS-aligned networks, lets residents see their records, share them at check-in with a QR code, and see who has viewed their record.
AI on clean, governed data. Once the data is reliable, use AI for specific, reviewed tasks like registry abstraction, rather than pointing it at a messy pile.
The hard parts
It would be dishonest to pitch this without them:
Sustainability. Federal funding ends. States that didn't plan the transition got into trouble. We need a funding model before we need a vendor.
Privacy. Hawaii's constitution protects privacy explicitly. Sensitive records need to be segmented, and patients deserve to see who looked at their data.
Incentives. Hospitals carry the cost while payers and patients get much of the benefit. Paying for onboarding milestones and retiring duplicate feeds helps balance that.
Identity. A state "health ID card" raises real legal and political questions. A well-run patient index with verified digital identity gets most of the benefit.
Neighbor islands. Broadband and staffing gaps are real. The design has to work for a small clinic on Molokai, not just a hospital on Oahu.
Help us poke holes in it
We're sharing this early because the best version of this plan won't come from one firm. If you work in a Hawaii hospital, clinic, health plan, state program or patient advocacy group, we want to hear from you:
What data feed do you build most often that you wish you never had to build again?
Where does a patient's information get lost in your workflow?
What would make you trust a statewide utility with your data, or your patients' data?
Reach out at brian@hi-res-consulting.com. We'll fold what we learn into the next version and publish what changed.
HI Resolution Consulting works on health IT strategy and interoperability in Hawaii.
