Health Care Equity

The Minnesota EHR Consortium

A unique pandemic-born partnership

By Deepti Pandita MD, FACP, FAMIA

It became apparent that health care delivery systems, both public and private were operating in silos, which clearly hindered the best responses to the pandemic. State health agencies and care delivery systems needed to know in a rapid manner how the pandemic was affecting its residents and where help should be deployed most quickly. The realization came that despite being cutting edge in technology and innovation, our state did not have adequate capacity to respond to a pandemic. It also became apparent that systems in place at state agencies did not have up to date information on race, ethnicity, preferred language, and geography. This is the best information available to address disparities in disease prevalence and testing, which helps health systems and the State develop a proactive testing strategy. All these challenges lead to the birth of the MN EHR Consortium-the first such collaboration in the country. The Consortium has a unified mission “to improve health by informing policy and practice through data-driven collaboration among members of Minnesota’s health care community”

Participation in the Consortium is open to any health system serving patients in the state of Minnesota. Current systems participating and contributing summary data include Allina Health, CentraCare, Children’s Hospitals and Clinics of Minnesota, Essentia Health, M Health Fairview, University of Minnesota, HealthPartners, Hennepin Healthcare, Mayo Clinic and Mayo Clinic Health System, and North Memorial Health, Sanford Health and the Minneapolis VA Health Care System.

Other affiliated organizations include Institute for Clinical Systems Improvement, Minnesota Community Measurement, and Minnesota Department of Health (MDH). Summary information is provided by each contributing health system and combined to provide weekly reports. No patient-level data is shared across member health systems and each health system controls their data within their firewall which has typically been the push back from care systems around data sharing with competing health care systems. The guardrails and assurance that the Consortium data would still “belong” to the organization, along with the unique threat of the pandemic, were the primary reasons most health systems signed on without much hesitancy.

During a pandemic, health systems cannot operate in silos.

Where we started

The first project tackled by the Consortium was the COVID-19 crisis. The project provides summary information to identify geographic areas where medical encounters for viral symptoms are increasing and aims to determine whether those symptoms are due to influenza or COVID-19, where COVID-19 testing is inadequate, and where COVID-19 positivity rates are concerning. These data can help health systems better prepare and respond to the unfolding COVID-19 pandemic. Through the many waves of the surges and ebbs of the pandemic the Consortium data guided care groups and state agencies to set up testing sites and understand the impact of the pandemic on various ethnic groups and design programs to create equity in care delivery.



Early 2021 vaccines became available for residents in the state. While this was welcome news and some light at the end of the tunnel, another reality became apparent- The Minnesota Immunization Information Connection (MIIC) had some limitations. This is a confidential system that stores electronic immunization records at the MN Department of Health. Health care providers, schools, child care centers, health plans, pharmacies and other locations that can provide immunizations are all participants in the system. MIIC did not have any race or ethnicity information due to privacy rules. The MN Department of Health reached out to the EHR Consortium and a healthy public-private partnership emerged. The Consortium has access to more granular information and capabilities to merge novel data sources de-identified, and to report vaccine administration by race/ethnicity, language, comorbidity status, and other factors. The consortium data became crucial to inform the equitable distribution of COVID-19 vaccines and the state welcomed this partnership. Now not only could the State display this data on their public website, but plans could be developed around equitable Vaccine distribution by SVI (social vulnerability index), zip code and county to identify hot spots and high need areas to target. Prior to the EHR consortium data availability, MDH was lacking an equity metric aligned with strategy. Developed by the CDC, Social Vulnerability Index uses 15 census variables to identify communities that may need support before, during, or after disasters. In addition to a summary score, there are 4 themes: Socioeconomic status (below poverty, unemployed, income, no high school diploma), household composition & disability (aged 65 or older, aged 17 or younger, older than age 5 with a disability, single-parent households), race/ethnicity & language (minority status, speak English “less than well”), and housing type & transportation (multi-unit structures, mobile homes, crowding, no vehicle, group quarters).

These data elements provide information on demographic and clinical trends in Minnesota’s COVID-19 vaccination effort. This information is critical for identifying gaps and disparities in vaccination efforts that can be acted on by health systems, state and local public health, and other health care organizations. This data was so compelling that MDH stepped up to fund some of the work being done by the EHR Consortium around these needs. The consortium also has experience merging different data sets. This is particularly important for its work around social determinants of health, where they are looking at vaccine rates among key populations experiencing housing insecurity, homelessness or incarceration. The Consortium has only really been a collaborative for about 13 months. In 12 of those months, we’ve been working on COVID, putting out fires pretty much day to day. So we are looking forward to Summer when, theoretically, we’re going to start talking as a group about the potential for adopting a common data model across the 11 health systems.

The technical work for the Consortium data support utilizes a distributed/federated analytic model where the MIIC vaccine data is linked to EHR data via secure one-way hashing algorithm. Each health system creates a standardized data set indicating COVID PCR test results, COVID-like-illness, vaccine date, demographics, comorbidities, zip code, etc. and summary data is produced and sent to the coordinating center at MDH where a dedicated group has been created to monitor and manage all the pandemic related data and analytics. Data is aggregated for public view on an easy-to-use internet dashboard tool. Prior to the EHR consortium creating this granular data around race, ethnicity and language, MDH could only show total numbers vaccinated by age but after this new methodology was implemented the data could be parsed out not only by race/ethnicity but also by zip code and SVI index which is crucial to drive vaccine equity in order to get shots in arms of those getting left behind. This methodology has been diligently designed to generate needed summary data on COVID-19 vaccination efforts while centering on privacy and data security. Only summary level data are collected for the reports, and the reporting and storage standards comply with state and federal regulations. The Consortium data cover approximately 92% of Minnesotans who have received the COVID-19 vaccine to date. Patients who have never been seen at any of the participating health systems are the ones who have no data included. It’s important to point out that data on race/ethnicity are missing for approximately 15% of vaccinated Minnesotans as these are typically required to be self-reported in health care systems.

Vaccination disparities are especially important to address.

What have we learned thus far?

Morbidity and mortality related to COVID-19 has been higher and occurred at lower ages for Black and Hispanic Minnesotans, so vaccination disparities are especially important to address. The health systems participating in the CDS Coalition that runs vaccine allocation for the health care systems have designed health equity plans using the EHR consortium data in order to close disparities. 

Initial results from the MN EHR Consortium indicate that vaccination rates among White, non-Hispanic Minnesotans are two times higher than Black Minnesotans and four times higher than Hispanic Minnesotans. Among people ages 65 and older, disparities are smaller but persist. The overall results are partly due to the age distribution of these populations in Minnesota, as well as the racial/ethnic composition of essential worker populations that have been vaccinated. Black and Hispanic Minnesotans are, on average, younger than White Minnesotans, so current allocation phases have resulted in smaller proportions of these groups being vaccinated. Vaccination rates among White, non-Hispanic and Native American populations were similar and may reflect early efforts to allocate vaccines to Native American Minnesotans

As vaccination became available to all Minnesotans 16 and over effective April 19th, the EHR Consortium data will further inform the state, federal and local vaccination sites on strategies to provide vaccinations where the need is the highest with the lens to health equity.



Minnesota has always been on the forefront of novel healthcare innovations but despite repeated attempts over the past decades and despite high use of electronic health records in the state since the early 1980’s, we have not succeeded in creating a seamless state level data exchange. The EHR consortium fills a much needed gap and we hope the value this effort has brought forth will result in a more permanent data sharing structure for the State. During a pandemic, health systems cannot operate in silos. Collaboration is needed to understand where and how the disease progresses and to plan for capacity and operational needs. This work also benefits the State’s response efforts by complementing other data.

Looking Ahead

The Consortium meets weekly and has representative members from all its participant systems. Each week there is a review of summary reports, ongoing needs and gaps to address the pandemic, develop governance structures to support decision-making, and make improvements. The coalition now has several sub groups who work on niche problem solving such as research and publications, refining data and analytics, public relations and outreach etc.

This work is adapting to address future COVID-19 surges, the potential for other epidemics/pandemics and improving future vaccination activities. Other topics, such as long-term impacts of COVID-19 infection and other public health issues may be addressed and the data can be used to drive future public policy.

The Consortium’s partnership, infrastructure and methodology for producing summary data will help Minnesota be prepared for future public health crises, syndromic surveillance and even for chronic disease management with the ultimate goal of creating healthy communities and improving the health of the residents of Minnesota. The data can guide clinicians and other care providers in the state to dive deeper into their own patient populations to identify gaps and better serve the needs of the populations they serve. In the future there is the potential to have partnerships with health plans, patient advocacy groups and other nonprofits that support health equity. Through this research we can design human-centered solutions for the health of our state using a lens of equity.

Deepti Pandita MD, FACP, FAMIA, is the Chief Health Information Officer for Hennepin Healthcare.