Health Information Exchange in NYS - LIHIMA · Health Information Exchange in NYS 1 Roy Gomes,...
Transcript of Health Information Exchange in NYS - LIHIMA · Health Information Exchange in NYS 1 Roy Gomes,...
NYeC Background
• Overview and programs
• Assist providers transitioning from paper to electronic records
• Assist providers to qualify for Meaningful Use reimbursements
RHIO and HIE
• New York State landscape
• Data and services (Search, Send, Subscribe)
• Additional services (consumers, vendors)
HIT Ecosystem
• Local marketplace
• New York State Department of Health – Health Homes initiative
Public Health
• Background and needs
• NYS initiatives and grants
Agenda
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NYeC is a not-for-profit organization, working to improve healthcare for all
New Yorkers through health information technology.
Promote the adoption and use of electronic health records
• Educate the public on the benefits of EHRs
• Assist providers transitioning from paper to electronic records
• Assist providers to qualify for Meaningful Use reimbursements
Build the SHIN-NY (Statewide Health Information Network of New York): A secure
network for sharing clinical patient data across the state
• Allow providers to share information
• Promote collaborative care so doctors work as a team to benefit the patient
Develop statewide policies regarding HIT
• Convene stakeholders and build consensus
• Collaborate with NYS Department of Health
NYeC Overview
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Information Systems
• HIE - Health Information Exchange
• HIT - Health IT
• API - Application Programing Interface
• HISP - Health Information Service
Provider
• SHIN-NY - Statewide Health Information
Network of New York
Clinical and Administrative
• PCMH – Patient Centered Medical Home
• HH – Health Home
• REC – Regional Extension Center
• RHIO – Regional Health Information
Organization
• SCP – Statewide Collaborative Process
Health Information Technology Acronyms
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NYeC Key Programs
• Statewide Health Information Network of NY. Connects the local exchanges
• Initial capabilities: Patient Record Look-Up and Direct, State HISP SHIN-NY
• Support physician adoption of HIT (EHR and HIE)
• Leverages regional experts to deliver services
• New Programs: Diabetes recognition program, à la carte services, grant opportunities for larger practices and mental health providers, PCMH support
Regional Extension Center
•In partnership with DOH NYeC develops common policies, procedures, and technical approaches through an open transparent process
•Current Activities: Policy committee currently updating and creating policy measures the protect personal health information
Statewide Collaborative Process
•Led a coalition of 14 States, 15 EHR vendors, and 16 HIE vendors to leverage existing standards and develop consistent implementation guides for interoperability
Multi-State Initiative
• Began the NYeC Accelerator Program in conjunction with the Partnership for New York City Fund to support the development of cutting edge technology products in care coordination, patient engagement, message alerts, and analytics that will leverage the SHIN-NY
SHIN-NY API and Innovation
NYeC
An active,
visible
organization
across the
HIT market
in New York
State.
The healthcare system needs HIT tools to enable broad
collaboration between patients, providers, public health
officials, and payers. This will improve the quality of care,
provide the necessary system efficiencies, and increase
individual satisfaction.
No single entity can deliver this set of tools.
It will take an ecosystem working together.
The Vision
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Acronym Soup: RHIO vs. HIE
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HIE Health Information Exchange
RHIO Regional Health Information
Organization
Activity or process that moves health-
related data
Entity that governs the interoperable
exchange of information
Agreed upon set of interoperable
standards, and processes needed to
implement information exchange
Entity that defines and has the
responsibility for establishing and
enforcing information sharing policies
Participants may be geographically or
non-geographically defined Participants are geographically defined
Purpose is to exchange information
Mission is to improve quality, safety, and
efficiency of healthcare for communities
in which it operates
Exchanges clinical and administrative information
Exchanges information among organizations that operate independently of
each other
RHIOs are able to currently provide:
• Patient encounter history (e.g., admission and discharge)
• Medication history
• Diagnosis codes
• Patient problem list, including allergies
• Chronic disease information
• Lab order and results
• Radiology order and reports
Patient Data Available from an HIE
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• SHIN-NY: Statewide Health Information Network of New York
• A network of RHIOs operating in New York State
• SHIN-NY v1.0:
• RHIOs operating HIEs within their referral regions
• SHIN-NY v2.0: Statewide Network of Networks
• RHIOs operating HIEs and connected to one another by a statewide backbone
The New York RHIOs
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The Anatomy of a RHIO
Health Information
Exchange Software
Provider
Database
Patient
Database
EHR data interfaces (custom development)
A B C X Y Z
HOSPITAL A
FQHC B
PRACTICE C
HOSPITAL X
PRACTICE Y
HOSPITAL Z
HIE
Software
PATIENT RECORD LOOK-UP
ADDITIONAL CAPABILITIES
RHIO
Governance: Each RHIO is a non-
profit company with a community led
Board of Directors.
Technical: Connect healthcare
providers to the HIE and provide
members with access to patient
records from across the community.
Business Operations: RHIOs
provide member services which
include resolution of data integrity
issues, management of consent and
other statewide policy, project
management for connection of new
members, and project management
for the development of new
capabilities.
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• SHIN-NY: Statewide Health Information Network of New York
• A network of RHIOs operating in New York State
• SHIN-NY v1.0:
• RHIOs operating HIEs within their referral regions
• SHIN-NY v2.0: Statewide Network of Networks
• RHIOs operating HIEs and connected to one another by a statewide backbone
The New York RHIOs
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• RHIOs develop interfaces with multiple provider practices
• Clinical data is fed to the RHIO
• Connected practices search for patient records in the RHIO
o The RHIO acts as a hub for clinical data
Creating a RHIO
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RHIO
Practice1
Practice 2
Practice 3
Search: Patient Record Lookup
Send: Direct Exchange
Subscribe: Notifications
Services Simplified – The Three S’s
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Evolution of Search
ds
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SHIN-NY v1.0
Regional record access from your RHIO
SHIN-NY v2.0
InterRHIO connectivity
Clinical document retrieval from ALL connected RHIOs
Consolidated Service
Platform
Statewide patient search
Consistent services
Patient Record Lookup: The ability to request all records for
a given patient. The healthcare provider can select which
records they would like to view.
Core Services of the Service Platform
Search
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Find Places with records for Patient X
•Step 1: Search Your RHIO for Patient X
•Step 2: RHIO responds back that it has
records for Patient X
Search: SHIN-NY v1.0
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RHIO A
RHIO B
RHIO C
Your RHIO
The Rest of NY
Step 1
Step 2
Retrieve records for Patient X
•Step 1: Request all Patient X documents
•Step 2: Your RHIO responds with the
documents it has for Patient X
Search: SHIN-NY v1.0
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RHIO A
RHIO B
RHIO C
Your RHIO
The Rest of NY
What about
documents in
other NY RHIOs?
Without a coordinated network you will not
be able to retrieve the documents in other
RHIOs unless you search and retrieve from
them manually.
Step 1
Step 2
You’ve already searched, now retrieve records
for Patient X
•Step 1: Request all Patient X documents
•Step 2: Your RHIO asks all the other RHIOs for
documents for Patient X
•Step 3: Your RHIO consolidates and responds
with all documents
Search: SHIN-NY v2.0
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RHIO A
RHIO B
RHIO C
Your RHIO
The Rest of NY
All RHIOs are connected together.
Your RHIO is state enabled!
Step 1
Step 3
Step 2
Find places with records for Patient X
•Step 1: Search Your RHIO for Patient X
•Step 2: Patient X does not exist in Your
RHIO, nothing to return
Search: SHIN-NY v2.0
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RHIO A
RHIO B
RHIO C
Your RHIO
The Rest of NY
What about other
RHIOs with records for
Patient X?
Even with an interRHIO network, the first
RHIO you search needs to have a record
in order for you to get additional records
Step 1
Find records for Patient X
•Step 1: Search the platform for Patient X
•Step 2: Patient X exists in the consolidated
platform, Patient X is identified as having
records which you can now retrieve
Search: NYeC Consolidated Platform
RHIO A
RHIO B
RHIO C
Your RHIO
Consolidated Platform
Patient search no longer limited to the
RHIO for which you are a member. All “on
ramps” to the SHIN-NY are equalized,
record search is universal. 22
Step 1
Step 2
Secure Mail: The ability to securely communicate messages
between providers
Direct Exchange: The ability to package the record for a
given patient and send it directly to another healthcare
organization. Similar to secure email. Used on hospital
discharge to send records to the receiving community
physician, between primary care and specialty care for
referrals, sending lab results between practices, etc. – just
like email it can be used in many ways.
Core Services of the Service Platform
Send
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Notifications: The ability for a healthcare provider or care
coordinator to receive email or mobile text notifications
when their patient is admitted or discharged from a
healthcare facility.
Core Services of the Service Platform
Subscribe
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• The RHIO “listens” to incoming transactions
• If a transaction contains an event “subscribed” to by another
provider (Practice 2 here) the software generates an alert
message to the subscribing provider
“Patient X was just admitted to Hospital A’s Emergency Dept.”
Subscribe
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RHIO
Practice1
Hospital A
Hospital B
Practice 2
ED Admit for
Patient X
Triggers and Recipients
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PCPs
Care Coordinators
Hospitals Tracking Readmits
Caregivers
ED Admit
Inpatient Admit
Inpatient Discharge T
rig
gers
R
ecip
ien
ts
The HIT Ecosystem
CUSTOMERS & USERS
(NY)
Providers (25-30K orgs)
Payers (40 companies)
Patients (18M 24M)
Public Health
PAYMENT REFORM
CONSUMER
ENGAGEMENT
SYSTEM
TRANSFORMATION
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Providers
HIT Entrepreneurs
Health Information Exchange
SHIN-NY 2.0
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The platform enables entrepreneurial companies to
develop new uses for HIE data and capabilities
Public Health Reporting and Programs
• Required reporting on immunization of children under 19 (State, City) Immunizations
• Hospitals required to test and report results (State)
Newborn Blood Spot Screening
• Providers and hospitals reporting on communicable diseases (State, City)
Notifiable Conditions
• MU optimal requirements to provide input for cancer registry (National)
Cancer Registry
• Syndromic surveillance of HPI to track outbreaks (National, State) such as H1N1 pandemic alert
Other
How does this work?
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Center for Disease Control
• Gather national data on infectious diseases
• Manage national prevention and surveillance programs
• Distribute funding and other resources
• Collaborate with state and local public health in outbreak response
NY State DOH
• State regulation and enforcement
• Monitor incidence of CDs
• Investigate outbreaks
• Intervene/treat populations
• Report data to CDC
County organization and practitioners
• Local service providers and information source
Successes of the 20th century – Polio, Smallpox
Local and Centralized Access to Public
Health Information
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SHIN-NY Statewide Health
Information Network of
New York
RHIO Regional Health
Information Organization
Compliance with NY state
reporting requirements
Compliance with local
reporting requirements
Support state level
syndromic surveillance
Enable outbreak detection
at earlier stage and smaller
scale
Develop bidirectional
capability to capture
immunization
Implement local tracking
mechanism to address
regional variability
Exchange information with
all connected RHIOs to
enable CDS
Capture regional
information required by the
state or local government