Improving Health and Healthcare with IT: An Update on the Healthcare Information Xchange of New York (HIXNY)

Scott Momrow, MPHVice President, Marketing & Adoption Healthcare Information Xchange of NYsmomrow@hixny.org518.357.3689 x14

Jayson WhiteHIE Adoption SpecialistHealthcare Information Xchange of NYjwhite@hixny.org518.357.3689 x19

www.hixny.org518.357.3689

NYAPRS 7th Annual Executive Seminar on Systems Transformation

April 28, 2011

Agenda

•Why HIE?•The value of a connected community•HIXNY’s service offerings•Existing uses of the HIE

HIXNY Update

•Primer on patient consent•Overview of HealthyView HIXNY’s window to the

HIE

Brief Demonstration

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Collaborative Care Measures Across 7 Cohorts

Measure A B C D E F G Rank of G

Percent for whom specialist did not have information about medical history

19 16 32 16 12 14 22 6

When PCPs refer a patient to specialists, they always or often receive a report back with all relevant health information

96 85 78 92 93 83 75 7

Percent of PCPs who report the amount of time they spend coordinating care for patients is a major problem

17 33 29 20 18 20 30 6

Time was often or sometimes wasted because medical care was poorly organized

26 29 31 21 23 18 36 7

Percent of PCPs that receive the information needed to manage a patient’s care from the hospital in 2 weeks or less from when their patients were discharged

89 63 81 87 96 75 82 4

With the same doctor ≥ 5 years 61 66 80 79 62 73 53 7Regular doctor always knows important information about patient’s medical history

69 67 78 71 69 63 62 7

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Driver of Meaningful Use of HITMeasure(overall ranking on all report measures)

Aus(3)

Can(6)

Ger(4)

Neth(1)

NZ(5)

UK(2)

US(7)

Rank of US

Percent for whom specialist did not have information about medical history

19 16 32 16 12 14 22 6

When PCPs refer a patient to specialists, they always or often receive a report back with all relevant health information

96 85 78 92 93 83 75 7

Percent of PCPs who report the amount of time they spend coordinating care for patients is a major problem

17 33 29 20 18 20 30 6

Time was often or sometimes wasted because medical care was poorly organized

26 29 31 21 23 18 36 7

Percent of PCPs that receive the information needed to manage a patient’s care from the hospital in 2 weeks or less from when their patients were discharged

89 63 81 87 96 75 82 4

With the same doctor ≥ 5 years 61 66 80 79 62 73 53 7

Regular doctor always knows important information about patient’s medical history

69 67 78 71 69 63 62 7

4Source: Mirror, Mirror on the Wall- How the Performance of the U.S. Health Care System Compares Internationally 2010 Update; The Commonwealth Fund

The System is Fragmented and so is the Information

Medical record

Medical history

Physical exam

Hand-written notes, transcribed notesHard copy reports (fax, mail)ImagesLettersCopies of copies, faxesFaxes of copies, faxesExisting

chart

Patient visit

Hand-written notes, transcribed notes

Laboratory & other tests

Consultants & colleaguesPhone Fax Mail Computer

Hand-written notesHard copy reports (fax, mail)Electronic reportsHard copy imagesElectronic images

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Health Information Exchange Enables Patient-Centered Delivery Systems

6

Rehab Centers

Home Health

HospitalsHospital

LabsNational

Labs

Hospital Imaging

Ortho

Imaging Centers

Nursing Homes

CardioPCPs

Am-surg

HIE

Other RHIOs

NYS Medicaid

Rx History

Health Information Exchange

Care Management

Clinician Viewer

Hospital System

Secure Messaging

Clinician EHR

Patient Portal

Quality Reporting

Continuity of Care Document

(CCD)

Public Health Reporting

Shared with various

settings via different services

HIXNY Membership(many more now participating as subscribers)

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Physician Class Hospital Class Payer ClassCapitalCare Medical Group Adirondack Medical Center CDPHPCommunity Care Physicians Albany Medical Center HealthNow/BSNENYHometown Health Centers Alice Hyde Medical Center MVP HealthCareHudson Headwaters Health Network Bassett Healthcare NY Health Plan AssociationPrime Care Physicians Community Providers, Inc.

(CVPH/Elizabethtown)

Whitney M. Young, Jr. Health Services Columbia Memorial Hospital Consumer ClassMedical Society of the County of Albany Ellis Medicine Schuyler Center for Analysis &

Advocacy

Rensselaer County Medical Society Inter-Lakes HealthIroquois Healthcare Association Government/EducationNortheast Health SUNY School of Public HealthNathan Littauer Hospital County of AlbanySaratoga Hospital Albany College of Pharmacy & Health

Sciences

Seton HealthSt. Mary’s Hospital, Amsterdam EmployerSt. Peter’s Hospital Center for Economic Growth

HIXNY Service Area

REC Practices

Participating Practices (including Standalone e-Rx users)

CHITA Practices

Member Hospitals

Other Hospitals

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Data Types and Contributors – Hospitals

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Q1 Data Contribution

Demographics Allergies Medications Procedures Immunizations DiagnosesNotes/

Dept Rpts Discharge Image Rpt Lab Results

Albany Medical Center Q2 Q2/Q3 Q3 Q3 Q2 Q2 Q2 Q2 Q2

Northeast (Samaritan, Alb. Memorial) 02/2009 02/2009 02/2009 Q2 Q2 11/2010 11/2010 11/2010 10/2010

Seton Health (St Mary's Troy) 02/2009 02/2009 02/2009 02/2009 Q2 01/2011 01/2011 12/2010

St Peter's Albany 02/2011 02/2011 Q2 Q2 Q2 Q2 Q2

Ellis Medicine (Ellis, Ellis HC, Bellevue) 06/2009 09/2010 06/2009 01/2011 03/2011

St. Mary's Hospital at Amsterdam 03/2009 03/2009 03/2009 03/2009 Q2 Q2 Q2 10/2010

Saratoga Hospital 03/2009 03/2009 03/2009 03/2009 02/2011 02/2011 Q2

Columbia Memorial Hospital 12/2010 12/2010 Q2 12/2010 01/2011 01/2011 12/2010 02/2011

Bassett Healthcare TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD

Nathan Littauer Hospital TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD

CVPH Medical Center 12/2010 02/2011 Q3 Q2 Q2 03/2011 03/2011 03/2011 Q2

Glens Falls Hospital via ARCHIE Pending Pending Pending Pending Pending Pending Pending Pending Pending

Inter-Lakes Health (Moses-Ludington) Q2 Q4 Q2 Q2

Adirondack Medical Q4 Q4 Q4 Q4 Q4 TBD Q4 Q4 Q4

Alice Hyde Hospital Q4 Q4 Q4 Q4 Q4 TBD Q4 Q4 Q4

Elizabethtown Community Hospital Q4 Q4 Q4 Q4 Q4 TBD Q4 Q4

CDPHP 01/2009 via RxHub Lab Corp

MVP 01/2009 via RxHub Lab Corp

HealthNow 01/2009 via RxHub Lab Corp

Medicaid Test Q1

Consumers (PHR) TBD TBD TBD

Retail Pharmacy (SureScripts) for eRXers

In ProductionImmediate (Q1/ Q2) HEAL X Planned

HEAL V Planned TBD

Data Types and Contributors – Ambulatory Practices

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Data Contribution

Demographics Allergies Medications Procedures Immunizations DiagnosesNotes/

Dept RptsImage

Rpt Lab Results CapitalCare Medical Group 06/2009 06/2009 06/2009 09/2010 09/2010 09/2010 Q2 Prime Care Physicians 03/2009 03/2009 03/2009 Q2 Q2 Q2 Q2 Q2 Community Care Physicians 02/2009 02/2009 02/2009 Unknown Unknown Unknown Unknown Unknown Unknown Hudson Headwaters Health Network Q2 Q2 Q2 Q2 Q2 Q2 Q2 Q2 Whitney M Young Jr Health Services Q2 Q2 Q2 Q2 Q2 Q2 Q2 Q2 Hometown Health Centers Q2 Q2 Q2 Q2 Q2 Q2 Q2 Q2 Albany Medical Center – Faculty Practices Q2 Q2 Q2 Q3 Q3 Q2 Q2 Q2 Columbia Memorial – CHITA (7 practices totaling 16 physicians) Q2 Q2 Q2 Q2 Q2 Q2 Q2 Q2 Glens Falls Hospital - Ambulatory Practices via ARCHIE Pending Pending Pending Pending Pending Pending Pending Pending Inter-Lakes Health - Ambulatory Practices Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Adirondack Medical - Ambulatory Practices Q2 Q2 Q2 Q2 Q2 Q2 Q2 Q2 Alice Hyde - Ambulatory Practices Q2/Q3 Q2/Q3 Q2/Q3 Q2/Q3 Q2/Q3 Q2/Q3 Q2/Q3 Q2/Q3 CVPH Medical Center - Ambulatory Practices Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4

Small Practice EMR Integrations :Projected Date Number of Practices:

Number of Providers:

Athena (Includes Hudson Headwaters, Dr. Russell Rider) Q2 13 97

eCW (Includes 6 Columbia Memorial CHITA practices) Q2 12 39 Medent (also Northeast Nephrology/Complete Women’s Care of Clifton Park/Kathleen Catalano, DO/Main St. Peds/Amsterdam Family) Q2 12 38 GE Q3 7 26 Greenway (Prime Columbia Greene Medical Associates) Q3 1 10 STI Q3 5 9 EncounterPro Q3 1 5 Allscripts (includes Dr. Kamini Ramani) TBD 2 5 NextGen (includes Prime Care) TBD 0 0 Criterions TBD 0 0

In Production

Immediate (Q1/ Q2) HEAL X Planned

HEAL V Planned TBD

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Small Practice Model

Small Practice Model– $250 per practice plus $240 per provider annually for 1 to 20 providers

– Implementation fee of $5,000 - waived if agree to implement in 2011, actively seek

patient consent, and integrate HIE health record into workflow

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Includes the entire suite of offerings

“Many HIE’s achieve sustainability by automating the provision of test results rather than offering more robust data-exchange functionality.”

Source: ARCH INTERN MED/VOL 170 (No. 7), APR 12, 2010

Increased Visibility, Increased HIE Use

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Existing Uses of the HIE

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Ambulatory practices• 298 users of eRX• 374 users of clinical portal• Staff and clinicians using

for patient history lookup at point of care (discharge summary , image report use)

Acute care • Data source for

medication reconciliation pre-admission testing

• Hospitalist using for patient history lookup at point of care

ED access• Data source for

medication reconciliation by pharmacists

• Designing workflow and beginning pilot activities for patient history lookup by ED staff and clinicians

Metrics• 1.6 million patients in the

master patient index• 7,500 logons per month• Over 225,000 e-

prescriptions• 14,000 patient history

accesses per month• 11,000 labs delivered per

month

PRIMER ON CONSENT

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NYS Consent Process Details

• Patient consent is not required for a facility to send data to a RHIO (HIXNY)– Sensitive data (HIV, Alcohol and Substance Abuse, Mental Health etc.) is

INCLUDED in the data flow• Consent is needed to view the patients’ clinical data

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NYS Consent Process Details

• Each patient must sign a consent form at each facility at which s/he seeks care, authorizing that facility’s authorized users to access his/her information

• A facility is defined as an organization under single governance, and is not location-dependent

• Consent for treatment at a facility is enduring until/unless it is withdrawn, by the patient

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Consent Status• Yes (granted)

– Consent has been granted to authorized users affiliated with the organization

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• No (denied)– Authorized users can’t access the

patient’s clinical data even in the event of an emergency

• Null (neither granted or denied)– Either the patient has not been

asked or they chose not to grant or deny consent in the past

– Clinicians can “break the glass” ONLY in the event of an emergency

Demonstration of HealthyView:A Clinical Portal to Support Providers in a Connected Community

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Questions?

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Scott Momrow, MPHVice President, Marketing & Adoption Healthcare Information Xchange of NYsmomrow@hixny.org518.357.3689 x14

Jayson WhiteHIE Adoption SpecialistHealthcare Information Xchange of NYjwhite@hixny.org518.357.3689 x14

www.hixny.org