Health Information Exchange in NYS

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Roy Gomes, RHIT, CHPS Implementation Project Manager

Who is NYeC?

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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.

What is the SHIN-NY?

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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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Subscribe:

aka Push

aka Event Notifications

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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

Platform of Connected Capabilities

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APPENDIX

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Public Health and Health Information Exchange

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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?

ds

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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

Questions

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