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InterconnectivityinNYS:CommunityHIEssupportstatewidehealthinformationexchangeJill Eisenstein
CEO & President Rochester RHIO
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OverviewThe Rochester RHIO (Regional Health Information Organization) is a secure, health information exchange.
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Overview
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SHINY‐NY (Statewide Health Information Network of NY) is a “network of networks.”
8 Qualified Entities (QEs) by Geographic Region
http://www.nyehealth.org/shin‐ny/qualified‐entities‐qes/
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http://www.nyehealth.org/shin‐ny/qualified‐entities‐qes/
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OverviewWe are a nonprofit, community‐run organization serving 13 counties.
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OurMission
Our Goal: Better information for better patient care by providing authorized participants access to patient health information.
Current Focus: Bring more comprehensive picture of patient to community by increasing data available in HIE.
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HospitalSystems
PhysicianPractices
Payers
ImagingCenters
ClinicalLabs
Public Health & Gov’t agencies
VeteransAdministration
SHIN-NY Data
Long TermCare
UrgentCare
CommunityBased Orgs
OurServices
We provide authorized medical providers, care managers, and appropriate community‐based organizations with electronic access to: • Lab reports
• Radiology results, images
• Hospital admission/discharge
• Clinical reports
• Discharge summaries
• Ambulatory care summaries
• Hospital admission/discharge notification
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OurServices
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Whoweare:Provenimpact“One of the single most important elements of patient care in our community and across the country is access to information. This improves quality by reducing medical errors, creating efficiencies, reducing costs by quelling redundant testing, and creating a common language for a care team to use.”
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Bridgette Wiefling, MD
Rochester Regional Health
Whoweare:Provenimpact“In the past decade and a half, the scientific evidence base of health information exchange and interoperable health information technology has grown exceedingly…. By my count, 16 scientific, peer‐reviewed journal articles are the product of the Rochester RHIO’s willingness to partner with academia for research and evaluation activities.”
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Joshua Ryan Vest PHD, MPH
Indiana University and Purdue University
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Whoweare:Provenimpact
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Study shows use of Rochester RHIO cuts costs.
“…for emergency doctors, who often need to make quick treatment decisions based on scant information, the clinical benefits of a RHIO’s fast access to patient health histories or imaging studies are incalculable”
‐Dustin Riccio M.D., Chairman of Unity Emergency Department. RBJ 2014
Note: Studies were conducted in Rochester with the use of Rochester RHIO’s data. Researchers from Weill Cornell Medical College. Three studies have been published by peer‐reviewed journals and demonstrate significant savings in system efficiency and improved health care quality.
CriticalSuccessFactorsCommunity HIEs are succeeding in NYS
• Regional focus
• Transparency
• Data security
• Funding (federal & state)
• Supportive regulatory environment
• Evolving policy and technology
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SHIN‐NYGovernance
The SHIN‐NY is governed by an open and transparent process that brings together key stakeholders in the State to contribute input and expertise on the development and implementation of SHIN‐NY policy and technical standards.
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SHIN‐NYGovernance
This process is known as the Statewide Collaboration Process. NYeC, in partnership with the New York State Department Of Health, convenes several Committees that are representative of stakeholders with an interest and investment in health information exchange via the SHIN‐NY.
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SHIN‐NYDataExchange
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• Current SHIN‐NY services • Query patient data summary – statewide data
• Cross QE Alerts
• Medicaid claims data
• Patient Portal
• Proposed SHIN‐NY services• Single sign on to Department of Health registries (NYSIIS, iSTOP, etc)
• Access to APD (All Payer Database)
PatientConsentMore than 1.4 million unique consented patients
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PatientConsentToday
• Consent is per HIPAA‐covered entity
• Patients provide written consent using approved NYS DOH form and choose: Yes, No, No to all
• Consent to View vs. Consent to Load Data
• Patients can revoke consent at any time
• Consent is durable until changed or revoked
• Patients can request an audit of who has accessed information
• Consent forms have been signed by 10.4 million unique patients in New York State
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PatientConsentToday
Other Consent Options
• Break the Glass
• RHIO‐wide denial
• Minor Consent
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PatientConsent:CFR42,Part2
New regulation (as of 3/21/17) did not make the changes needed to allow for including Part 2 data in community HIEs
• General rule is to ask data sources to filter out Part 2 data
• Significant issue for each QE. In general, Part 2 data will not be widely available in HIEs until technology allows for the identification and segmentation of Part 2 data.
• Rochester RHIO and all participants are a QSO, and all Part 2 data requirements are followed, in order to account for assumed commingled Part 2 data.
• Nationwide, HIEs are struggling with including Part 2 data.
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PatientConsentTomorrow
Process to update patient consent policy in NYS is unfolding.
• Investigation of issues and opportunities focused on needs of value‐based care initiatives.
• Short Term proposed changes – alerts policy and expanded types of consent “forms”.
• Long Term proposal – Opt‐out consent
• will require changes to NYS public health law
• 38 states are currently opt‐out
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BeyondtheSHIN‐NY
• SHIEC (Strategic Health Information Exchange
Collaborative)
• Sequoia Project
• eHealth Gateway
• VA/DOD
• Social Security
• Carequality
• Direct Trust
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