Health Information Exchange in NYS

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1 Health Information Exchange in NYS Roy Gomes, RHIT, CHPS Implementation Project Manager 1

2 Who is NYeC? 2

3 Agenda 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 3

4 NYeC Overview 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 4

5 Health Information Technology Acronyms 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 5

6 NYeC Key Programs SHIN-NY Statewide Health Information Network of NY. Connects the local exchanges Initial capabilities: Patient Record Look-Up and Direct, State HISP NYeC An active, visible organization across the HIT market in New York State. Regional Extension Center Statewide Collaborative Process 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 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 Multi-State Initiative Led a coalition of 14 States, 15 EHR vendors, and 16 HIE vendors to leverage existing standards and develop consistent implementation guides for interoperability SHIN-NY API and Innovation 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

7 What is the SHIN-NY? 7

8 The Vision 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. 8

9 Acronym Soup: RHIO vs. HIE HIE Health Information Exchange Activity or process that moves healthrelated data Agreed upon set of interoperable standards, and processes needed to implement information exchange Participants may be geographically or non-geographically defined Purpose is to exchange information RHIO Regional Health Information Organization Entity that governs the interoperable exchange of information Entity that defines and has the responsibility for establishing and enforcing information sharing policies Participants are geographically defined 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 9

10 Patient Data Available from an HIE 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 10

11 The New York RHIOs 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 11

12 The Anatomy of a RHIO RHIO Governance: Each RHIO is a nonprofit 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. HOSPITAL A HIE Software ADDITIONAL CAPABILITIES PATIENT RECORD LOOK-UP Health Information Exchange Software Patient Database Provider Database EHR data interfaces (custom development) A B C X Y Z PRACTICE C PRACTICE Y FQHC B HOSPITAL X HOSPITAL Z 12

13 The New York RHIOs 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 13

14 Creating a RHIO 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 Practice1 Practice 2 RHIO Practice 3 14

15 Services Simplified The Three S s Search: Patient Record Lookup Send: Direct Exchange Subscribe: Notifications 15

16 Evolution of Search SHIN-NY v1.0 Regional record access from your RHIO ds SHIN-NY v2.0 InterRHIO connectivity Clinical document retrieval from ALL connected RHIOs Consolidated Service Platform Statewide patient search Consistent services 16

17 Core Services of the Service Platform Search 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. 17

18 Search: SHIN-NY v1.0 Find Places with records for Patient X The Rest of NY Step 1: Search Your RHIO for Patient X Step 2: RHIO responds back that it has records for Patient X RHIO A Step 1 Step 2 Your RHIO RHIO B RHIO C 18

19 Retrieve records for Patient X Search: SHIN-NY v1.0 The Rest of NY Step 1: Request all Patient X documents Step 2: Your RHIO responds with the documents it has for Patient X RHIO A Step 1 Your RHIO RHIO B What about documents in other NY RHIOs? Step 2 Without a coordinated network you will not be able to retrieve the documents in other RHIOs unless you search and retrieve from them manually. RHIO C 19

20 Search: SHIN-NY v2.0 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 The Rest of NY RHIO A Step 1 Your RHIO Step 2 RHIO B Step 3 All RHIOs are connected together. Your RHIO is state enabled! RHIO C 20

21 Search: SHIN-NY v2.0 Find places with records for Patient X The Rest of NY Step 1: Search Your RHIO for Patient X Step 2: Patient X does not exist in Your RHIO, nothing to return RHIO A Step 1 Your RHIO RHIO B 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 RHIO C 21

22 Find records for Patient X Step 1: Search the platform for Patient X Search: NYeC Consolidated Platform Step 2: Patient X exists in the consolidated platform, Patient X is identified as having records which you can now retrieve Consolidated Platform RHIO A Step 1 Step 2 Your RHIO RHIO B 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. RHIO C 22

23 Core Services of the Service Platform Send 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 . 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 it can be used in many ways. 23

24 Core Services of the Service Platform Subscribe Notifications: The ability for a healthcare provider or care coordinator to receive or mobile text notifications when their patient is admitted or discharged from a healthcare facility. 24

25 Subscribe: aka Push aka Event Notifications 25

26 Subscribe 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. Practice1 Hospital A ED Admit for Patient X RHIO Practice 2 Hospital B 26

27 Recipients Triggers Triggers and Recipients Inpatient Admit ED Admit Inpatient Discharge PCPs Care Coordinators Hospitals Tracking Readmits Caregivers 27

28 The HIT Ecosystem PAYMENT REFORM CONSUMER ENGAGEMENT Providers SYSTEM TRANSFORMATION CUSTOMERS & USERS (NY) Providers (25-30K orgs) Payers (40 companies) Patients (18M 24M) Public Health Health Information Exchange HIT Entrepreneurs 28

29 SHIN-NY 2.0 The platform enables entrepreneurial companies to develop new uses for HIE data and capabilities 29

30 Platform of Connected Capabilities 30

31 APPENDIX 31

32 Public Health and Health Information Exchange 32

33 Public Health Reporting and Programs Immunizations Required reporting on immunization of children under 19 (State, City) Newborn Blood Spot Screening Hospitals required to test and report results (State) Notifiable Conditions Providers and hospitals reporting on communicable diseases (State, City) Cancer Registry MU optimal requirements to provide input for cancer registry (National) Other Syndromic surveillance of HPI to track outbreaks (National, State) such as H1N1 pandemic alert

34 How does this work? 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 ds 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 20 th century Polio, Smallpox 34

35 Local and Centralized Access to Public Health Information SHIN-NY Statewide Health Information Network of New York Compliance with NY state reporting requirements Support state level syndromic surveillance Develop bidirectional capability to capture immunization Exchange information with all connected RHIOs to enable CDS RHIO Regional Health Information Organization Compliance with local reporting requirements Enable outbreak detection at earlier stage and smaller scale Implement local tracking mechanism to address regional variability Capture regional information required by the state or local government 35

36 Questions 36

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