Statewide Health Information Network of New York. Darryl Hollar Director, Product Management

Transcription

1 Statewide Health Information Network of New York Darryl Hollar Director, Product Management 40

2 New York ehealth Collaborative 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: A secure network for sharing electronic medical records Allow providers to share information Promote collaborative care so doctors work as a team to benefit the patient Create an health ecosystem that fosters innovation Develop statewide policies regarding HIT Convene stakeholders and build consensus Collaborate with NYS Department of Health 41

3 Helping to Drive the 3-Part Aim Better healthcare Improving patients experience of care within the Institute of Medicine s 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. Better health Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Reduced costs $ Lowering the total cost of care while improving quality, resulting in reduced expenditures for Medicare, Medicaid, etc. Health Information Technology 42

4 Product Management: Identify - Stakeholder needs analysis - Technology analysis - Market analysis - Business Case creation Scope - Requirements Analysis - Customer Use Case Definition - Process Flow Mapping - User Interface Mockups Accept and Release - Test Plan Strategies - User Acceptance Testing - Deployment Strategy Identify, Scope and Release Products and Services to Enhance New York State Interoperability Initiatives 43

5 New York Marketplace at a Glance Hospitals: 200 Practices: 20,000 Physicians: 67,000 Active Physicians Payers: 40 Patients: 19.5 Million Public Health: 57 Counties + the 5 of NYC Visits: 70M per year 44

6 Upstate vs Downstate High concentration of population in the downstate region - Downstate is the Southeastern portion of the state surrounding NYC - 12M people of the 19.5M people in NY live here Insurance coverage differs greatly - Downstate: National insurers have strong presence No dominant payer - Upstate: National insurers have low presence Downstate Local community payers highly dominate 45

7 Provider Organizations are grouped by Region Provider organizations are grouped by Region into Regional Health Information Organizations (RHIOs) In 2004 NYS passed the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program (HEAL Grant) A primary objective includes implementing a 21st Century Health IT infrastructure to support the delivery of high quality care Through HEAL the NYS DOH helped create the 9 RHIOs in New York RHIOs create local network of stakeholders including hospitals, practices, long term care, etc. 46

8 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 EHR data interfaces Provider Database A B C X Y Z PRACTICE C PRACTICE Y FQHC B HOSPITAL X HOSPITAL Z 47

9 Patient Consume Care Differently Upstate - Patients are spread out - Consume care mostly within a single RHIO Downstate - Geographically dense - Patients cross RHIO boundaries for home, work, etc. - Consume care across multiple RHIOs - RHIO Providers have a limited view 48

10 A Connected Infrastructure Can Solve Common Use Cases Patient Use Case - Lives in Brooklyn; PCP in Manhattan near job - Taken to ER (non-responsive) on business trip in Albany Provider Use Case - High-risk patients with chronic illnesses - Provider can help coordinate care if there is an ER admission event Public Health Use Case - Needs centralized access to patient data at the state-level 49

11 Example: Impact of a Connected Infrastructure The U.S. Railroad Early on the railroad system was mostly a local affair Many systems built by private sector with equipment that could not integrate Standardizing the infrastructure united the US Stimulated economic development 50

12 Connecting the NY Healthcare Infrastructure The Statewide Health Information Network of New York (SHIN-NY) is a Network of NY Networks Under the direction of the NY DOH The SHIN-NY was established to allow electronic exchange of clinical records between participating providers The nine participating RHIOs must be certified as Qualified health IT entities (QE) 51

13 SHIN-NY Stakeholder Adoption % OF ENTITIES ACCESSING OR SUPPLYING DATA 52 52

14 Key Services of the SHIN-NY Provider Search - Statewide Patient Record Lookup (sprl) Patient Search - New York Patient Portal (NYPP) Secure Send - Direct Message Exchange Provider Notifications - Alerts and Subscriptions Practice Transformation - Regional Extension Center (REC) 53

15 Provider Search: Statewide Patient Record Lookup The process - Healthcare provider organizations connect to each RHIO - All RHIOs connect to the statewide service - A Provider at a specific RHIO requests patient data from the statewide service ( querying RHIO ) - The statewide service identifies which RHIOs have the patient data - The statewide service distributes the patient data request to the other RHIOs ( responding RHIOs ) - The Statewide service forwards patient data from responding RHIOs to the RHIO that originated the query 54

16 Statewide PRL Promotes Standards Built on a service-oriented architecture Leverages the IHE suite of standards Promotes standards, legal agreements and governance to participants Enforces participants to adopt Data Usage Agreements Harmonizes with Healtheway s ehealth Exchange standards Statewide Service HeLink MPI Statewide Gateway Statewide MPI HIXNY MPI Healthix MPI HLinkNY MPI Interboro Rochester ehnli HeCon Bronx MPI MPI MPI MPI MPI 55

17 Building a Secure Network to Protect PHI Web Services Security (Message Encryption): - Sign SOAP messages to assure integrity - Encrypt SOAP messages to assure confidentiality - Attach security tokens to ascertain the sender s identity 2-way TLS (Transport Security) - Specifies how integrity and confidentiality can be enforced - X.509 Certificates ensures the server is who it claims to be - Dated signature prevents replay attacks SAML Assertions (User Authentication) - Security Assertion Markup Language - Standard for exchanging authentication and authorization data - Validate SAML and TLS to ensure only authorized entities can request services from the gateway 56

18 What Information is Available via sprl? Information Categories Demographics Cardiology Results Diagnosis/Procedures Encounters Pathology Results Problem List Encounter Summaries Discrete Lab Values Immunizations Diagnoses Microbiology Reports Social/Family History Allergies Other Transcribed Reports OB/GYN/Resp/Card Reports Contacts/Next of Kin Prescribed Medications Discharge Summary Insurance Medications Advanced Directives Radiology Reports Medication History Clinician Information Lab Test Reports Medication Allergies Care Plan Microbiology Results Vital Signs/Observations ACO/Health Home Status 57

19 Statewide services store patient demographics but do not store clinical data distributed from RHIOs Provider clinical data is copied to a RHIO Statewide Service The RHIO copies and synchronizes patient Statewide Gateway Statewide MPI Healthix demographic data to the statewide service (smpi) The RHIO queries the statewide service to obtain Bronx clinical data from other participating RHIOs 58

20 The Statewide Master Patient Index is an MPI of MPIs Statewide Master Patient Index (smpi) - smpi is an MPI of MPIs - Each RHIO maintains an MPI which feeds the smpi The smpi is capable of linking patient records across RHIO communities Each RHIO can automatically discover and retrieve information without a complex query Enforces use of consistent MPI algorithms Enhances performance as matching of identity is done ahead of time by the smpi SHIN-NY RHIO A smpi RHIO B RHIO C 59

21 smpi Management Requires Governance and Data Remediation Policies and Procedures Process and Operating procedures - Error and issue resolution - Change control processes Analyze smpi data and tune the algorithm - Demographic scoring and matching thresholds Build protocols - manual matching, near matches, unlinking process Review QE best practice tools 60

22 Planning and Implementation Processes SHIN-NY and RHIO services use the ITT Test Tool for Conformance Testing and are certified by the Department of Health Business Case Requirements Technical Specification Approved IHE Services Development ITT Conformance Testing Integration Testing NYeC Audit RHIO Certification Testing Prod Up Go-Live Connectivity and Security Testing March April & May July Q3/Q4 61

23 Joint Interoperability Testing and Certification Program The EHR/HIE Interoperability Workgroup (IWG) sponsored by NYeC formed a strategic partnership with HIMSS and IHE USA to streamline the process for achieving connectivity between EHR and HIE systems This alliance will strengthen IWG s current program to test and certify EHR and HIE vendors to enable reliable transfer of data within and across organizational and state boundaries Fulfills a need for tightly specified implementation-level requirements and automated compliance testing to achieve interoperability 62

24 The SHIN-NY Roadmap What s Next? What s Next?: After the infrastructure is in place what s next? Enhance the Provider s enduser experience In-house application development Unleash innovation throughout the marketplace with 3 rd party APIs 63

25 New York Patient Portal Primary Objectives: Patient driven healthcare Enable patients to access their aggregate health records across NYS Allow data aggregation and abstraction for enhanced usability Enable Direct secure messaging between patients and their providers Patient Safety 64

26 NY Patient Portal Promotes Standards and Leverages the SHIN-NY Infrastructure Built on a service-oriented architecture Adheres to IHE standards prescribed in the Statewide PRL functional specification Patients can pull information but cannot currently push information to the SHIN-NY 65

27 The Current NY Patient Portal Pilot Experience is RHIO-centric Features and Process Flow: RHIO and Participant Organization centric Marketing by the RHIOs, distributed in Provider offices Requires in-person Identity proofing by Provider staff Enables deterministic match to clinical records 66

28 Functionality in Development Allows for a RHIO-Agnostic Experience Upcoming Features: Electronic Identity Proofing - User is not known - No ability for manual intervention Electronic methods to match patients to their clinical records - Identity is known - Need to be sure these are your records 67

29 Enable Parents and Guardians to Access Immunization Records of Minors Upcoming Features: Enable authorized users of the NYPP to access immunization history for their guardians Integrate with the NY State and City immunization registries Enable users to view / print an official immunization record to be used at camps, back-up daycare, etc. Working with the NY registries in regards to data use agreements, policy implications, addressing security concerns, contracting, etc. 68

30 The Power of Patient Driven Data What s Next?: After the infrastructure is in place Internet of Things integration? Mashup clinical data with Patient self-generated data? Enable users to push information into the SHIN- NY? 69

31 Secure Send: Direct Message Exchange Mail box Mail box Practice 1 Practice 2 Send documents and messages directly between Providers Secure Message Exchange (aka HISP) Secure Message Exchange (aka HISP) Practice 4 Mail box Mail box Practice 3 Secure Messaging with a broader reach! ereferral Care Coordination Results Delivery General Messaging Secure transmission of PHI between Covered Entities 70

32 Provider Notifications: Subscribe Receive notifications when your patient is admitted or discharged from a healthcare facility anywhere in the state. Practice 1 Your Practice/ Organization Your RHIO or another RHIO Statewide Hospital A Send notification when Event occurs HEAL 5 Listen for an event Hospital B Get notified when there is an Event ED Admit Inpatient Admit Discharge 71

33 Practice Transformation Services Core capabilities in HIT adoption and practice transformation REC formed in 2010 via federal grant, serving NY State outside of NYC providers supported to adopt EHRs, for Meaningful Use Subcontractor (Agent) network in place to deliver practice level services Relationships with ONC, CMS, DOH, QE s, vendors enable NYeC to function as convener 72

34 Previous Funding and Future Sustainability NY EHR HIE Interoperability Workgroup Launched NYeC Established SHIN-NY Launched HEAL 10 HEAL 22 HEAL 1 HEAL 5 HEAL

35 Previous Funding and Future Sustainability ALBANY, NEW YORK, March 31, 2014 The New York State Legislature approved $55 million in funding for the Statewide Health Information Network for New York (SHIN-NY) as part of its Fiscal Year budget. In connection with the state budget, a regulatory package compels usage of the SHIN-NY - DOH regulated entities (Hospitals, Retail Clinics and Urgent Care Centers) will be mandated to connect and share (bidirectional) via the SHIN-NY within a two year period 74

36 Recommendations for Building Connected Infrastructure Adopt standards Incentivize stakeholders to work together Create trust between partners throughout the value chain Think big but implement cyclically on smaller scales Leverage smaller successes to do bigger things Build a strong team Keep the team intact throughout the process 75

37 THANK YOU! 76