The Statewide Collaboration Process
New York State’s Strategy:
Health Information Exchange Infrastructure
Key to Support “Meaningful” Use by Clinicians
and Consumers
Rachel Block
Deputy Commissioner for Health IT Transformation,
NYS Department of Health
Academy Health Annual Conference
June 29, 2009
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Health IT Is Necessary but Not Sufficient
• Health information exchange is essential
complement to health IT:
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Incentive to use health IT
Track care across continuum, hand-offs
Empower consumers and families
Create longitudinal information
Strengthen public health surveillance
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The Statewide Collaboration Process
Key Concepts in Health Information Exchange
• Technical interoperability of health
information systems would facilitate
exchange
• Broad acceptance and use of certain
policies and standards is also required
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Governance and accountability
Protections re access and use: consent, disclosure of breach
Technical policies and standards: data structure,
communications; security requirements for authorization,
authentication
Clinical imperatives: quality, safety, care management policies
Financing and incentives
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The Statewide Collaboration Process
NYS Funding for Health IT and HIE
• HEAL I – Seed funding for regional health information
organizations and other multi-stakeholder health IT
projects
(~ 20 projects = ~$50 million)
• HEAL V – Development of statewide network
infrastructure, support for clinical improvements using
health IT, and implementation of EHRs in physician
practices ($106 million = 19 projects)
• HEAL X – further support of EHR implementation for
improved quality and efficiency with focus on primary care
medical home, expansion of support of the SHIN-NY
infrastructure $100 million
• State funds $150 million; matching funds and in kind
support also supplied by projects
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The Statewide Collaboration Process
Governance and Accountability
• Public trust and trust among participants are key
underpinnings for these systems
• Need authority, structure and means to set policy,
monitor use, enforce standards
• Federal government has established some policies and
mechanisms but not comprehensive
• Need to establish governance and organizational
capability at state and regional levels
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The Statewide Collaboration Process
Governance and Organizational Components: Policy
Development and Implementation Framework
NYS Dept of Health
Fund health IT
Oversee contracts
Enforce regulations
$
Funding and contractual
obligations
Evaluation tools, other
resources
CHITAs
CHITAs
Statewide collaborative process
Deliberate & decide policies
Assist RHIOs/CHITAs
Implementation guides, tools,
other resources
CHITAs
State
$
Region
Create evaluation tools
Assess sustainability
Measure progress
NYeC
CHITAs
RHIO
RHIO
RHIO
RHIO
RHIO
Patients
Providers
Payers
Purchasers
Patients
Providers
Payers
Purchasers
Patients
Providers
Payers
Purchasers
Patients
Providers
Payers
Purchasers
Patients
Providers
Payers
Purchasers
Local
HITEC
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RHIO: A governance entity that oversees HIE in its region
CHITA: A collaboration supporting adoption of health IT
The Statewide Collaboration Process
Policies Governing Access to and Use of Data
• Current law and practices protects privacy
and confidentiality – need to translate and
adapt to health care enabled by HIE –
consent, review of disclosures, notification
and remedies for breach
• Policies Governing Disclosure and Use –
Treatment, Public Health, Research, etc
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The Statewide Collaboration Process
Technical Standards
• Data definitions and record structure
• Product certification requirements
• Strategy for connectivity
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Hard coded interface specifications versus…
Open source, service oriented architecture as
in what we use for the internet
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The Statewide Collaboration Process
Policies and Standards for Technical Security
• Authentication of users (clinicians,
consumers)
• Authorization (role-based rights to access
patient data)
• Audit (tracking disclosures)
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The Statewide Collaboration Process
Framework for New York’s Health IT Strategy
“Cross-Sectional” Interoperability
APPLY
AGGREGATE
&
ANALYZE
ACCESS
Clinician/EHR
Consumer/PHR
Community
Clinical Informatics Services
Aggregation Measurement Reporting
Statewide Health Information Network – NY (SHIN-NY)
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The Statewide Collaboration Process
EHR with Unshared Services
Pharmacies
•Weak integration
Hospitals
Labs
•Costly
•Deadend solution
Immunization
Health Plans
Clinician
EHR
Radiology clinics
Public health
•No path to future
interoperability
•Increased risk of
duplication
•Increased risk
missing data
Medicaid
Consumers
•HIGH risk for failed
implementation
Clinicians
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The Statewide Collaboration Process
*RHIOs = Policy
**SHIN-NY = Technology
Public Health
Other NYS DOH
Databases
Medicaid
CDC Biosurveillance
and Public Health
Investigation Project
Immunization
and Child
Health
CDC
NYS DOH
UPHN
Local Health Depts.
SHIN-NY**
NYC Health Dept.
Multiple RHIOs*
Home Health
Care and
Telemedicine
Diagnostic
Centers
SHIN-NY**
Pharmacies
and PBMs
Patients’
Secure
Personal
Health
Records
Managed
Care
Physicians
Offices
and Clinics
Hospitals, Nursing
Homes, IDNs, etc
CHITA projects
Clinical Imperatives for HIE
• Clinical uses structured around “use
cases” which cross walk to technical
requirements
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Continuum of care – medication management
Safety and efficiency – e-prescribing
Quality Improvement – quality measures for
decision support and public reporting
Population health surveillance and
management
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The Statewide Collaboration Process
Clinical Priorities: Definitions, Requirements and Applications
Define clinical priorities that best
demonstrate critical areas and opportunities
for improvement in both the quality and
efficiency of health care for New Yorkers
1
Demonstrate and communicate the value of
interoperable health IT adoption and effective
use to clinicians and other stakeholders
2
3
Workflow
requirement
documents and
narratives to
support clinical
practice redesign
Clinical Scenarios
that illustrate
value proposition
•Create scenarios
based on use cases
and subgroup priorities
Develop clinical requirements, identify
workflow issues, and advance policy
recommendations to help drive and test
the development of policies, protocols and
standards for NYS Health Information
Infrastructure
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Clinical requirements document to guide technical
development and implementation:
• Hone value proposition for increased patient safety, improved
quality, efficiency and decreased cost;
•Identify and prioritize clinical data types & elements, features and
functions & CDS
•Provide detailed workflow analysis, including charts and
narratives
Reimbursement
requirements
document
•Identify and
prioritize
reimbursement
requirements to
support
sustainability
Coordinate with other Workgroups (EHR Collaborative, Protocols/Services, Privacy & Security)
Medicaid / Medication Management
1. Reconciliation relies on crosscontinuum data
2. Coordination with NHIN projects
3. Promote e-prescribing in context
of advancement to a full EHR
with CDS
4. Prioritization of clinical needs for
financial incentive models
Quality Reporting
1. Statewide quality standards
2. Locus of aggregation
3. Key data elements/specifications
4. CDS across care settings
5. Intersection with medication
management
6. Physician adoption/trust
Connecting NYers and Clinicians
1. PHR and medication management crossover
2. Emergency services and coordination (DNR)
3. Patient education and decision support
4. Patient identification and consent
5. Current PHR product readiness
6. Continuity of care record with the PHR
7. Secure patient-clinician clinician-clinician
interaction
8. Additional patient data sources including
Telemedicine
The Statewide Collaboration Process
Public Health
1. Integrating current public
health data sources –
coordinated input
2. High priority to deal with
projects already out
3. Bi-directional data flow
through the Universal Public
Health Node
4. Access to public programs as
an issue for public health
5. Coordination with other
efforts – CDC and NHIN
Successful HIE Also Depends on Comprehensive System
of EHR Adoption Support Services
Knowledgesharing
Convene and share best
practices and lessons
learned among participants
and users
Policies &
Standards
Products &
Services
Recommend common
policies, standards, and
technical approaches among
HEAL projects
Recommend statewide
services to reduce the cost
and/or increase the quality
and consistency of EHR
adoption and support
Value-Oriented Project Management
Readiness
assessment &
planning
Vendor selection
and contracting
Practice
transformation &
workflow
planning
System
deployment &
implementation
Reporting,
decision support,
and performance
measurement
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The Statewide Collaboration Process
Inter-operating
with internal and
external systems
Postimplementation
support
NY Health IT Strategy Is A Framework for “Meaningful” Use
Framework for NY’s Health Information
Infrastructure
Three Components
• Uses EHR in a meaningful manner,
which includes electronic prescribing
as determined to be appropriate by the
HHS Secretary
• Uses EHR that is “connected in a
manner” that provides for the
electronic exchange of health
information to improve the quality of
health care, such as promoting care
coordination (in accordance with law
and standards applicable to the
exchange of information)
• Submits information on clinical quality
measures and other measures as
selected and in a form and manner
specified by the Secretary
Clinician/EHR
Clinical Informatics Services
Statewide Health Information Network
Financing and incentives should be aligned
to support development and use of the
whole infrastructure
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The Statewide Collaboration Process
Information Resources
• NYS DOH –
www.health.state.ny.us/technology
• NY eHealth Collaborative –
www.nyehealth.org
The Statewide Collaboration Process