A Private HIE Operations, Challenges, Strategy and Analytics

April 14th, 2015

Anthony Antinori / Director / NYU Langone Medical Center Frat M. Iqbal / Manager / NYU Langone Medical Center

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest

Frat Iqbal Anthony Antinori Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives & Agenda Illustrate lessons from managing and maintaining large HIE with 3.6+ Million individual patient records

Evaluate pains and gains of connecting with 46+ EMR’s

Discuss maturity and shift in strategy of a HIE by pay for performance healthcare reform

Explain the strategy and plans of NYULMC HIE clinical data analytics.

Agenda:

• Private Health Information Exchange (HIE) – What and Why?

• How is NYULMC able to maintain a large EMR portfolio

• Care 360 for patients in the community

• Geographical coverage and future plans

• Healthcare reform and Clinical Analytics

• System maturity – migrating to a new HIE 2.0 platform

• Summary of learning objectives

• Surprise Quiz

• Q&A

Benefits Realized for the Value of Health IT

http://www.himss.org/ValueSuite

HIMSS Value Steps - HIE Satisfaction = Introducing a communication interface to share clinical data between providers and institutions

Treatment: = Proactive and efficiency in care of patients

Electronic Information/ Data = Notification and clinical result delivery faster than ever

Prevention and Patient Education = Repository of clinical data to identify @RISK patients

Savings = $$$$ are saved by reducing clinical data and process redundancies

Source: National Highway Authority

What and Why a Private HIE

What: • Focused on a specific region and community. • Funded by a private organization. • Limited or no reliance on State or National funding. • Maintain independent strategic goals and policies.

Why: • Agility to connect multiple systems and practices . • Value add for local Providers and Patients. • Focused attention to healthcare needs of a community. • Rapid alignment to strategic goals of organizations.

Agility Value Add Focused Rapid Strategic Alignment

NYC Private HIE - Why

7397 Registered Group Practices (GP) in NYC 24.4 GP/ SqM

Source: Healthgrades.com

Healthix & Bronx Regional Exchanges

Healthcare Environment - NYC

Facility A Facility C Facility B

EMR AR EMR

CR EMR BR

Inefficient Clinical Information Sharing - Phone, Fax, Mail, Courier

Facility C

14

Facility A

Facility B

EMR AR EMR

CR EMR BR

Electronic Clinical Information Sharing using HIE Demographics, Results, Notes, Images, allergies, Meds, history etc.

Central Repository - Health Information

Exchange (HIE)

Efficent 360 Care with help of Technology

NYULMC Overview?

NYULMC HIE Established Mid – 2011 Privately Funded by NYU Langone Medical Center

Goal – Central Repository of clinical information

For – Community Providers TO – Review, reference and share data to provide Care 360

to Patients

Agility Value Add Focused Attention

Rapid Strategic Alignment

How is NYULMC using it?

Optum HIE (Axolotl) 1.5 current platform (SaaS)

CCDA & Hl7 V2 compatible ADT, Lab results, Rad results, Dermatology, Pathology, EKG, Medications, Allergies,

Discharge summaries& transfer forms, Images (X-ray, CT scan, MRI) , Notes, Notification and Result delivery

Connection to HEALTHIX NY state RHIO

426+ connected EMRs – Target 46

Direct and hub model

200+ Independent Private Practices and Institutions

2200+ Providers accessing and sharing data

3.6 Million + Patient Lives

Processing 1 Million + transaction per month

Who, What and How did we do it? Leverage EMR hub technology EMR’s

Amazing Charts Macpractice. AdvancedMD - Half Penny Mdintellesys Allegiance MD MDLAND Athena MDonline Chartmaker (STI Computer Services) MEDENT Comtron, Medgen EMR Medi-EMR Criterions: Meditab (Computer Zone) Cure MD: Modernizing Medicine Docutap Nextech ECW Nextgen ENCITE Office Practicum - Connexin EYEMD OmniMD GE Centricity/ logician: Picasso-Doctor.com GloStream Praxis EMR GMED Raintree: Greenway SRS Greenway UNIEMR. Physicians solution Imedicware UROcharts (Healthtronics) Intelligent Medical Software (IMS) Veracity - AllegianceMD IO Practiceware Vitera, EMR is Intergy iPatientCare Waitingroomsolutions

Pains:

Gains:

• Interfacing with 46+ EMR’s • Resource, scheduling and

priority challenges. • Technical incompetency

• Talent Acquisition • Non standardize support and

follow-up. • Managing Practice expectation.

• Value of setting standards • Data being collected from

various sources. • Ease for the Partner Providers • One time setup in HUB spoke

Model • Create a true central repository

for clinical data. • Alive ability to share clinical data

Care 360 with help of Technology - Benefits

For Providers: • Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health

when using the HIE • Providers will be able to reduce unneeded patient visits and lower the cost of care • Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making

frontiers • HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related

research and actual practice

For Patients: • Patients can expect improved payment coordination & smoother care transitions • Patients can embrace opportunities for increased involvement in their healthcare • Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to

participate in the HIE

For the Community: • The collection and linking of data across the HIE facilitates extensive and robust community health records that

can foster the ability to quickly detect, respond and efficiently prevent threats to public health • The HIE will also enhance public health practices at all levels of government through infectious disease case

investigation and health surveillance

NYULMC HIE Area Coverage

Challenges & Lesson Learned

• Resistance to change.

• Technical boundaries.

• Talent shortage.

• Legislation and legal issues.

• Federal and State Policies.

Healthcare Future

• Clinical Integrated Network.

• Shared Savings from Payers.

• Accountable Care Organizations.

• Meaningful Use Stages

Effects on NYULMC HIE

• Population health.

• Clinical Care Coordination

• Shared Saving – ACO Reporting

• Patient Risk Analysis

• Various clinical data registries

• Meaningful Use Stages

• Geographical Benchmarking.

Unrealized HIE Benefits

• Lab Result delivery – Standard to all EMR’s

• Radiology images for non affiliated Providers

• Specific benefits for Dermatology practices

• Lutheran Healthcare acquisition

• Access to data in case of Emergencies

Migrating to a new HIE 2.0 platform • Migrating current HIE 1.5 infrastructure to Optum 2.0.

• Largest client being migrated to Optum new product.

• New Technology and Infrastructure. PHI Management. Clinical Analytics. Additional Data Points and Parsing

• Plan and Challenges.

• Impact to projected progress.

• Technical and training efforts.

Guidance, help and support

NYULMC Management, Advisory committee members, Clinical and IT Staff members

University Physician Network (UPN)

Strategic Health Information Exchange Collaborative (SHIEC)

HIE User Group

CHIT - NYU Community Health IT User Group

Summary of Realized Benefits HIMSS Value Steps

HIE Highway of Clinical data Satisfaction = NYULMC HIE has created a medium of

communication for smaller practices to share clinical data to a state level

Treatment: = Auto result delivery and central repository pledgees Proactive and Efficient Patient care

Electronic Information/ Data = NYULMC provides proactive Notification and clinical result delivery faster than ever

Prevention and Patient Education = HIE offers a repository of data for clinical analytics

Savings = HIE saves $$$$ by reducing the cost of creating separate interface for labs, practice staff , dupliacted clinical

procedures and process redundancies

National Healthcare System

Surprise Quiz • What is one of the biggest challenges that NYULMC HIE faced when developing a

strategy to connect with 46+ EMR’s? A. Buy in from the EMR’s B. Determining what EMR to connect C. Buy in from the Providers D. Determining clinical specialties to connect

• What is the biggest challenge of maintaining a large number of patients in CPI? A. Automatic patient matching tools B. Database maintenance C. Matching dependency on manual resources D. Both A and C

• Is it True that HIE’s will play a key role in improving Healthcare quality and cost

reduction? Why?

Questions?

Anthony Antinori Senior Director

Clinical Affairs IT 1 Park Ave, 3rd Floor | New York, NY |

10016 Tel: (212-404-4330)

Email: Anthony.Antinori@nyumc.org

Frat M. Iqbal Senior Manager

Clinical Affairs IT & HIE 1 Park Ave, 3rd Floor | New York, NY |

10016 Tel: (212-404-3628)

Email: Frat.Iqbal@nyumc.org