HITEC:Evaluating the Economic Effects of Health Information Exchange

Programs across New York State

Rainu Kaushal, MD, MPHAssociate Professor, Weill Medical College

Director of Pediatric Quality and Safety at KCCH/NYPHExecutive Director, HITEC

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Background

• Clinical decisions are data driven

• Health information technology (HIT) with health information exchange (HIE) has been embraced as one strategy to improve health care quality and reduce costs by improving access to data

• Regional clinical data exchanges are occurring, with unknown effects

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HEAL NY(Healthcare Efficiency and Affordability Law

for New Yorkers Capital Grants Program)

• $200 million investment• Implementation grants of $50,000 - $10,000,000

per grant (for capital investments)• Supporting multi-stakeholder HIE initiatives• Grantees are required to provide matching

funds and dedicate some funds for evaluation• Evaluation efforts are likely to vary in quality

and be non-standardized

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Why Evaluate?

• Demonstrate value of HEAL initiative– Demonstrate uptake and usage

• Encourage future HIT and HIE adoption– Demonstrate economic benefits– Demonstrate consumer and provider satisfaction– Demonstrate quality and safety benefits

• Iteratively refine HIT and HIE– Understand what is working well– Understand what can be improved

• Disseminate lessons learned and successes broadly

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HITEC

• Not for profit, multi-institutional academic collaboration – Based at Weill Medical College – With collaboration from Columbia University, SUNY-

Albany, University of Rochester and others

• Aims to ensure robust evaluations of HEAL NY and other HIE initiatives in NY State– Provides expertise in evaluation methodology, health

information technology, health economics, survey methodology and biostatistics

– Conducts analyses across active HIE initiatives

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CMWF Grant: Financial Methods

• Specific aim: Determine the ROI for providers of HIT/HIE implementation

• Methodology: Will include costs, benefits, and usage measures

• Design: Pre-post studies with concurrent controls

• Participants: 7 HEAL NY grantees– Diverse in terms of clinical setting, geography, and

type of HIT/HIE intervention– Community based interventions– Evaluation team has no control over type or timing

of HIT/HIE implementation

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Progress to Date

1. Developed a financial framework at the level of HIT/HIE functionalities

a. 104 functionalities

b. 5 settings

c. Each rated on likelihood of successful implementation and use, magnitude of financial benefit, ability to measure benefit

2. Validated by an expert panel

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Progress to Date (cont)

3. Each participating grantee determined which HIT/HIE functionalities they were implementing and prioritized their studies of interest

4. Mapped against HITEC framework

5. Now engaged in planning 7 studies

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Challenges

1. Varied HIT implementations for varied purposes2. Varied perspectives on what is important to

evaluate3. Variable timing of implementations4. Community based studies, network effects5. Confounders6. Rapid time-frame for studies7. Data source challenges

a. Availabilityb. Uniformityc. Metric definitiond. Importance of numerators and denominators

8. Financial constraints for data collection