Health Information

Exchange in NYS

Roy Gomes, RHIT, CHPS

Implementation Project Manager 1
Who is NYeC?

2
 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
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 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

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 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
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 NYeC Key Programs

• Statewide Health Information Network of NY. Connects the local

SHIN-NY exchanges
• Initial capabilities: Patient Record Look-Up and Direct, State HISP

• Support physician adoption of HIT (EHR and HIE)

Regional Extension • Leverages regional experts to deliver services
NYeC • New Programs: Diabetes recognition program, à la carte services,
Center grant opportunities for larger practices and mental health providers,
An active, PCMH support
visible
organization
•In partnership with DOH NYeC develops common policies, procedures, and
across the Statewide Collaborative technical approaches through an open transparent process
HIT market Process •Current Activities: Policy committee currently updating and creating policy
in New York measures the protect personal health information
State.

•Led a coalition of 14 States, 15 EHR vendors, and 16 HIE vendors to

Multi-State Initiative leverage existing standards and develop consistent implementation guides
for interoperability

• Began the NYeC Accelerator Program in conjunction with the Partnership for
SHIN-NY API and New York City Fund to support the development of cutting edge technology
products in care coordination, patient engagement, message alerts, and
Innovation analytics that will leverage the SHIN-NY
What is the SHIN-NY?

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 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.

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 Acronym Soup: RHIO vs. HIE

HIE RHIO
Health Information Exchange Regional Health Information
Organization
Activity or process that moves health- Entity that governs the interoperable
related data exchange of information
Agreed upon set of interoperable Entity that defines and has the
standards, and processes needed to responsibility for establishing and
implement information exchange enforcing information sharing policies
Participants may be geographically or
Participants are geographically defined
non-geographically defined
Mission is to improve quality, safety, and
Purpose is to exchange information efficiency of healthcare for communities
in which it operates
Exchanges clinical and administrative information
Exchanges information among organizations that operate independently of
each other

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 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

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 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

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 The Anatomy of a RHIO
RHIO
Governance: Each RHIO is a non- ADDITIONAL CAPABILITIES
profit company with a community led
Board of Directors. PATIENT RECORD LOOK-UP

Technical: Connect healthcare

providers to the HIE and provide Health Information
members with access to patient Exchange Software
records from across the community.
HIE Patient Provider
Business Operations: RHIOs Software Database Database
provide member services which
include resolution of data integrity EHR data interfaces (custom development)
issues, management of consent and
other statewide policy, project A B C X Y Z
management for connection of new
members, and project management
for the development of new
capabilities.
PRACTICE C PRACTICE Y
HOSPITAL A

FQHC B HOSPITAL X HOSPITAL Z

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 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

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 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
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 Services Simplified – The Three S’s

Search: Patient Record Lookup

Send: Direct Exchange

Subscribe: Notifications
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 Evolution of Search

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

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 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.

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 Search: SHIN-NY v1.0
The Rest of NY
Find Places with records for Patient X

•Step 1: Search Your RHIO for Patient X RHIO A

•Step 2: RHIO responds back that it has
records for Patient X

Step 1 RHIO B
Your RHIO
Step 2

RHIO C
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 Search: SHIN-NY v1.0
The Rest of NY
Retrieve records for Patient X

•Step 1: Request all Patient X documents RHIO A

•Step 2: Your RHIO responds with the
documents it has for Patient X
What about
documents in
other NY RHIOs?
Step 1
RHIO B
Your RHIO
Step 2

Without a coordinated network you will not

be able to retrieve the documents in other
RHIOs unless you search and retrieve from RHIO C
them manually. 19
 Search: SHIN-NY v2.0
The Rest of NY
You’ve already searched, now retrieve records
for Patient X
•Step 1: Request all Patient X documents RHIO A
•Step 2: Your RHIO asks all the other RHIOs for
documents for Patient X
•Step 3: Your RHIO consolidates and responds
with all documents
Step 1
RHIO B
Your RHIO Step 2

Step 3

All RHIOs are connected together.

Your RHIO is state enabled! RHIO C
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 Search: SHIN-NY v2.0
The Rest of NY

Find places with records for Patient X

•Step 1: Search Your RHIO for Patient X RHIO A

•Step 2: Patient X does not exist in Your
RHIO, nothing to return
What about other
RHIOs with records for
Patient X?
Step 1
RHIO B
Your RHIO

Even with an interRHIO network, the first

RHIO you search needs to have a record RHIO C
in order for you to get additional records
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 Search: NYeC Consolidated Platform
Consolidated Platform
Find records for Patient X
•Step 1: Search the platform for Patient X
•Step 2: Patient X exists in the consolidated RHIO A
platform, Patient X is identified as having
records which you can now retrieve

Step 1
RHIO B
Your RHIO
Step 2

Patient search no longer limited to the

RHIO for which you are a member. All “on
ramps” to the SHIN-NY are equalized, RHIO C
record search is universal.
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 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 email. 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 email it can be used in many ways.

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 Core Services of the Service Platform
Subscribe

Notifications: The ability for a healthcare provider or care

coordinator to receive email or mobile text notifications
when their patient is admitted or discharged from a
healthcare facility.

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Subscribe:
aka Push
aka Event Notifications

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 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

ED Admit for
Patient X
Hospital A RHIO Practice 2

Hospital B
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 Triggers and Recipients

Inpatient
Triggers

Admit

Inpatient
ED Admit
Discharge
Recipients

PCPs
Care Coordinators
Hospitals Tracking
Readmits
Caregivers

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 The HIT Ecosystem

PAYMENT REFORM
Providers
CONSUMER
ENGAGEMENT

SYSTEM
TRANSFORMATION

CUSTOMERS & USERS

(NY)
Providers (25-30K orgs) Health
Payers (40 companies) HIT
Patients (18M  24M) Information
Entrepreneurs
Public Health Exchange

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 SHIN-NY 2.0

The platform enables entrepreneurial companies to

develop new uses for HIE data and capabilities
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Platform of Connected Capabilities

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APPENDIX

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Public Health and
Health Information
Exchange

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 Public Health Reporting and Programs

• Required reporting on immunization of children

Immunizations under 19 (State, City)

Newborn Blood Spot • Hospitals required to test and report results

Screening (State)

• Providers and hospitals reporting on

Notifiable Conditions communicable diseases (State, City)

• MU optimal requirements to provide input for

Cancer Registry cancer registry (National)

• Syndromic surveillance of HPI to track

Other outbreaks (National, State) such as H1N1
pandemic alert
 How does this work?

Center for Disease Control

• Gather national data NY State DOH
on infectious diseases • State regulation County organization
ds and
• Manage national enforcement and practitioners
prevention and • Monitor incidence of
surveillance programs • Local service providers
CDs and information source
• Distribute funding and • Investigate outbreaks
other resources
• Intervene/treat
• Collaborate with state populations
and local public health
in outbreak response • Report data to CDC

Successes of the 20th century – Polio,

Smallpox 34
 Local and Centralized Access to Public
Health Information

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

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Questions

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