Health Information Technology

Transcription

1 Health Information Technology Moderator: Dr. Salvatore Volpe Staten Island Performing Provider System Panelists: Cindy Sutliff Director of Policy, NYeC Jason Thaw Senior Director, Member Services, Healthix Matthew Gannon Strategy Manager, NYC REACH Boris Molchanskiy MSN, FNP, CCRN Richmond University Medical Center

2 Primary Care Symposium Staten Island Cindy Sutliff Director of Policy December 2, 2017

3 What is the New York ehealth Collaborative? NYeC is a public private partnership established a decade ago The NYS Department of Health has made NYeC the State Designated Entity charged with leading and coordinating health information exchange (HIE) across the New York Beginning in April 2018, NYeC will contract directly with QEs for SHIN-NY services using a new performance based contracting methodology Vision A dramatically transformed healthcare system where health information exchange is universally used as a tool to make lives better Mission Improve healthcare by collaboratively leading, connecting and integrating health information exchange across the State 3

4 What is the SHIN-NY? The SHIN-NY is the Statewide health Information Network for NY SHIN-NY is a network of networks and includes 8 local HIEs + NYeC to provide statewide sharing of clinical information (with appropriate consent) QEs provide free core services, using government funding QEs offer different value-added services (for a charge) Statewide Patient Record Lookup Fully Implemented 4

5 SHIN-NY Enables and Supports Value-Based Care Leads to Better Care and Lower Costs Use of the SHIN-NY to access patient information is associated with: 57% reduction in patient readmissions within 30-days after hospital discharge 30% fewer emergency department admissions 52% reduction in laboratory tests and a 36% reduction in the estimated number of radiology exams 25% fewer repeat images within 90-days of first imaging procedure Improve patient Improve outcomes patient outcomes Reduce healthcare costs Increase accuracy and Less speed time testing of diagnosis & more on patient care Less time testing & more on patient care 5

6 2020 Roadmap -- Five Basic Strategies 1 Ensuring Strong HIE Foundation 2 Supporting Value-Based Care (Tools, Supports, and Services) 3 Enabling Interoperability and Innovations 4 Promoting SHIN-NY Efficiency and Affordability 5 Advocating Collectively Approved by NYeC s Board and NYS DOH 6

7 Strategy 1: Ensuring Strong HIE Foundation Connections, contribution, completeness and data quality Customer satisfaction and reliability Security

8 Strategy 2: Supporting Value Based Care Up to 3 enhanced functionality Up to 3 additional data & services Policy changes

9 Value-Based Care Potential Projects Medication fills Quality measurement reporting Standardized data formats Medical claims (via APD) emolst EDRS Registries Housing/hunger/other SDOH indicators Single sign-on for Health Commerce System (I-STOP, others) Smarter, actionable alerts MACRA/MIPS compliance Care plan exchange Additional EHR integration Patient-centered data home Others No written consent for alerts when treating relationship Incorporation of SHIN-NY consent with other forms Exploration of opt-out Data governance Others 9

10 Improve Provider Experience: Quadruple Aim Value-Based Care Support Examples Claims Quality Reporting Social Determinants of Health Enhanced Functionality I- STOP/PDM P Smarter Alerts Policy Compliance DSRIP MACRA/MIPS APC 10

11 Strategy 3 & 4: Enabling Interoperability and Innovations & Promoting Efficiency and Affordability Using performance-based contracting to promote market-based solutions: Interoperability and Innovations Patient engagement tools Value-based care tools / services HL7 FHIR pilot / discrete data Blockchain Artificial intelligence Machine learning Natural language processing Others Core Infrastructure Payments to Encourage Group purchasing QE specialization Standardization Shared services Potential QE mergers Policy Changes New wire once / pay once policy 11

12 Strategy 5: Advocating Collectively Working together using all available resources: Value, Funding and Policy Academic studies Consistent messaging Consumer education New advisory groups Strong advocacy with Executive and Legislature Funding levels Proposed statutory changes Support for provider assistance programs Others EHR Vendors Adherence to CCD/C-CDA Lack of certified EHRs Prioritization of QE participants Responsiveness to development of gateways Inconsistent pricing and charging for HIE connections Interoperability and Standards Participate and influence federal discussions Collaborate with other states and regional HIEs Promote standards statewide 12

13 SHIN-NY Future We want to support your work This is a collaborative effort Quadruple Aim is our goal 13

14 40 Worth Street, 5 th Floor New York, New York South Swan Street, 29 th Floor Albany, New York 12210

15 Staten Island PPS Partner Conference December 2, 2017 Jason Thaw

16 16 About Healthix Statistics SHIN-NY Role of Healthix Sources & Types of Data Uses Cases Healthix Services Consent

17 Largest Public HIE in the Nation More than 16,000,000 patients Healthix contains data from healthcare organizations throughout New York City and Long Island. Healthix uses sophisticated software to reconcile data of over 58 million provider Medical Record Numbers (MRNs) to create composite profiles of over 16 million patients. 17

18 About Us Healthix is the largest public Health Healthix Information Monthly Exchange Statistics (HIE) in the United States (October 2017) Hundreds of healthcare organizations at more than 4,400 sites across New York City and Long Island participate in Healthix. Supplies secure data to improve 51 Million healthcare inbound clinical quality, efficiency messages and effectiveness Provides 904,646 Real-time a range of clinical alerts information 48,125 Patient Summary in Documents real-time Shared (CCDs) Facilitates care coordination 18

19 Healthix and the SHIN-NY The SHIN-NY is composed of 8 HIEs or Qualified Entities (QEs). The NYS DOH establishes common services, privacy and security policies, and technical standards for interoperability. When a user queries for patient data, Healthix automatically returns data from both Healthix and the SHIN-NY. 19

20 Role of Healthix in Exchanging Information SHIN-NY PRIVATE HIEs PRIVATE HIEs INCLUDE: Health Plans Large Provider Systems PPS Pharmacies More ehealth exchange and SHIEC HEALTHIX 550 Participants ~ 4,400 Sites 20

21 Sources of Data The breadth of data in Healthix is expanding in the number and type of contributors Hospitals Independent Physician Practices of All sizes Long-term Care, Nursing Facilities Behavioral Health Facilities Federally Qualified Health Centers (FQHCs) Community Based Organizations Home Care EMS In development Health Plans PPS Leads Medicaid Health Homes Independent Pharmacies Independent Labs & Radiology Centers NYC Correctional Health Services All Other Public HIEs in New York State Medicaid Claims Veterans Administration 21

22 Types of Data 22 Demographics (Name, Gender, DOB, Race, Ethnicity, Language) Allergies Medications Medication Allergies Smoking Status Immunizations Encounters Observations Vital Signs (Hgt, Wgt, BP, BMI) Problem Lists Pharmacy Fill Data Lab Tests, Values / Results Radiology Reports Radiology Images Other Diagnostic Results Diagnoses Procedures Functional / Cognitive Status EMS Run Sheets Discharge Instructions / Clinical Summaries Advanced Directives emolst In development Care Plans/ Team Members Medicaid Claims Data Social Determinants of Health

23 uses of Healthix data to facilitate treatment & care management Accessing Patient Data in an Emergency Situation Managing Patients with Serious Medical Conditions using Clinical Event Notifications Providing Transition of Care Documents for Physicians Supporting Secure Direct Messaging Between Providers Providing Alerts for Frequent Users of ED (3+ visits in 30 days) Reduce Lab and Radiology Testing Connecting PPS Leads and Partners IN DEVELOPMENT Delivering Alerts from Health Plans to Providers re: Gaps in Care 23

24 Healthix core services Patient Record Search: Access to a more comprehensive patient profile Statewide Delivery of Clinical Summaries: Ability to push clinical summaries (CCD, C-CDA) and lab results Clinical Event Notifications (CENs): 24/7 Custom alerts provide real-time updates for patients in care Direct Messaging: Secure HIPAA-compliant messaging Predictive Analytics: Assessing risk and managing patients to optimize care 24

25 Contact Us If you have questions, would like to see a demonstration or are interested in connecting with Healthix Jason S. Thaw Senior Director, Member Services jthaw@healthix.org 25

26 Primary Care Practices, HIT, and Value Based Care Matt Gannon, Strategy Manager

27 Health IT Drives Success Value-Based Payment Quality Improvement EHR Adoption Quality of Data = Quality of Care Meaningful Use Quality Payment Program Patient-Centered Medical Home Advanced Primary Care Regional Health Information Organization Encounter- Based Patient-Based Population- Based 2 7

28 Primary Care Information Project / NYC REACH HISTORY: PCIP was founded in 2005 as a bureau of the NYC DOHMH NYC REACH created in 2010 MISSION: Support and promote primary care for all New Yorkers Improve quality of care in medically underserved areas through health information technology Promote new models of care focusing on prevention and public health priorities Develop new tools in population health management Prepare providers for healthcare reform SUCCESSES: Over 21,000 providers have joined NYC REACH, including over 1,400 small practices 2 Over 6,000 providers transmit data 8

29 Transition to Value-Based Payment We are well into a large-scale transition to value-based payment 2 9

30 What is Value-Based Payment? Value-Based Payment is any arrangement where payment is tied to value and cost of care. $ Quality Patient Satisfaction Total Cost of Care 3 0

31 Key Drivers for VBP Success Care of the patient requires care of the provider. Quality Patient Satisfaction Provider Satisfaction Total Cost of Care Source: Bodenhimer, T, Sinsky C. Ann Fam Medi. 2014; 12(6):

32 VBP Transition Will Not Be Easy Financial: How providers manage their patient panel will need to change: New concept: Attributed Patients vs. Patient Panel Attributed primary care patients drive revenue potential. Most costly patients with preventable ED and inpatient activities are a big potential source of new revenue Other revenue opportunities: Get paid more for prevention, care coordination and care management activities People: Providers compensation incentives provider contracts may incentive volume vs. value Rely more on team based approach. Delegate more activities to support staff. Use staff at top of license Potential new roles: outreach, care coordinator, care manager 3 2

33 VBP Transition Will Not Be Easy Process: It s not enough to keep patients healthy, take care of acute issues, and manage the chronically ill. Providers must also consider risk, quality, utilization, and cost Provider success will depend on activities like outreach, transitions of care, maximizing patient attribution, accuracy and consistency of risk coding, and new billing opportunities Technology: Understand your data: Go beyond clinical data. Risk, cost, utilization data just as important Need to know where your patients are getting care outside your organization 3 3

34 Practice Transformation Supports VBP Readiness Preparing for VBP requires implementing systematic change to primary care practice. How do I ensure my patients are following up on specialty referrals? What quality metrics will I be evaluated on, and how can I be aware of my performance throughout the year? Does my supply of appointments meet my demand? Are my patients sufficiently engaged? Source: Bodenhimer, T, Sinsky C. Ann Fam Medi. 2014; 12(6):

35 Practice Transformation Programs Primary Care Providers are not alone through this transition. NCQA Patient-Centered Medical Home (PCMH) NYS Advanced Primary Care Goal Technical Assistance Set practices up with the medical home framework; supports VBP Cost involved, fee covered by DSRIP in Prepare practices with many processes and enhancements needed for VBP Two years of fully funded assistance, paid by NYS Financial Support Areas of Focus $7.50pmpm Care Management fee for all Medicaid and Managed Medicaid patients Access, Team-Based Care, Population Management, Care Management, Care Coordination, Quality Multi-payer Patient-Centered Care, Care Management, Access, HIT/Quality, payers/contracting 3 5

36 Health IT and Practice Transformation Optimized Health IT is key to make PCPs lives easier throughout this transition Evidence-based care: alerts that display to your staff during pre-visit planning Patient outreach: lists of which patients need which services Patient engagement: messaging through the portal (yes, even older patients!) Population management: quickly identify who is highest risk Access: determine times of highest supply and demand Care Coordination: see which specialists are not returning consult notes Quality: know exactly what your metrics are 3 6

37 Unlocking Potential with RHIO Connections RHIOs are an important resource for VBP success. Closing the referral loop has been a priority topic in 2017 and the RHIO incentive program supports activity alignment. Through each program, practice facilitators encourage the connection and use of a community RHIO. Data Exchange Incentive Program: money available for eligible practices interested in connecting (must have 30% Medicaid patient encounter threshold) 3 7

38 Next Steps Continue meeting Meaningful Use measures for Medicaid MU, MIPS, or both Evaluate gaps in your current HIT functionality Maintain your Patient-Centered Medical Home processes, if you are already recognized Enroll in the NYS Advanced Primary Care program 3 8

39 Visit Our Website! Learn more about us Learn how NYC REACH can meet the needs of your practice, Read Success Stories Read about how NYC REACH has helped providers throughout NYC succeed. Explore our library NYC REACH is constantly developing new resources on multiple QI initiatives for our members. Become a member NYC REACH membership is free and available to all providers in New York City, 3 9

40 Thank You!

41 Practice Unite/Uniphy Health At Richmond University Medical Center By Boris Molchanskiy MSN FNP CCRN

42 Disclosure None 4 2

43 Agenda Practice Unite/Uniphy Introduction System integration and Expanded Functionality Quality Health Outcomes Patient Experience New Initiatives References 4 3

44 Practice Unite/Uniphy Health Introduction What is it? Who has access to it? Is it hard to use? Can I use it anywhere? Is it HIPPA compliant? What kind of information can I share? How secure is it?

45 System integration and Expanded Functionality Consult delivery CPOE (Computerized Physician order entry) Critical lab delivery Radiology report delivery Pathology report delivery VOIP (Voice Over Internet Protocol) communication to hospital phones Pager integration and/or replacement Preventable readmission initiatives Bed turnover management Patient satisfaction management 4 5

46 Quality Jersey City Medical Center (JCMC) 2013 Research Study Reduction inpatient care delay by 1.25 hours/physician/day Reduced referral leakage by 1 patient/month/physician 10% of patients discharged at least (1) day earlier/physician 20% reduction in ED patient waiting times leading up to discharge/admission Reduced hospital referral leakage by 2 cases/month/physician Specialist response time to consult request in 50% of all patients was reduced from 1-2 days (24-48 hrs) to 30 min 25% of patients length of stay reduced by one (1)day 25% of patients transferred out of CCU at least 1 day earlier 4 6

47 Health Outcomes Direct Access to CPOE Ability to Send PHI Consulting physician can send notes directly to CPOE Increase in co-management of patients between primary physician and hospital physicians 4 7

48 Patient Experience Improved communication between primary care physician and ED Physician Shorter length of stay in ED/hospital Transfer/Hand off improvement from ED to the Medical/Surgical Unit Improve Hand off from Critical Care to the Med/Surgical Unit JCMC

49 New Initiatives Unite PPS/RUMC and Primary Care Providers (PCP) Notify PCP when patient is discharged and schedule an appointment Send Patient s discharge summary directly to PCP s CPOE 4 9

50 References 5 0

51