Interconnectivity in NYS: Community HIEs support statewide health information exchange Jill Eisenstein CEO & President Rochester RHIO Overview The Rochester RHIO (Regional Health Information Organization) is a secure, health information exchange. 1
Overview SHINY NY (Statewide Health Information Network of NY) is a network of networks. 8 Qualified Entities (QEs) by Geographic Region http://www.nyehealth.org/shin ny/qualified entities qes/ SHIN NY: 8 QEs or RHIOs http://www.nyehealth.org/shin ny/qualified entities qes/ 2
Overview We are a nonprofit, community run organization serving 13 counties. Our Mission Our Goal: Better information for better patient care by providing authorized participants access to patient health information. Current Focus: Bring more comprehensive picture of patient to community by increasing data available in HIE. 3
SHIN-NY Data Veterans Administration Long Term Care Hospital Systems Community Based Orgs Urgent Care Physician Practices Payers Public Health & Gov t agencies Clinical Labs Imaging Centers Our Services We provide authorized medical providers, care managers, and appropriate community based organizations with electronic access to: Lab reports Radiology results, images Hospital admission/discharge Clinical reports Discharge summaries Ambulatory care summaries Hospital admission/discharge notification 4
Our Services Our Services 5
Who we are: Proven impact One of the single most important elements of patient care in our community and across the country is access to information. This improves quality by reducing medical errors, creating efficiencies, reducing costs by quelling redundant testing, and creating a common language for a care team to use. Bridgette Wiefling, MD Rochester Regional Health Who we are: Proven impact In the past decade and a half, the scientific evidence base of health information exchange and interoperable health information technology has grown exceedingly. By my count, 16 scientific, peer reviewed journal articles are the product of the Rochester RHIO s willingness to partner with academia for research and evaluation activities. Joshua Ryan Vest PHD, MPH Indiana University and Purdue University 6
Who we are: Proven impact Study shows use of Rochester RHIO cuts costs. for emergency doctors, who often need to make quick treatment decisions based on scant information, the clinical benefits of a RHIO s fast access to patient health histories or imaging studies are incalculable Dustin Riccio M.D., Chairman of Unity Emergency Department. RBJ 2014 Note: Studies were conducted in Rochester with the use of Rochester RHIO s data. Researchers from Weill Cornell Medical College. Three studies have been published by peer reviewed journals and demonstrate significant savings in system efficiency and improved health care quality. Critical Success Factors Community HIEs are succeeding in NYS Regional focus Transparency Data security Funding (federal & state) Supportive regulatory environment Evolving policy and technology 7
SHIN NY Governance The SHIN NY is governed by an open and transparent process that brings together key stakeholders in the State to contribute input and expertise on the development and implementation of SHIN NY policy and technical standards. SHIN NY Governance This process is known as the Statewide Collaboration Process. NYeC, in partnership with the New York State Department Of Health, convenes several Committees that are representative of stakeholders with an interest and investment in health information exchange via the SHIN NY. 8
SHIN NY Data Exchange Current SHIN NY services Query patient data summary statewide data Cross QE Alerts Medicaid claims data Patient Portal Proposed SHIN NY services Single sign on to Department of Health registries (NYSIIS, istop, etc) Access to APD (All Payer Database) Patient Consent More than 1.4 million unique consented patients 9
Patient Consent Today Consent is per HIPAA covered entity Patients provide written consent using approved NYS DOH form and choose: Yes, No, No to all Consent to View vs. Consent to Load Data Patients can revoke consent at any time Consent is durable until changed or revoked Patients can request an audit of who has accessed information Consent forms have been signed by 10.4 million unique patients in New York State Patient Consent Today Other Consent Options Break the Glass RHIO wide denial Minor Consent 10
Patient Consent: CFR 42, Part2 New regulation (as of 3/21/17) did not make the changes needed to allow for including Part 2 data in community HIEs General rule is to ask data sources to filter out Part 2 data Significant issue for each QE. In general, Part 2 data will not be widely available in HIEs until technology allows for the identification and segmentation of Part 2 data. Rochester RHIO and all participants are a QSO, and all Part 2 data requirements are followed, in order to account for assumed commingled Part 2 data. Nationwide, HIEs are struggling with including Part 2 data. Patient Consent Tomorrow Process to update patient consent policy in NYS is unfolding. Investigation of issues and opportunities focused on needs of value based care initiatives. Short Term proposed changes alerts policy and expanded types of consent forms. Long Term proposal Opt out consent will require changes to NYS public health law 38 states are currently opt out 11
Beyond the SHIN NY SHIEC (Strategic Health Information Exchange Collaborative) Sequoia Project ehealth Gateway VA/DOD Social Security Carequality Direct Trust 12