Care Coordination and Care Coordination and Information ExchangeInformation Exchange

Integration of Health Information Exchange with Primary Care Provider Work Flow

Agenda

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NYCLIX Background

Migration from Application to Integration

Integration with Primary Care Workflow

Subscribe and Notify Pilot

Future State and Initiatives

Status of NYCLIX today

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Health Information Exchange (HIE) in the NYC area. Data aggregated from all sites and displayed in a Clinical Portal

Aggregating patient data since November 2008 Now have data on over 3.2 million patients

Over 280,000 of patients have data from more than one NYCLIX site

Each Facility obtains patient consent at the point of registration or when accessing data Approximately 250,000 patients have given consent.

Initially, the consent process was implemented in the Emergency Departments.

Original Use-Case was for Emergency Room Physicians. ER physicians started accessing data from NYCLIX in late 2009.

Recently added internal medicine and HIV clinics at some facilities

NYCLIX participants

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Hospitals -- Manhattan Beth Israel Mount Sinai NewYork-Presbyterian New York University MC St. Luke’s-Roosevelt St. Vincent’s

Home care Visiting Nurse Service of New

York

Allied participants New York Business Group on

Health Pfizer, Inc. IPRO

Hospitals – outside Manhattan Kings County Hospital Staten Island University

Hospital SUNY Downstate

Ambulatory Institute for Family Health ColumbiaDoctors

Health plans SelectHealth

Nursing homes Village Care Hebrew Home for the Aged

Statistics (as of May 2010)

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Patient Overlap in the ED

Patients at Multiple Sites

User Testimonials

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“… had a patient who had an ultrasound at SLR one week ago to r/o DVT, and I was able to pull it up in NYCLIX and document it in our EHR”

“I heard from one of the senior residents that they looked up a cardiology study from NYU on another pt last week that allowed them to discharge her, when they otherwise would have certainly admitted her”

“…another pt who we were going to admit until we saw that the lab work from 5 days ago at SLR was actually now improved”

“I saw a patient who said she had a recent stress test at NYU that was “abnormal”. I was able to locate the test which was negative. I was able to discharge the patient instead of either admitting or redoing her stress test.”

Clinical Portal Summary Screen Sample

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Migration from Application to Integration

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Use of Clinical Portal is difficult in most workflows Requires separate Login to another application Additional search by MRN or Name and DOB Only10-20% of patients have data elsewhere Many patients have not given consent

NYCLIX data is only valuable if there is data from other sites. Most sites with an EMR system don’t need NYCLIX for

their own data. Their systems already have the necessary clinical information.

Users would like to see information from the RHIO in their own system.

Four Use-Cases for RHIO Integration

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1. Push data to systems Notify Emergency

Department Systems of data that is available

Notify Primary Care EMR that new data exists from another site

2. Pull Data on Demand Request a Continuity of

Care Document (CCD) from RHIO.

3. Patient Transfer and Referral

Acute – Sub-Acute Transfers (Hospital to/from Nursing Home or Home Health)

Referral to Specialist

4. Centralize Data for Patient Primary Care Physician

and Care Team Registry

Subscribe & Notify InitiativeIntegration of RHIO Data with Primary Care Workflow

Phases of Implementation Benefits

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Phase 1 – Simple subscription and

notification All patients of a Primary

Care Physician Notification of Emergency

and Inpatient Admits Phase 2

Facility and/or Provider to control subscriptions

Phase 3 Incorporate other event

notifications (Abnormal Lab Results, etc)

Exchange of CCD

Coordination of Care for the Patient Centered Medical Home, e.g. reduce re-admission rate, monitor important lab results, monitor patients with chronic disease

Method for Primary Care Physician to be pro-active in Patient Care

Hospital benefits from Primary Care Physician’s involvement

Interaction directly with PCP’s system for Electronic Medical Record.

Subscribe & Notify

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Physician “subscribes” to a patient – requests notification of selected clinical events, e.g. hospital admission

A subscribed-to patient is brought to the emergency room of a participating hospital

NYCLIX matches the hospital admission to a subscription

A message is sent to the physician’s EMR and is routed to his/her inbox

The physician reviews the clinical information from the hospital admission

Through the NYCLIX portal Through a Continuity of Care Document (CCD) send to the

EMR By contacting the hospital/attending physician

Use Case Overview

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Primary care physician is notified when selected events occur in patient care

3. NYCLIX “listener” detects that a subscribed event has occurred4. Notification is sent to the subscribing physician via their EHR inbox

1. Physician “subscribes” to selected events (e.g. ED admission) for some or all patients

2. Subscribed event occurs at one of the NYCLIX sites

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Notification in EHR InBox

ZZTEST, MICHELLE with IFH MRN 1235830 was admitted to STLH

Emergency Room at 10:52 on 2010-04-05 with MRN 2000000458685.

Click Here to use the NYCLIX Clinical Portal for further

information. 9/30/201013 IFH Meaningful Use - HIT Conference

Future State and Initiatives

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CCD exchange between RHIO and EHR

Subscription Management for Notification Events

Provider Directory and management of eReferrals

State and national level exchange of patient information (RHIO to RHIO)

Integration with Personal Health Record (PHR)