institute of medicine: linking ehrs to public health departments
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Institute of Medicine: Linking EHRs to Public Health Departments. Michael Buck, PhD Director of Biomedical Informatics [email protected] April 8, 2014. Actionable Information in NYC : Primary Care Information Project (PCIP). Mission - PowerPoint PPT PresentationTRANSCRIPT
Institute of Medicine:Linking EHRs to
Public Health DepartmentsMichael Buck, PhD
Director of Biomedical [email protected]
April 8, 2014
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Actionable Information in NYC:Primary Care Information Project (PCIP)
Mission• Improve quality of care in medically
underserved areas through health information technology
• “Clinical Action Arm” bureau of the NYC Department of Health and Mental Hygiene
• Promote new models of care focusing on prevention and public health priorities
• Develop new tools in population health management
• Transition providers from paper charts to an EHRSuccess• Over 12,000 providers joined PCIP and the
Regional Extension Center (NYC REACH), including more than:• 1095 independent practices • 63 community health centers• 54 hospitals & outpatient clinics• Millions of patients
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Data• We receive eClinicalWorks EHR data on 3000 providers, caring for ~1.8 M
patients per year, ~350,000 encounters per month, data on 5M+ patients since 2009
• Using Medicaid claims data – to analyze and create dashboards to reach non-eClinicalWorks providers
• Commercial claims dataInformation• We turn raw data into usable, targeted, actionable information and use it to
drive public health focused interventionsAction • Dashboards: over 20,000 sent last year• On-site QI: over 4,000 site visits last year• PCMH: PCIP sites are 439 out of 1051 total sites in NYS
(42%)• Pay for Quality Programs: Health eHearts, Health eQuits• Community Engagement activities
Data -> Information -> Action
Infrastructure to Retrieve EHR Data:The Hub Population Health Network
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“The Hub” allows secure exchange of aggregate data with PCIP practices on the eClinicalWorks EHR Send out queries Receive patient counts
overnight The Hub currently covers:
• 700+ practices• ~1.8 M patients per year• 5 M+ patients since 2009
Buck MD, Anane S, Taverna J, Amirfar S, Stubbs-Dame R, Singer J. The Hub Population Health System: Distributed Ad Hoc Queries and Alerts. J Am Med Inform Assoc. Published Online First: 9 November 2011. doi:10.1136/amiajnl-2011-000322.
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>100
80,000 60,000 40,000 20,000 0 20,000 40,000 60,000 80,000
Hub 2012 Population Pyramid
MaleFemale
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Patient Care-seeking Behaviorby Borough
Ambulatory ILI Syndromic Surveillance during 2009 H1N1
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% o
f Inf
luen
za-L
ike-
Illne
ss V
isits
Feedback to Providers
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Proposal: Develop and validate best practices for using data from EHRs for population health surveillance. In partnership with CUNY School of Public Health, the NYC Health Department will create EHR-based estimates and compare them to a “gold standard” 2013 local HANES survey. We will select high performing measures as the basis of the NYC Macroscope EHR surveillance system.
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The NYC Macroscope Project
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Gold Standard:NYC HANES 2013
• Partnership with CUNY SPH• Representative sample of 1,500 randomly selected
New Yorker adults— Household-based sampling— Citywide estimation
• Detailed health interviews (CAPI, ACASI)• Brief physical exam• Biological specimen collection (blood, urine)• Mental health screening
2002 2003 2004 2005 2006 2007 2008 2009 20100
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Obesity Among NYC Adults as Measured by the Com-munity Health Survey, NYC HANES and the PCIP Hub
% Obese(BMI ≥ 30)
Year
First NYC HANES
PCIP Hub
Community Health Sur-vey
Adults ages 20 and over. Data are age-adjusted to the U.S. standard 2000 population. For more information about the CHS or the 2004 NYC HANES, please see www.nyc.gov/health/epiquery
EHR Limitations: Bias and Measurement Error
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National ONC Standard:Query Health
• Completed federal initiative to build distributed query capabilities across healthcare IT vendors.
• http://wiki.siframework.org/Query+Health• New York City/State Depts. of Health
completed one of the first pilots of this new national standard across HIE and EHR data sources.
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CCDA-basedData Model
Develop modular, testable portfolio of Query Health standards and specifications that can adopted by the industry, and support key HITECH and govt. priorities
Standardize Privacy and
Security
Reference Implementation
Services
Vocabularies: SNOMED-CT, LOINC,
RxNorm
i2b2
The ResultsNew QRDA 2 & 3
PopMedNet
Query Health Standards and Reference Implementation Stack
Reference Implementation
Stack
The QuestionNew HQMF
Query Envelope Privacy Policy Enablement
hQueryStandardize Services
Standardize Meaning
Standardize Structure
Sharing Value Sets
Klann JG, Buck MD, Brown J, Hadley M, Elmore R, Weber GM, Murphy SN. Query Health: standards-based, cross-platform population health surveillance. J Am Med Inform Assoc. Published Online First: 4 April 2014. doi:10.1136/amiajnl-2014-002707
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NYS DOH
NYC PCIP
Information Requestors Data Sources
Hospital
Practice
Sends Query to HIE
New York Population Health RegistryStage 2 Meaningful Use Proposal
Statewide HIECCDA
Repository(SHIN-NY)
Other
Returns Aggregate Results
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Literature1. Klann JG, Buck MD, Brown J, Hadley M, Elmore R, Weber GM, Murphy SN. Query Health: standards-based, cross-
platform population health surveillance. J Am Med Inform Assoc. Published Online First: 4 April 2014. doi:10.1136/amiajnl-2014-002707
2. Kaye K1, Singer J, Newton-Dame R, Shih SC. Health information technology and the primary care information project. Am J Public Health. 2014 Mar;104(3):e8-9. [Epub 2014 Jan 16].
3. Wang JJ, Sebek KM, McCullough CM, Amirfar SJ, Parsons AS, Singer J, Shih SC. Sustained improvement in clinical preventive service delivery among independent primary care practices after implementing electronic health record systems. Prev Chronic Dis. 2013 Aug 1;10:E130.
4. Andrew M. Ryan, Tara F. Bishop, Sarah Shih and Lawrence P. Casalino. Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records. Health Affairs, 32, no.1 (2013):53-62
5. DeLeon SF, Pauls L, Shih SC, Cannell T, Wang JJ. Early Assessment of Health Care Utilization Among a Workforce Population With Access to Primary Care Practices With Electronic Health Records. J Ambul Care Manage. 2013 Jul-Sep;36(3):260-8.
6. Begum R, Smith Ryan M, Winther CH, Wang JJ, Bardach NS, Parsons AH, Shih SC, Dudley RA. Small Practices’ Experience with EHR, Quality Measurement, and Incentives. Am J Manag Care 2013;19(11 Spec No. 10):eSP12-eSP18.
7. Bardach NS, Wang JJ, DeLeon SF, Shih SC, Boscardin WF, Goldman LE, Dudley RA. Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: A randomized trial. JAMA. 2013;310(10):1051-1059.
8. Ancker JS; Singh MP; Thomas R; Edwards A; Snyder A; Kashyap A; Kaushal R. Predictors of success for electronic health record implementation in small physician practices. Appl Clin Inform. 2013 Jan 16;4(1):12-24.
9. Ryan AM, Bishop T,Shih S, Casalino LP. Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records. Health Aff (Millwood). 2013 Jan;32(1):53-62.
10. Buck MD, Anane S, Taverna J, Amirfar S, Stubbs-Dame R, Singer J. The Hub Population Health System: Distributed Ad Hoc Queries and Alerts. J Am Med Inform Assoc. Published Online First: 9 November 2011. doi:10.1136/amiajnl-2011-000322.
11. Plagianos MG, Wu WY, McCullough C, Paladini M, Lurio J, Buck MD. Syndromic surveillance during pandemic (H1N1) 2009 outbreak, New York, New York, USA. Emerg Infect Dis 2011; 17:1724-6. http://wwwnc.cdc.gov/eid/article/17/9/pdfs/10-1357.pdf. Accessed October 5, 2011.