Transcript Care Coordination and Information Exchange

Care Coordination and
Information Exchange
Integration of Health Information Exchange with
Primary Care Provider Work Flow
Agenda
 NYCLIX
Background
 Migration
from Application to Integration
 Integration
 Subscribe
 Future
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with Primary Care Workflow
and Notify Pilot
State and Initiatives
IFH Meaningful Use - HIT Conference
9/30/2010
Status of NYCLIX today
Health Information Exchange (HIE) in the NYC area.
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Data aggregated from all sites and displayed in a Clinical Portal
Aggregating patient data since November 2008
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Now have data on over 3.2 million patients
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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
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Approximately 250,000 patients have given consent.
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Initially, the consent process was implemented in the Emergency Departments.
Original Use-Case was for Emergency Room Physicians.
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ER physicians started accessing data from NYCLIX in late 2009.
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Recently added internal medicine and HIV clinics at some facilities
IFH Meaningful Use - HIT Conference
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NYCLIX participants
Hospitals – outside Manhattan
 Kings County Hospital
 Staten Island University Hospital
 SUNY Downstate
Hospitals -- Manhattan
 Beth Israel
 Mount Sinai
 NewYork-Presbyterian
 New York University MC
 St. Luke’s-Roosevelt
 St. Vincent’s
Ambulatory
 Institute for Family Health
 ColumbiaDoctors
Home care
 Visiting Nurse Service of New York
Allied participants
 New York Business Group on Health
 Pfizer, Inc.
 IPRO
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Health plans
 SelectHealth
Nursing homes
 Village Care
 Hebrew Home for the Aged
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Statistics (as of May 2010)
Patient Overlap in the ED
Patients at Multiple Sites
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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”
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“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”
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“…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”
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“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.”
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Clinical Portal Summary Screen Sample
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Migration from Application to Integration
Use of Clinical Portal is difficult in most workflows
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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.
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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.
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Four Use-Cases for RHIO Integration
Push data to systems
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Notify Emergency
Department Systems of
data that is available
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3.
Notify Primary Care EMR
that new data exists from
another site
Pull Data on Demand
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Request a Continuity of
Care Document (CCD)
from RHIO.
Patient Transfer and Referral
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Acute – Sub-Acute Transfers
(Hospital to/from Nursing
Home or Home Health)
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Referral to Specialist
Centralize Data for Patient
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Primary Care Physician and
Care Team Registry
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Subscribe & Notify Initiative
Integration of RHIO Data with Primary Care Workflow
Phases of Implementation
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Phase 1 –
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Coordination of Care for the Patient
Centered Medical Home, e.g. reduce
re-admission rate, monitor important
lab results, monitor patients with
chronic disease
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Method for Primary Care Physician to
be pro-active in Patient Care
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Hospital benefits from Primary Care
Physician’s involvement
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Interaction directly with PCP’s system
for Electronic Medical Record.
Facility and/or Provider to control
subscriptions
Phase 3
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Simple subscription and notification
All patients of a Primary Care
Physician
Notification of Emergency and
Inpatient Admits
Phase 2
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Benefits
Incorporate other event
notifications (Abnormal Lab
Results, etc)
Exchange of CCD
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Use Case Overview
Subscribe & Notify
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Physician “subscribes” to a patient – requests notification of selected
clinical events, e.g. hospital admission
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A subscribed-to patient is brought to the emergency room of a
participating hospital
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NYCLIX matches the hospital admission to a subscription
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A message is sent to the physician’s EMR and is routed to his/her inbox
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The physician reviews the clinical information from the hospital admission
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Through the NYCLIX portal
Through a Continuity of Care Document (CCD) send to the EMR
By contacting the hospital/attending physician
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Primary care physician is notified when selected
events occur in patient care
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Physician “subscribes” to selected events (e.g. ED admission)
for some or all patients
Subscribed event occurs at one of the NYCLIX sites
NYCLIX “listener” detects that a subscribed event has occurred
Notification is sent to the subscribing physician via their EHR inbox
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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.
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Future State and Initiatives
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CCD exchange between RHIO and EHR
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Subscription Management for Notification Events
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Provider Directory and management of eReferrals
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State and national level exchange of patient information
(RHIO to RHIO)
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Integration with Personal Health Record (PHR)
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