Transcript Slide 1

NYS Health IT Strategy:
Policy and Infrastructure Support
for Health Care Transformation
Rachel Block
Deputy Commissioner, NYS Dept of Health
NYAPRS
April 28, 2011
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Broad Goals for NY’s
Health IT Strategy
• Build health information infrastructure to support state health
reform goals
– Support clinicians and consumers with information at point
of care
– Advance care coordination
– Strengthen public health surveillance and response
– Enhance quality and outcome measures
OVERALL STRATEGY IS ABOUT SYSTEMS CHANGE,
NOT JUST HEALTH IT
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Principles and Functions of
Health Information Network
• Principles
– Network operations and core services are a public good
– Maximize information liquidity
• Functions
– Accountability - Ensure adherence to common policies and standards
(including compliance and enforcement activities)
– Efficiency – Shared costs to develop and maintain networks, easy to
add users and services
– Effectiveness – Develop and maintain capacity to address social and
individual needs
Framework for New York Health IT Strategy
“Cross-Sectional” Interoperability
APPLY
AGGREGATE
&
ANALYZE
ACCESS
Clinician/EHR
Consumer/PHR
Community
Clinical Informatics Services
Aggregation Measurement Reporting
Statewide Health Information Network – NY (SHIN-NY)
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Governance and Organizational Components: Policy Development
and Implementation Framework
Create evaluation tools
Assess sustainability
Measure progress
NYS Dept of Health
$
Fund health IT
Set Policies “big P”
Enforce regulations
Funding and contractual
obligations
Evaluation tools, other
resources
NYeC
$
Statewide collaborative process
Deliberate & decide policies
Assist RHIOs/CHITAs
Implementation guides, tools,
other resources
State
HITEC
RHIO
CHITA
RHIO
RHIO
RHIO
RHIO
CHITA
CHITA
CHITA
CHITA
RHIO: A governance entity that oversees HIE in its region
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CHITA: A collaboration supporting EHR adoption.;
emphasis on primary care and Medicaid providers
Local
Region
Statewide Health Information Network for NY (SHIN-NY)
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Consent Policy Components
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Scope of HIE activities governed
RHIO definition
Uses of information
At what point consent is obtained
Where and by whom consent may be obtained
Provider participation in HIE
Sensitive information
Standardized consent process
Durability and revocability
Consumer engagement
Audit and transparency
RHIO-to-RHIO transfers
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RHIO Consent “Rules of the Road” Adopted
by NYS
• Consent for access to information
• No consent required for uploading or converting data
• Consent obtained at provider organization or
practice level
• Consent for treatment, quality improvement/care
management
• Consent for payment and other uses
• Access to data in a medical emergency or for public
health reporting
Key Elements for Health Care
Transformation
• Focus on patients and populations
• Focus on specific opportunities for improved
quality and safety, lower costs
• Focus on characteristics of practice settings
and delivery system that will promote use of
evidence based standards, coordination of
care across settings
• Focus on enhanced availability and use of
information
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Health and Mental Health:
Challenges and Opportunities
Slides 9-10 courtesy of Michael Hogan, NYS Commissioner of Mental Health
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Basic physical and mental health care should be
available in virtually all settings
– Many adult mental health issues stem from
undiagnosed child behavioral health issues and
trauma; early diagnosis would save lives and money
– People with mental health issues are typically seen in
general medical settings, not specialized mental
health clinics; missed opportunities for diagnosis and
referral
– Many people with mental health diagnoses also have
multiple chronic medical conditions; mental health
providers do not consistently diagnose and refer
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Health and Mental Health (cont’d)
• Episodic, point of service treatment is
ineffective and inefficient for chronic and
mental illnesses
– Co-morbidity for people with mental illnesses and
other chronic medical conditions is high; need
better coordination and integration between
primary and specialized care providers
– Specialty care management for behavioral health
needs is effective
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NYS Commitment to Fund Health IT
• HEAL 1 – ($50 million) – seed funding for regional HIE governance models and
EHR adoption support
• HEAL 5 – ($106 million) – statewide governance and policy model;
interoperability standards for health information exchange and EHRs; clinical
priority use cases integrated at all levels; EHR adoption support
• HEAL 10 + 17 – ($240 million)
– EHR implementation to achieve improved care
coordination through support of the patient
centered medical home (H17 includes focus on
behavioral health and LTC providers)
– Continued operation of governance/policy process and statewide
interoperability
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HEAL 10 and 17
• Continue to advance New York’s health information
infrastructure based on clinical and programmatic priorities and
specific goals for improving quality, affordability and outcomes
• Aligning health information infrastructure as an underpinning to
improved coordination of patient care leveraging new care
delivery and reimbursement models -- the Patient Centered
Medical Home (PCMH)
• Build on health information infrastructure and advance key
health reforms included in the PCMH model to improve care
• Advance health IT as a key component to payment and broad
health care reform
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Care Coordination Zone (CCZ)
Long Term Care
Home Care
Hospitals
Labs, X-ray, etc
Pharmacies
Target Patient
Population with
Chosen Diagnosis
Patient Centered
Medical Home
(PCMH)
Public
Health
and Other
Agencies
Physical Therapy,
Nutrition Services,
etc
Health Plans and
PBMs
Consultant
Physicians
CHITA
Mental Health Services
EHR
Technical
Infrastructure
Services and
Support
Organizational
Relationships
NYeC/RHIOs
SHIN-NY
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HEAL 17 -Maimonides Medical Center
• The project integrates mental health and medical care in Southwest
Brooklyn to the benefit of the target population with diagnoses ranging
from schizophrenia only to all patients with serious and persistent mental
illness ("SMI"), which include individuals with schizophrenia,
schizoaffective disorder, bipolar disorder, and severe chronic depression
• Access will be provided to a secure care coordination plan template
(“CCP”) that offers a presentation layer aggregating relevant patient
diagnostic information and recommended next steps in care, and that
enables providers to add relevant documentation and orders to the plan
throughout the patient’s course of care. Project stakeholders who do not
have interoperable EHRs will be able to view and update select data
elements of the template through a clinical portal.
• Approximately 15,000 persons, diagnosed with schizophrenia,
schizoaffective disorder, bi-polar disorder, and severe depression.
• PCPs: 81
• Psychiatry: 95
• Other Specialists: 190
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HEAL 17 – THINC RHIO
• Each of the six participating NCQA Level 3 PCMHs have deployed a
comprehensive, interoperable EHR system with registry-like features
specifically designed to support the Care Model, manage both individual
and population-based health, and report nationally-recognized quality
outcome data.
• Working collaboratively and through THINC, project participants will
develop an interoperable health information infrastructure that includes
advanced functionality, and development of new uses of the EHR, with
clinician involvement in that development, to create an improved
approach to the delivery of care.
• Target population is 8,550 patients with affective disorders in NY State’s
Hudson Valley.
• Primary Care Providers: 120 PCPs organized in six PCMHs
• Psychiatrists: 36
• Psychologists: 174
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HEAL 17 – NYC REACH
• NYC REACH = NYC Department of Health and Mental Hygiene sponsored
regional extension center
• Under HEAL 17, REACH will be creating a new division of the Extension
Center dedicated exclusively to extending EHRs to mental health
providers. The proposed project will utilize NYC REACH’s existing HIT and
interoperability infrastructure to facilitate health information exchange
between designated mental health providers in the care coordination zone
(CCZ) and existing PCMH-qualified PCIP primary practices.
• The target population for this grant is 285,000 adults with significant
mental illness (specifically schizophrenia and other psychotic disorders
and/or major depression), who are likely to be treated both in the primary
care and mental health.
• Primary Care Providers: 299
• Mental Health Providers: 426
• FQHCs: 4
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Summary: National and State Efforts
Support Care Improvement
• Growing body of research supports focus on capacity of
practices to improve care
• Capacity includes practice structure, multi-disciplinary teams,
patient outreach, AND health IT
• Specific focus and support for care models and payment
incentives that emphasize capacity and outcomes – patient
centered, primary care; chronic care management
• Improving care management and outcomes for high cost, high
utilization populations requires models that will integrate
primary and behavioral health AND requires information
liquidity at the community level
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CONTACT INFO
Rachel Block
Deputy Commissioner
Office of Health Information Technology Transformation
New York State Department of Health
Office: 518-474-5423
[email protected]
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