care coordination and information exchange integration of health information exchange with primary...
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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.”
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)
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