NYS Health IT Strategy: Policy and Infrastructure Support for Health Care Transformation

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

2. 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

3. 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

4. Framework for New York Health IT Strategy “Cross-Sectional” Interoperability APPLY Clinician/EHR Consumer/PHR Community Clinical Informatics Services Aggregation Measurement Reporting AGGREGATE & ANALYZE • ACCESS Statewide Health Information Network – NY (SHIN-NY)

5. Governance and Organizational Components: Policy Development and Implementation Framework HITEC Create evaluation tools Assess sustainability Measure progress NYS Dept of Health Fund health IT Set Policies “big P” Enforce regulations NYeC Statewide collaborative process Deliberate & decide policies Assist RHIOs/CHITAs $ $ Funding and contractual obligations Evaluation tools, other resources Implementation guides, tools, other resources State Statewide Health Information Network for NY (SHIN-NY) RHIO RHIO RHIO RHIO RHIO Region CHITA CHITA CHITA CHITA CHITA Local CHITA: A collaboration supporting EHR adoption.; emphasis on primary care and Medicaid providers RHIO: A governance entity that oversees HIE in its region 5

6. Consent Policy Components 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 6

7. 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

8. 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

9. Health and Mental Health:Challenges and OpportunitiesSlides 9-10 courtesy of Michael Hogan, NYS Commissioner of Mental Health • 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

10. 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

11. 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

12. 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

14. HEAL 17 -Maimonides Medical Center • The project integrates mental health and medical care in Southwest Brooklynto 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

15. 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

16. 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

17. 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

18. CONTACT INFO Rachel Block Deputy Commissioner Office of Health Information Technology Transformation New York State Department of Health Office: 518-474-5423 rxb17@health.state.ny.us