Care Coordination and Information Exchange

1. Care Coordination and Information Exchange Integration of Health Information Exchange with Primary Care Provider Work Flow

2. Agenda • NYCLIX Background • Migration from Application to Integration • Integration with Primary Care Workflow • Subscribe and Notify Pilot • Future State and Initiatives IFH Meaningful Use - HIT Conference

3. Status of NYCLIX today • 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 IFH Meaningful Use - HIT Conference

4. NYCLIX participants 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 IFH Meaningful Use - HIT Conference

5. Statistics (as of May 2010) Patient Overlap in the ED Patients at Multiple Sites IFH Meaningful Use - HIT Conference

6. User Testimonials • “… 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.” IFH Meaningful Use - HIT Conference

7. Clinical Portal Summary Screen Sample IFH Meaningful Use - HIT Conference

8. Migration from Application to Integration • 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. IFH Meaningful Use - HIT Conference

9. Four Use-Cases for RHIO Integration • Push data to systems • Notify Emergency Department Systems of data that is available • Notify Primary Care EMR that new data exists from another site • Pull Data on Demand • Request a Continuity of Care Document (CCD) from RHIO. • Patient Transfer and Referral • Acute – Sub-Acute Transfers (Hospital to/from Nursing Home or Home Health) • Referral to Specialist • Centralize Data for Patient • Primary Care Physician and Care Team Registry IFH Meaningful Use - HIT Conference

10. Subscribe & Notify InitiativeIntegration of RHIO Data with Primary Care Workflow Phases of Implementation Benefits • 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. IFH Meaningful Use - HIT Conference

11. Use Case Overview Subscribe & Notify • 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 IFH Meaningful Use - HIT Conference

12. Primary care physician is notified when selected events occur in patient care 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 IFH Meaningful Use - HIT Conference

13. 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 Hereto use the NYCLIX Clinical Portal for further information. IFH Meaningful Use - HIT Conference

14. Future State and Initiatives • 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) IFH Meaningful Use - HIT Conference