Rainu Kaushal, MD, MPH Associate Professor, Weill Medical College

1. HITEC:Evaluating the Economic Effects of Health Information Exchange Programs across New York State Rainu Kaushal, MD, MPH Associate Professor, Weill Medical College Director of Pediatric Quality and Safety at KCCH/NYPH Executive Director, HITEC

2. Background • Clinical decisions are data driven • Health information technology (HIT) with health information exchange (HIE) has been embraced as one strategy to improve health care quality and reduce costs by improving access to data • Regional clinical data exchanges are occurring, with unknown effects

3. HEAL NY(Healthcare Efficiency and Affordability Law for New Yorkers Capital Grants Program) • $200 million investment • Implementation grants of $50,000 - $10,000,000 per grant (for capital investments) • Supporting multi-stakeholder HIE initiatives • Grantees are required to provide matching funds and dedicate some funds for evaluation • Evaluation efforts are likely to vary in quality and be non-standardized

4. Why Evaluate? • Demonstrate value of HEAL initiative • Demonstrate uptake and usage • Encourage future HIT and HIE adoption • Demonstrate economic benefits • Demonstrate consumer and provider satisfaction • Demonstrate quality and safety benefits • Iteratively refine HIT and HIE • Understand what is working well • Understand what can be improved • Disseminate lessons learned and successes broadly

5. HITEC • Not for profit, multi-institutional academic collaboration • Based at Weill Medical College • With collaboration from Columbia University, SUNY-Albany, University of Rochester and others • Aims to ensure robust evaluations of HEAL NY and other HIE initiatives in NY State • Provides expertise in evaluation methodology, health information technology, health economics, survey methodology and biostatistics • Conducts analyses across active HIE initiatives

6. CMWF Grant: Financial Methods • Specific aim: Determine the ROI for providers of HIT/HIE implementation • Methodology: Will include costs, benefits, and usage measures • Design: Pre-post studies with concurrent controls • Participants: 7 HEAL NY grantees • Diverse in terms of clinical setting, geography, and type of HIT/HIE intervention • Community based interventions • Evaluation team has no control over type or timing of HIT/HIE implementation

7. Progress to Date • Developed a financial framework at the level of HIT/HIE functionalities • 104 functionalities • 5 settings • Each rated on likelihood of successful implementation and use, magnitude of financial benefit, ability to measure benefit • Validated by an expert panel

8. Progress to Date (cont) 3. Each participating grantee determined which HIT/HIE functionalities they were implementing and prioritized their studies of interest 4. Mapped against HITEC framework 5. Now engaged in planning 7 studies

9. Challenges • Varied HIT implementations for varied purposes • Varied perspectives on what is important to evaluate • Variable timing of implementations • Community based studies, network effects • Confounders • Rapid time-frame for studies • Data source challenges • Availability • Uniformity • Metric definition • Importance of numerators and denominators • Financial constraints for data collection