With a dense population that swells to twice its size every day of the week, Manhattan is an especially tough proving ground for the health information exchange concept. Yet the New York Clinical Health Information Exchange has succeeded in building a viable provider network that ties major Manhattan hospitals to those in surrounding areas, as well as ambulatory and homecare agencies, a health plan and nursing homes.
Following the historic Hudson River Valley south takes the traveler out of the Catskill Mountains and into the tunnels and streets of Manhattan-and the New York Clinical Information Exchange or NYCLIX. Many people travel this commute daily, which is one of the challenges in building a health information exchange (HIE) in the country's densest urban area.
“Manhattan has some unique qualities,” says Gil Kuperman, M.D., board chair and executive director of the NYCLIX, in a clear understatement. “It has a population of 1.3 million people and the number of daytime commuters who come in from outside is 1.4 million people. The flux in and out of Manhattan is mind-boggling. Having a RHIO [regional health information organization] that covers just Manhattan doesn't begin to cover the needs of the people who may receive some portion of their care here.”
Despite the challenges, NYCLIX, which emerged from conversations that began at the Greater New York Hospital Association in 2004, is beginning to exchange clinical information. NYCLIX is significantly driven by the Health Care Efficiency and Affordability Law of New York State (HEAL NY), from which it received half its total $4.7 million funding in 2005. The goals of NYCLIX's HEAL project are:
Build a technical infrastructure interconnecting the participants;
Implement data exchange in the emergency department (ED) setting;
Support public health activities, such as reporting;
Evaluate the impact on cost, quality, and safety; and
Create an extensibility plan.
Current participants include six hospitals in Manhattan: Bellevue Hospital Center, Beth Israel Medical Center, The Mount Sinai Medical Center, NewYork-Presbyterian Hospital, NYU Langone Medical Center, and St. Luke's-Roosevelt Hospital Center. Hospitals outside Manhattan include Kings County Hospital Center, Staten Island University Hospital, and SUNY Downstate Medical Center. NYCLIX also includes ambulatory and homecare agencies, a health plan, and nursing homes. Allied organizations on the board of directors include the New York Business Group on Health, IPRO, Pfizer Inc., and North Shore-Long Island Jewish Health System.
A NON-TRADITIONAL COMMUNITY
Clearly, with Manhattan as the primary service area, even these big names have their work cut out for them. “We're a geographic region, but we're not exactly a community in the traditional sense,” says Kuperman. People are as likely to travel outside Manhattan for care as seek it in Manhattan. Part of the reason for the fragmented approach is that the HEAL NY program's goal was primarily to fund a variety of initiatives, with less attention given to the way they would all eventually fit together, he says. “So, there's a bit of rework to be done.”
NYCLIX's technical architecture employs a federated database with a central master patient index (MPI) that relies on a statistical algorithm to match the patient's records across the various members. Clinical data is held in “edge servers” to eliminate the need for one big database. “This is the most common infrastructure for an HIE,” notes Kuperman.
NYCLIX CAN BE VERY VALUABLE IN PRESENTING TO THE RECEIVER ALL THE UPDATED INFORMATION ON THE PATIENT.-TOM CHECK
With the technical platform running, eight organizations are contributing data involving 80 logical feeds across 42 physical interfaces. The MPI is linking patients across sites and users have access to a clinical results viewer. “We started from a blank slate, and after the registration feeds began our MPI started to fill up. We now have 2.5 million patients in the MPI,” he says. “These are very busy hospitals and the growth of the MPI reflects the movement of patients through these facilities.”