NYCLIX: New York HIE Life

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.”

Even in its fledgling state the figures begin to reflect the HIE's scope:

• 160,000 or 8 percent of patients in the MPI have been to two sites;

• 17,600 or about 1 percent have been to three sites;

• 500 had been to more than three sites.

Movement among patients who visit the ED is striking: on average, nearly 20 percent of the patients who walk into an ED have data elsewhere, meaning they had been seen somewhere else. “The extent of movement is a validation of the HIE,” Kuperman says.

REAL MEDICAL HOME

On any given day, the 3,500 nurses, therapists and other staff of the Manhattan-based Visiting Nurse Service of New York (VNSNY), the largest home health agency in the United States, care for 30,000 patients in their homes, about 125,000 during a year. “As a result, we use a point-of-care EHR [electronic health record],” says Tom Check, CIO at VNSNY, which staffers access on a laptop and includes clinical guidelines for various patient conditions. “A couple of times a day, they use a cellphone connection to communicate the information they've acquired on patients,” he says, and most of that information is submitted electronically to NYCLIX.

New York State requires a patient's written consent to share his or her clinical information across such a broad spectrum, but Check says that nine out of 10 do so in VNSNY's service area that includes all of New York City, as well as Westchester and Nassau Counties. “So, we've been submitting patient information to NYCLIX whenever the patient authorized it,” says Check.

That information is run against clinical decision support software to identify any possible adverse reactions to medications based on the patient's condition. If there's risk of an adverse event, VNSNY nurses can then call to advise the patient's doctor and have the physician adjust the patient's medication accordingly.

The HIE allows homecare clinicians to see patients’ diagnoses, treatment, and medications to allow them to follow up on their care.

“We think the patient-centered medical home is really important. A lot of patients don't really have a physician, so we have to coordinate that with the physician of record,” says Check. Transitions of care such as when a patient goes from home to hospital and from hospital to home are particularly fraught with risk of losing information critical to their continuity of care. “NYCLIX can be very valuable in presenting to the receiver all the updated information on the patient,” he says.

“We extract our information daily from our systems and export a copy of relevant information-demographic, acknowledgment of their service with VNSNY, medications they're on, diagnoses, and lab results to the NYCLIX database,” notes Check.

ED CALL HOME

One of the leaders in founding NYCLIX, Paul Conocenti, CIO at Manhattan-based NYU Langone Medical Center, says a driving need among the nearly 70 brutally competitive hospitals in New York City, was the fact that any patient at any given time in the city could wind up at any one of several EDs. “If we can share data among EDs in many cases that are life threatening, that would break down the competitive wall. So we found a vendor (Mason, Ohio-based MedPlus, Inc.) and put a lot of work into areas like governance. NYU was the first to go live with patient consent forms,” he says, adding that 70 to 80 percent of the patients that walk into an ED give their written consent, a rate bolstered by the fact that desk staffers undergo a training program on what it means for patients to share data.