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The Pain (and Gain) of Building a Private HIE in NYC

April 24, 2015
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HIE exec calls it "one of the most complicated projects I have ever embarked on.”
Frat Iqbal, senior manager of information management at New York University’s Langone Medical Center, led off his presentation at HIMSS15 in Chicago with two photos that provided a stark reminder of what happens when information doesn’t flow properly through the healthcare system. They were two pictures of his brother two years apart, one in full health and the other wheelchair-bound and permanently disabled by multiple sclerosis.
“It took two years to diagnose MS as he went from doctor to doctor, lab to lab,” he said. “His life was ruined by inefficiencies in the healthcare system.”
Iqbal said it is a reminder of the importance of improving patient care at the community level, of connecting all the small practices in New York so that data can flow from their offices to specialists, labs and hospitals. 
NYU Langone has been working to build a private health information exchange to link 200 practices and 1,900 clinicians using 26 different EHRs as the state and country work toward building larger exchanges.
The HIE was established in mid-2011 and privately funded by NYU Langone Medical Center. The goal was to become a central repository of clinical information for community providers to review, reference and share data and to provide 360-degree care to patients, Iqbal said.
Anthony Antinori, senior director of clinical affairs IT at NYU Langone, said a private HIE has advantages over a public one. “We can make decisions quickly. We have a small ecosystem of private practices and one governing body. We are local and funded by a private organization, with no federal or state funding required,” he said. The HIE is able to rapidly align itself with the strategic goals of the organizations it is serving, he added.
Instead of dictating which EHRs it would support, NYU Langone decided to work with whatever the providers had. “We left it open. If the EHR has the capability, we will integrate with it. It’s more headaches for us, but we did that for the community,” he said. 
They knew it was going to be challenging, and it has been, Iqbal said. “It is one of the most complicated projects I have ever embarked on,” he said. Interfacing with all those EHRs has been a “project management nightmare,” he added. Project prioritization has been tough, in terms of deciding which data is most valuable to the HIE. A whole team has been focused on privacy and security of the 4 million patient records in the HIE.
There are technical challenges, but more difficult have been cultural changes and setting the right expectations, he said. Many physicians are not inclined to share data and don’t want to change. Most EHRs are designed to retain, not share, information. 
Some providers are resistant to change. They don’t care if more information is available and they don’t want to share information. With these providers, you really have to make them realize the benefit the HIE brings to the table, he said. (Members of the NYU Provider Network are mandated to connect to the HIE.)
Legal and policy issues were a challenge. Getting data sharing agreements vetted by the practices, vendors and NYU Langone’s legal teams took longer than the integration itself. Consent policies are also difficult to work through, he said.
Despite the huge challenges in getting it set up, the HIE offers an array of benefits. Here are a few listed in the NYU presentation:
• Providers gain immediate access to valuable clinical data that provides a more holistic view of patient health when using the HIE;
• Providers will be able to reduce unneeded patient visits and lower the cost of care;
• Providers can begin to embrace the powerful benefits of trend and pattern analysis toward new decision-making frontiers;
• HIE facilitates evidence-based medicine and creates a potential positive feedback loop between health-related research and actual practice.
• Patients can expect improved payment coordination and smoother care transitions
• Duplicative procedures or tests will be reduced and visit satisfaction will be improved when patients opt to participate in the HIE;
• The collection and linking of data across the HIE facilitates extensive and robust community health records that can foster the ability to quickly detect, respond and efficiently prevent threats to public health;
• The HIE will also enhance public health practices at all levels of government through infectious disease case investigation and health surveillance.
The next step, he said, is analytical innovation that will pull together payer data, HIE data and Epic data from the hospital system to get more proactive at recognizing issues and monitoring patients and populations.