Recently, the New York State Legislature voted to support New York’s HIE system—the statewide health information network of New York (SHIN-NY)—by including $55 million in state funding for the network in the New York’s Fiscal Year 2014-15 budget. Officials say the money will go towards building an innovative, public network in New York designed to give doctors and patients instant access to their complete health records, anywhere and anytime. The majority of the funding for the SHIN-NY in Governor Andrew Cuomo’s budget will go towards interconnecting the SHIN-NY’s 10 regional health information organizations (RHIOs)—hubs of electronic health records scattered throughout the state—and increasing doctor and patient participation in the network.
New York, which has been at the forefront of health innovation, will now be one of the first large states in the country to build a public network of interconnected HIEs of this kind, according to the New York eHealth Collaborative (NYeC), a regional extension center and not-for-profit organization that works in partnership with the New York State Department of Health to improve healthcare for New Yorkers through health IT. Founded in 2006 by healthcare leaders, NYeC receives funding from state and federal grants to serve as the focal point for health IT in the state. The organization additionally works to develop policies and standards to assist healthcare providers in making the shift to EHRs, and to coordinate the creation of the SHIN-NY.
According to Dave Whitlinger, NYeC’s executive director, the whole funding process started in January 2013 when stakeholder communities got together and discussed how to proceed when federal grants for HIEs dried up, which was going to happen in a year from that time. “We knew there was a lot of value in this network for the provider community,” Whitlinger says. “So we had to figure out how we would proceed.”
The options, he continues, were to work with the government and establish a public utility that’s paid for through taxation; or have the users of the network pay for the usage, known as fee-for-service. The stakeholders of the community emphatically responded, preferring a public utility model to avoid the “free riders”—organizations that are using the network and receiving the benefits, but not paying for it, explains Whitlinger. “We wanted to serve the public good in one segment of the marketplace, so that’s what the stakeholder community in New York decided on. We really believe it should be a public good and paid for through taxation.”
With the budget set in place, Whitlinger says that going forward, the immediate plan contains multiple parts. First, he says, in the context of the public utility, every RHIO in the state has to provide a minimum set of services. Those services include the Direct messaging protocol, exchange, patient record look up, consent management, public health reporting—all of the basic HIE capabilities. Each of the regions is working on getting all of those services in place, although 80 to 90 percent are already there, he says.
Secondly, Whitlinger continues, an infrastructure will be put in place such that record exchange and Direct works across regions, so there are no “borders” in the state network. “Record exchange will work across the whole state regardless of where the records are,” he notes.
Another key piece to building the network is the patient portal, which is being developed by the New York City-based health IT startup Mana Health, which won NYeC’s Patient Portal Design Challenge last year. Indeed, according to a report from the New York Daily News, New York will be the first state in the nation to make health data available to consumers through a patient portal, asserts Nirav R. Shah, M.D., the state’s health commissioner.
Mana Health is currently in the final stages of testing, says Whitlinger, and the portal will start to roll out in data form in June, with the hope to have it out much more substantially by the end of the year, he says. “By this time next year, we’re hoping that all patients will have access to their records and the records will be statewide. But it will start out as a few at a time to start—you can’t unleash it and then have a problem that creates substantial issues. And it’s a ‘skinnable’ system, in that it lets any provider organization across the state implement the portal and personalize it with minimal configuration.”
Growing the Network
Whitlinger says that while continuing to grow adoption of the network is crucial, counting the number of providers who have joined is not the right way to measure success. “There are 240 hospitals [in the state], which all have a lot of clinical information. We are closing in on having 85 percent inside the network, and as far as the last 15 percent, some of those hospitals are in a different financial situation, so a number of those places might decrease,” Whitlinger says. “And that might not be a bad thing.”
Digging down to the individual provider practices, the state is highly fragmented, with 20,000 single-doctor practices, with fewer of these practices upstate than in the city. As such, Whitlinger says that after going through all the claims data for the state, it was determined that most of the delivery of clinical healthcare happens at 234 locations. “So if we get all of those 234 medical organizations signed up and contributing their records, we will have 70 percent of the clinical data generated in the state inside the network. Our target this year is getting those 234—and a lot of them are the big hospitals and largest independent practice associations—in our network,” he says.
With that, the challenge is two-fold, says Whitlinger: “Are they connected and are they giving us all of their clinical data, or only a small subset? We’re doing that assessment right now, we believe most are connected, but might not be contributing all of their data. However, the value of the network is really based on the volume of critical information that it manages, so we really might not be too far off. It’s more about increasing the quality of the data that they’re contributing, rather than increasing the overall percentage,” he says.
And because New York planned the development of a statewide network over several years, it has robust security and privacy policies in place, says Whitlinger. “We were one of the first states to actually do policy development before building a network. These are the policies that allow for who has access to a certain patient's records and what they can use that data for. They dictate that the patient has the control,” he says.
In the years to come, Whitlinger believes that in highly-densely populated areas such as New York, it will take a lot of time to get real value out of an HIE. “You also need good support from the government and the stakeholder community that they will do this for the public good,” he says. “Right now, statewide, the whole network—lock, stock, and barrel—is around $70 million total, or about $3.50 per capita,” he says. “But we are still in the growth and adoption stage, too, so we have the ability to get down to around $2 per capita, and that’s less than a subway fare. Two dollars per person, per year, to access all of your records, and have your providers have access, entails so many benefits. From that vantage point, like roads, bridges, power lines, and other public infrastructure, this is pretty inexpensive for what you’re getting.”