The New York eHealth Collaborative (NYeC), the state designed entity for the Statewide Health Information Network for New York (SHIN-NY), recently announced that SHIN-NY, a “network of networks” that links New York’s eight regional Qualified Entities (QEs) throughout the state, now holds healthcare records for more than 40 million patients, processes over 2.8 million transactions a month, and has over 62,000 users.
Indeed, NYeC works in partnership with the New York State Department of Health (NYSDOH) to improve healthcare 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 of New York. NYeC coordinated the creation of the SHIN-NY to allow the electronic exchange of clinical records between participating healthcare providers.
But despite the healthcare data that is in-house and the high volume of transactions per month via the health information exchange (HIE), state health IT leaders still face the core challenge of making the data it has, from stakeholders throughout the state, usable. This was a key topic of discussion at the New York HIT Summit, sponsored by Healthcare Informatics, on Sept. 27. The panel discussion on health data exchange and interoperability, held at the Convene in New York City's downtown financial district, included notable health informatics experts with connections in the state: Paul Wilder, CIO, NYeC; Christie Allen, technical program advisor, Office of Quality and Patient Safety (OPQS), NYSDOH; Carole Cusack, vice president of emerging business, 3M Health Information Systems; and Lin Wan, chief technology officer, Stella Technology. Moderating the panel conversation was Mark Hagland, Editor-in-Chief, Healthcare Informatics.
Wilder noted that the eight QEs in the state, which serve as the backbone to SHIN-NY, are designed to collect data from patient care organizations, primarily hospitals, and then send the data up through the HIE. Wilder said that NYeC doesn’t worry about who has access to the data until someone tries to query it, and they aren’t concerned about consent until someone looks about it. “So the good news is that you can build a system if the upload is frictionless,” he said. He said that about 90 percent of hospitals in the state are providing some data to the HIE, and about 45 percent are sending what they call “a minimum data set.” But Wilder noted, “There is still a lot of work to do. We find that data is missing and that data is hiding inside documents.”
As such, Wilder said the greatest challenge is getting the data in a place where the system can do something actionable with it. He added that while people talk a lot about document standards such as the Health Level Seven International (HL7) standard, as well as complete, widely accepted document formats, such as continuity of care documents (CCDs) and the HL7 consolidated clinical document architectures (C-CDAs), the problem is that while a human who is looking at the document can find something with relative ease, getting it from an electronic medical record (EMR) via XML format can be “an impossible task” as it can't “screen-scrape” the information out of free text-based areas in a CCD.
Wilder added that it only takes one “bad actor,” or in this case, one patient care organization, along the care continuum, to take it from a “nice, coded spot” and put it in a “non-coded spot.” In sum, Wilder said that NYeC “has a lot hooked up, and has 2 million people looking at data.” But he noted that much of the volume that takes place right now is in the form of clinical alerts that will say an inpatient event happened at X facility at Y time, and then gives a phone number to call. While these alerts are certainly important and good for people who are underserved and on the hospital readmissions track, overall, Wilder admitted that “there is good usage, but we want more.”
NYSDOH’s Allen added that while SHIN-NY was a concept for a long time, all eight of the QEs went live by October 2015, resulting in a “built infrastructure.” To this end, interoperability played a big part since all of the QEs needed to take information from each other and understand what to do with it, Allen said. “Now it's about making use of the data. The data content itself is not standardized, even though we have a standard format.” She agreed with Wilder in that “All it takes is one hospital along the way entering information [differently] that will lead to inconsistencies. Fields have to be filled in; you can't ‘tab past it.’ Now we are pulling back the curtains to look inside, and we are figuring out how to make the data usable. We need good data so we can find the quality measures. So the perspective of the state is that we have built the infrastructure, but now we are growing and assessing,” Allen said.
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