In Record-Breaking Hurricane Season, U.S. HIE Leaders Understand What’s at Stake | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

In Record-Breaking Hurricane Season, U.S. HIE Leaders Understand What’s at Stake

October 10, 2017
by Rajiv Leventhal
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One health IT executive in New York says that HIE leaders are “part of the first response team if they want to be”

In the wake of two recent hurricanes that caused major damage in some U.S. regions, health information exchange (HIE) leaders around the nation, even in those areas that were not affected, watched with eager eyes how their colleagues took a hands-on role during the emergencies.

Indeed, the two storms—Harvey, which severely impacted Texas and some surrounding areas, and Irma, which similarly affected several Southeast states—had wide-ranging healthcare implications in these pockets of the U.S. Thousands of residents throughout the regions were displaced from their homes due to the massive flooding, with an estimated 10,000 people living in shelters in Houston alone, including nursing home and hospital patients. Many pharmacies, hospitals, clinics and doctor’s offices were closed and prescribing patterns disrupted, leading many patients needing to reconnect with their care regimens, often in new settings. As a result, HIEs can play a large role in disaster relief efforts.

While HealthlinkNY, which operates the HIE connecting providers and patients in 13 counties in the Hudson Valley and southern tier of New York, was not directly involved in either of the two hurricanes (read here how Texas HIE leaders helped with Harvey), its president and CEO Christina Galanis fully understands how much support HIEs— which store thousands of patient records and can provide the data emergency medical personnel need—can provide.

Galanis was actually at an annual meeting of HIE organizations at the same time when Hurricane Harvey hit. There were nearly 60 members at the meeting, but two of the HIE leaders could not attend since they were providing disaster relief efforts from their HIEs in Texas. One core use case for HIEs in these moments, says Galanis, is to be able to jump right in on the ground level at an evacuation center that has a medical area, where there are segregated patients who don’t need to be admitted to a hospital, but still need some medical treatment or supervision. “People with cardiovascular disease or a respiratory illness are particularly prone to health problems after a storm,” explains Galanis. “But emergency medical personnel can’t get their health records from their doctor's office or a hospital, which are facing emergencies of their own.”

Christina Galanis

This is why Galanis advocates that HIEs take a hands-on role during emergencies, as HealthlinkNY did when Tropical Storm Lee forced hundreds of people into shelters in 2011 in Broome County, N.Y. HealthlinkNY set up workstations at shelters so personnel could quickly access their records. Today, HealthlinkNY is part of Broome County Health Department’s emergency response plan.

Speaking from her experience during that storm, Galanis notes how many patients’ records were not available in real-time, and some pharmacies were flooded so that medication lists were not easily accessible either. “We stepped in and set up a server system on the fly, got in front of the triage line, and we were able to pull and print records, and put them on clipboards,” she says. “We ended up saving [doctors] 15 to 20 minutes per patient, as before they were handwriting everything out and interviewing the family and the patient. Having accurate information is important, and you’re also bringing a level of confidence to the providers so that they won’t inadvertently hurt a patient if they didn’t know he or she was allergic to latex, and the patient didn’t tell them, [for example].”

Galanis notes that family members and patients are not always together in disaster situations, and often don’t have their medications on hand, yet still need them right away. “So, it can be difficult. As we saw during Hurricane Sandy [in the New York region], hospital systems got flooded out. Luckily, everyone is building their server house above ground these days, but back in the day, a lot of hospitals [originally] put their IT department down in the basement, so some of them are still there today.” Says Galanis, “Those floods, in the Binghamton area, were nowhere near what we saw today, but in a small community they can be debilitating.”

During major storms such as Harvey and Irma, patients sometimes are evacuated from a nursing home into one of multiple hospitals that can actually take them, explains Galanis. “So you have people calling the Red Cross asking where their mom is. But the Red Cross doesn’t know. We are the ones who know; we’re getting their ADT [admission/discharge/transfer] as long as the hospital is up and running. And now we give that to the Red Cross as well.”

In addition, HealthlinkNY is working with home health agencies to identify certain patients by address and zip code and flag them in the HIE’s data, notes Galanis. These might be patients who are dependent on electricity for things like oxygen, and other folks who need to be evacuated sooner than the “walking well,” as Galanis puts it, “so we can intervene when the power goes out.”  She adds, “Also, we have the ability to [simply] check on the elderly so that we know where they are. Our data allows us to do that; we work with EMS agencies to actually do the retrieval.”

What’s more, Galanis explains how the patient-centered data home project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—is also playing a part. She notes that 17 HIEs are currently trading information across state boundaries, with 30 to 35 more slated to join the project by next summer, and right now the focus is primarily on notifying providers when a patient has been admitted into any of the participating hospital ERs.

Essentially, explains Galanis, “You are ‘casting out’ who has the zip code among the participating HIEs, and the provider can send a response saying ‘yes we have patients with that zip code’ and then they can do a specific query. And then you return the data if your consent model allows it in your state,” she says, noting that not every state has the same consent model across the U.S. “And some of us also have [42 CFR Part 2] data, which requires specific consent. So we are work on designing some additional features as a group of RHIOs across the country by building a consent store and then have the patients get a text to approve the movement of their data, assuming they are awake. It would be great if we had a national patient identifier, or had everything the same across every state, but we don’t,” she says.

Galanis further articulates that New York is an opt-in state, meaning patients have to be asked by each organization they cross paths with if they give consent to have their HIE data accessed by providers at that organization. To be clear, patient data is already contained in the HIE—but patients have to give each organization consent to access it. Some 95 percent of patients say “yes,” but nonetheless, notes, Galanis, HIEs in opt-out states likely have more data flowing in situations like these since patients are automatically “in” unless they specifically opt-out.

In the end, when a hurricane or other natural disaster hits a region that an HIE operates in, Galanis says the first step for HIE leaders is to, “Get a plan, get your teams together, collaborate with other responders in the community, figure out how to help, and [run] drills.” She adds, “We have ‘bug out bags’, with MiFis and extra batteries, and if we even think something might happen, we do a drill over the weekend where people take the bags with them. Make sure you have a very tight and coordinated process. You are part of the first response team—if you want to be.”

 


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One New York Regional HIE Opposes Expansion of Another, Highlighting Issues with Competition Among HIEs

September 24, 2018
by Heather Landi, Associate Editor
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A New York regional health information exchange (HIE), HealthlinkNY, based in Binghamton, has publicly come out against another regional HIE’s plans to expand its services into HealthlinkNY’s market, saying it creates “confusion and uncertainty” in the marketplace.

Last week, Hixny, an HIE based in Albany that historically covered north and west of the Capital District, announced that it had added nine counties to its territory, specifically Chenango, Broome, Sullivan, Ulster, Dutchess, Orange, Putnam, Westchester and Rockland counties in southern New York. These nine counties are part of HealthlinkNY’s 13-county service area. HealthlinkNY’s service area spans the Hudson Valley, Catskills, and the Southern Tier of New York (the Southern Tier encompasses counties of New York west of the Catskill Mountains along the northern border of Pennsylvania).

With the expansion, Hixny now serves 28 counties and the HIE already has updated its website to state that it serves communities from Westchester to the Canadian border and Binghamton to Vermont.

Both HIEs are two among the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health and managed by the New York eHealth Collaborative (NYeC). According to the NYeC website, participating healthcare organizations can connect with the QE that best aligns with their business, operational, and service delivery needs. 

HealthlinkNY issued a strongly worded press release late last week in response to Hixny’s expansion plans. “The truth is that an unnecessary expansion into this service area compromises the effectiveness of the Health Information Exchange [HIE],” Staci Romeo, executive director of HealthlinkNY, said in the press release.

During interviews Romeo and Hixny CEO Mark McKinney both addressed the expansion plans. Romeo says Hixny’s expansion into its territory creates competition between the HIEs and says the competition is a “distraction, it’s confusing for participants and it’s completely unnecessary.”

McKinney says, “The primary reason for us to consider expansion is because patients and providers really are not bound by county borders. We have long been a trail blazer as an HIE both in the state and around the country. From our perspective, reaching into those regions helps to meet the needs of those patients.” McKinney says Hixny officials recognized that there was an overlap of patients seeing providers both in Hixny’s territory and HealthlinkNY’s territory.

“We looked at data for patients already inside our master patient index, and we saw significant percentages of patients already had records inside our systems, so for those providers and those patients, getting a more accurate and complete record and making that system available to providers seemed like a valuable exercise to bring all that information to one place,” he says. “This gives providers a choice in terms of what they value with regard to the services that are provided.”

According to Hixny’s website, 1 in 5 residents of the Hudson Valley and Southern Tier already have Hixny records, and that figure increases to more than 1 in 2 in counties neighboring Hixny's established service area, the website states.

HealthlinkNY's service area

Hixny's service area

McKinney also notes that it is not uncommon for multiple HIEs to serve multiple markets and he believes its beneficial to have two HIEs serving the same counties. “I think what’s most important is to meet the needs of patients and providers. Ultimately, it’s about patients and providers and making sure they have access to the information that they need,” he says.

And in response to Romeo’s statement that Hixny’s expansion creates “confusion and uncertainty in the marketplace.” McKinney says, “I can’t comment on her response; what I can say it that we’re very committed to our expansion and delivering the data and the information that will improve care and lower costs for patients and providers in the region.”

Hixny (formerly known as the Health Information Xchange of New York) launched in 1999 as a collaboration between Iroquois Health Care Alliance, which represents upstate hospitals, and the New York Health Plan Association. The HIE currently serves 1.7 million patients.

Regional HIEs enable provider organizations to access and exchange health information with participants in their region, and, in New York State, all eight QEs connect to SHIN-NY, which acts as a hub to provide access to patients’ health information statewide. When contacted for comment, Valerie Grey, executive director of the New York eHealth Collaborative (NYeC), stated, “Ultimately, our role is to help expand participation in the information network and support all of our partners in that process. We’re going to continue that work with each of our eight regional networks because increased participation will improve health outcomes across New York.”

Historically, HIEs separately increase their networks within their agreed-upon geographic areas, while there also is a great deal of collaboration between regional HIEs. However, one challenge for many HIE leaders is determining how to exchange information with competing organizations.

Healthcare researcher Julia Adler-Milstein, Ph.D., who has done extensive research on HIEs, says there are regions with multiple HIEs operating and competition among HIEs is a common issue, although it’s often discussed in “backroom” conversations. Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, at the University of California San Francisco.

Three years ago, Adler-Milstein was part of a team of researchers from the Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan, School of Information that published research examining health IT adoption, including the advancement of community HIEs. As part of that study, the researchers surveyed HIE leaders about barriers to development, and 84 percent of respondents cited competition among HIEs as a barrier to their development.

A Case of "Sour Grapes"?

HealthlinkNY officials also take issue with the wording of Hixny’s press release with regard to HealthlinkNY’s performance in those nine counties. Specifically, the press release Hixny issue last week stated that “the region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.”

“There has been public information that has demonstrated that the growth of SHIN-NY across the state has been uneven and so we’re basing it on some of that information that has demonstrated that certain areas have grown faster than others,” McKinney says. He adds, “We think our press release stands for itself, in terms of demonstrating that there is a need for Hixny to deliver the data and the information that will improve care and lower costs for patients and providers in the region.”

In HealthlinkNY’s press release, Romeo said Hixny’s claims against HealthlinkNY’s impact and progress are "completely unfounded.”

HealthlinkNY, which launched in 2005, already has all 35 hospitals in the Hudson Valley and Catskill region participating and sending data to their HIE, as well as 1,207 sites, according to Romeo. HealthlinkNY also recently hit the two million patient consent mark and has 374 participating provider organizations, up from 271 at the end of 2017, according to Romeo. HealthlinkNY also administers two Population Health Improvement Programs (PHIPs) in the Hudson Valley and Southern Tier. HealthlinkNY’s service area population is just shy of 2.9 million residents and includes nearly 1,800 participating locations.

Hixny has 21 sites and no hospitals in those nine counties, Romeo stated in the press release.

Further, Romeo stated in the press release that Hixny’s claims “sound like a case of sour grapes after being passed over during our search for a strategic partner.” HealthlinkNY has entered into strategic partnership discussions with HealtheConnections, another HIE located in Syracuse that serves central New York, and Romeo stated, “HealthlinkNY had recently advised Hixny that they did not make the cut.”

When reached for comment on Romeo’s claim, McKinney responded, “Hixny’s strategy for expansion is solely based on getting providers data that is complete, accurate and up-to-date and supporting the success of the SHIN-NY by improving the overall health of our communities.” 

Romeo notes that HealthlinkNY has significant plans underway in the Hudson Valley and Catskill regions to increase its presence and breadth of services offered. As part of this strategy, HealthlinkNY is looking to work with a strategic partner with “innovative services and an unwavering commitment to providing value,” she says. After interviewing potential partners, HealthlinkNY decided to collaborate with HealtheConnections.

Romeo said in the press release that HealthlinkNY entered discussions with HealtheConnections because “they are in alignment with us with respect to mission, best practices, services, capabilities, and culture.” She further stated, “They also will help power a more sophisticated technology platform as well as a complementary program for population health, critical with today’s burgeoning opioid crisis and the need for increased access to mental health services. We want to take this to the next level.”

Romeo further expanded on the partnership: “The combination of services currently provided by both QE's will be expanded by this partnership. Just a few examples are: additional functionality regarding actionable analytics, HEDIS reporting, as well as alerts provided how and when participants need them. We are looking forward to synergies and shared best practices between both organizations.”

HealthlinkNY covers a region of New York State with a significant population, geographic and cultural density. The future partnership will bring great value to both QEs’ participants, Romeo said.

“All of the hospitals in the region are already successfully contributing data to HealthlinkNY. We are the only QE in the region with data immediately available for healthcare providers. While others seek to confuse the marketplace for their own professional gain, our focus is pure: to help providers improve the continuum of care,” Romeo stated in the press release.


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One New York Regional HIE Opposes Expansion of Another, Highlighting Issues with Competition Among HIEs

September 24, 2018
by Heather Landi, Associate Editor
| Reprints
Click To View Gallery

A New York regional health information exchange (HIE), HealthlinkNY, based in Binghamton, has publicly come out against another regional HIE’s plans to expand its services into HealthlinkNY’s market, saying it creates “confusion and uncertainty” in the marketplace.

Last week, Hixny, an HIE based in Albany that historically covered north and west of the Capital District, announced that it had added nine counties to its territory, specifically Chenango, Broome, Sullivan, Ulster, Dutchess, Orange, Putnam, Westchester and Rockland counties. These nine counties are part of HealthlinkNY’s 13-county service area. HealthlinkNY’s service area spans the Hudson Valley, Catskills, and the Southern Tier of New York (the Southern Tier encompasses counties of New York west of the Catskill Mountains along the northern border of Pennsylvania).

With the expansion, Hixny now serves 28 counties and the HIE already has updated its website to state that it serves communities from Westchester to the Canadian border and Binghamton to Vermont.

Both HIEs are two among the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health and managed by the New York eHealth Collaborative (NYeC). According to the NYeC website, participating healthcare organizations can connect with the QE that best aligns with their business, operational, and service delivery needs. 

HealthlinkNY issued a strongly worded press release late last week in response to Hixny’s expansion plans. “The truth is that an unnecessary expansion into this service area compromises the effectiveness of the Health Information Exchange [HIE],” Staci Romeo, executive director of HealthlinkNY, said in the press release.

During interviews Romeo and Hixny CEO Mark McKinney both addressed the expansion plans. Romeo says Hixny’s expansion into its territory creates competition between the HIEs and says the competition is a “distraction, it’s confusing for participants and it’s completely unnecessary.”

McKinney says, “The primary reason for us to consider expansion is because patients and providers really are not bound by county borders We have long been a trail blazer as an HIE both in the state and around the country. From our perspective, reaching into those regions helps to meet the needs of those patients.” McKinney says Hixny officials recognized that there was an overlap of patients seeing providers both in Hixny’s territory and HealthlinkNY’s territory.

“We looked at data for patients already inside our master paten index, and we saw significant percentages of patients already had records inside our systems, so for those providers and those patients, getting a more accurate and complete record and making that system available to providers seemed like a valuable exercise to bring all that information to one place,” he says. “This gives providers a choice in terms of what they value with regard to the services that are provided.”

According to Hixny’s website, one in five residents of the Hudson Valley and Southern Tier already have Hixny records, and that figure is more than one in two in counties neighboring its established service area, the website states.

HealthlinkNY's service area

Hixny's service area

McKinney also notes that it is not uncommon for multiple HIEs to serve multiple markets and he believes its beneficial to have two HIEs serving the same counties. “I think what’s most important is to meet the needs of patients and providers. Ultimately, it’s about patients and providers and making sure they have access to the information that they need,” he says.

And in response to Romeo’s statement that Hixny’s expansion creates “confusion and uncertainty in the marketplace.” McKinney says, “I can’t comment on her response; what I can say it that we’re very committed to our expansion and delivering the data and the information that will improve care and lower costs for patients and providers in the region.”

Hixny (formerly known as the Health Information Xchange of New York) launched in 1999 as a collaboration between Iroquois Health Care Alliance, which represents upstate hospitals, and the New York Health Plan Association. The HIE currently serves 1.7 million patients.

Regional HIEs enable provider organizations to access and exchange health information with participants in their region, and, in New York State, all eight QEs connect to SHIN-NY, which acts as a hub to provide access to patients’ health information statewide. When contacted for comment, Valerie Grey, executive director of the New York eHealth Collaborative (NYeC), stated, “Ultimately, our role is to help expand participation in the information network and support all of our partners in that process. We’re going to continue that work with each of our eight regional networks because increased participation will improve health outcomes across New York.”

Historically, HIEs separately increase their networks within their agreed-upon geographic areas, while there also is a great deal of collaboration between regional HIEs. However, one challenge for many HIE leaders is determining how to exchange information with competing organizations.

Healthcare researcher Julia Adler-Milstein, Ph.D., who has done extensive research on HIEs, says there are regions with multiple HIEs operating and competition among HIEs is a common issue, although it’s often discussed in “backroom” conversations. Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, at the University of California San Francisco.

Three years ago, Adler-Milstein was part of a team of researchers from the Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan, School of Information that published research examining health IT adoption, including the advancement of community HIEs. As part of that study, the researchers surveyed HIE leaders about barriers to development. Eight-four percent of respondents cited competition among HIEs as a barrier to their development.

HealthlinkNY officials also take issue with the wording of Hixny’s press release with regard to HealthlinkNY’s performance in those nine counties. Specifically, the press release Hixny issue last week stated that “the region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.”

“There has been public information that has demonstrated that the growth of SHIN-NY across the state has been uneven and so we’re basing it on some of that information that has demonstrated that certain areas have grown faster than others,” McKinney says. He adds, “We think our press release stands for itself, in terms of demonstrating that there is a need for Hixny to deliver the data and the information that will improve care and lower costs for patients and providers in the region.”

In HealthlinkNY’s press release, Romeo stated, “Hixny’s claims against HealthlinkNY’s impact and progress are completely unfounded.” HealthlinkNY, which launched in 2005, already has all 35 hospitals in the Hudson Valley and Catskill region participating and sending data to their HIE, as well as 1,207 sites, according to Romeo. HealthlinkNY also recently hit the two million patient consent mark and has 374 participating provider organizations, up from 271 at the end of 2017, according to Romeo. HealthlinkNY also administers two Population Health Improvement Programs (PHIPs) in the Hudson Valley and Southern Tier. HealthlinkNY’s service area population is just shy of 2.9 million residents and includes nearly 1,800 participating locations.

Hixny has 21 sites and no hospitals in those nine counties, Romeo stated in the press release.

Further, Romeo stated in the press release that Hixny’s claims “sound like a case of sour grapes after being passed over during our search for a strategic partner.” HealthlinkNY has entered into strategic partnership discussions with HealtheConnections, another HIE located in Syracuse that serves central New York, and Romeo stated, “HealthlinkNY had recently advised Hixny that they did not make the cut.”

When reached for comment on Romeo’s claim, McKinney responded, “Hixny’s strategy for expansion is solely based on getting providers data that is complete, accurate and up-to-date and supporting the success of the SHIN-NY by improving the overall health of our communities.” 

Romeo notes that HealthlinkNY has significant plans underway in the Hudson Valley and Catskill regions to increase its presence and breadth of services offered. As part of this strategy, HealthlinkNY is looking to work with a strategic partner with “innovative services and an unwavering commitment to providing value,” she says. After interviewing potential partners, HealthlinkNY decided to collaborate with HealtheConnections.

Romeo said in the press release that HealthlinkNY entered discussions with HealtheConnections because “they are in alignment with us with respect to mission, best practices, services, capabilities, and culture.” She further stated, “They also will help power a more sophisticated technology platform as well as a complementary program for population health, critical with today’s burgeoning opioid crisis and the need for increased access to mental health services. We want to take this to the next level.”

Romeo further expanded on the partnership: “The combination of services currently provided by both QE's will be expanded by this partnership. Just a few examples are: additional functionality regarding actionable analytics, HEDIS reporting, as well as alerts provided how and when participants need them. We are looking forward to synergies and shared best practices between both organizations.”

HealthlinkNY covers a region of New York State with a significant population, geographic and cultural density. The future partnership will bring great value to both QEs’ participants, Romeo said.

“All of the hospitals in the region are already successfully contributing data to HealthlinkNY. We are the only QE in the region with data immediately available for healthcare providers. While others seek to confuse the marketplace for their own professional gain, our focus is pure: to help providers improve the continuum of care,” Romeo stated in the press release.


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Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent, according to Hixny officials.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”

 

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