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Leveraging HIE to Improve Care Delivery

July 21, 2011
by Adam Aponte, M.D., MSc, FAAP
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A case study demonstrates how and why one Brooklyn-based provider organization chose an HIE platform to provide better care to its underserved patient population

Every health care provider is familiar with the balancing act required to provide optimal care delivery while simultaneously controlling costs. It’s a scenario that becomes even more challenging when the majority of the patient population you serve are underinsured, uninsured or insured by a public payer. The situation is exacerbated when that same community has been historically underserved in healthcare and experiences an undue disease burden.

At the Brownville Multi-Service Family Health Center (BMS) in Brooklyn, N.Y., we are taking a major step to meet that challenge by making use of the Brooklyn Health Information Exchange (BHIX) for bidirectional transfer of critical patient information with health care providers at other locations. BHIX is one of multiple regional health care information organizations in New York that are leading the health information exchange (HIE) efforts that are the cornerstone of the Nationwide Health Information Network (NHIN). Running on the InterSystems HealthShare, Cambridge, Mass. HIE platform, the BHIX network includes hundreds of clinical end-users at multiple hospitals, nursing homes, home care agencies and health centers throughout Brooklyn and Queens, N.Y. One of the organizations connected to BHIX is Brookdale University Hospital and Medical Center and its affiliates. It’s with Brookdale that BMS is working on its first automated HIE project.

As a Federally Qualified Health Center, BMS provides high-quality medical, dental and social services to a patient base that includes 27 percent of Brooklyn’s entire high-need population. When necessary, we refer our patients to surrounding hospitals and providers for specialty care. For example, mothers-to-be receive prenatal, perinatal and postnatal care at BMS. However, for certain tests as well as when the time comes to deliver the baby, services are provided in part by Brookdale.

As a result, transfer of patient records, including visit history, test results, ultrasound and screening reports, patient/family history, medications and allergies, depends on ongoing exchange via fax, mail, staff or even patients who hand-carry the requisite documents between the locations. As most are aware these methods can be quite unreliable and result in poor communications among health care providers and patient frustrations. This can also lead to duplication of efforts when certain important information is required but not received, necessitating repeating of test or procedures. It can also lead to delays in care and potentially adverse outcomes. To decrease the barriers in terms of access to care that this manual process entails, BMS is moving to automated HIE.

The Road to HIE
The HIE process began more than a year ago as part of a New York state-funded Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY Phase 5) grant. In order to define the scope of work for this project, a series of discussions took place with BHIX, BMS and key stakeholders about issues running the gamut from how the system would work, through potential impact on workflow, and staff and clinician training, to name just a few. Based on the grant’s program requirements and organizational priorities, an internal decision was made to implement the system beginning with the OB/GYN Use Case.

The process of getting physicians to buy into the need to enter patient data into the BMS electronic health record (EHR) was a fairly minor challenge with little internal resistance. Based on best practices, BMS uses a form developed by the American Congress of Obstetricians and Gynecologists (ACOG) as the standard for providing treatment at all stages of pregnancy. Some of our physicians felt that entering ACOG-based data into the EHR was more time-consuming than writing it down, but with training, template development, and encouragement, that challenge was overcome. The OB/GYN physicians became internal champions of the HIE transition.

Ongoing communication with appropriate personnel at Brookdale has been another major emphasis. Since we are dealing with underserved patients who are impoverished and deal with a multitude of psycho-social issues that may create barriers to obtaining health care, it is imperative for both organizations to eliminate any potential barriers to care delivery and to reach total agreement on data formats. Once a patient has registered at BMS, for example, she will be linked to her records at Brookdale, so when she visits either facility, care can be better coordinated by the providers at both organizations.

HealthShare-based BHIX enables bidirectional HIE by providing a single interface for data access in the locations connected to the network. So, once the data has been entered in our respective source systems, it’s brokered and aggregated by BHIX and available in any BHIX-supported locations. At BMS, we will access BHIX data via a single-click query directly through our organization’s EHR. Over time, we expect patient information updates to be event-driven so that when a birth takes place at Brookdale, for example, the information can be proactively pushed to BMS clinicians rather than waiting for them to enter a query.


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