Composed of NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork Presbyterian Healthcare System is one of more renown organizations in the country. The system is also affiliated with two Ivy League medical institutions, Columbia University College of Physicians & Surgeons and Weill Medical College of Cornell University. Aurelia Boyer — senior vice president and CIO, NewYork-Presbyterian Hospital & NewYork-Presbyterian Healthcare System — is in charge of making sure the massive amounts of data collected and produced by the organization can be put to good use by patients, physicians and researchers. Anthony Guerra, HCI editor-in-chief, recently had a chance to talk with Boyer about her work at NYP.
AG: Let’s talk a little bit more about www.mynyp.org. When patients log in, are they in the HealthVault application?
AB: No, actually they don’t start there. So what we tried to do with www.mynyp.org is create a sister site to www.nyp.org, which is more generic. We wanted to create a patient experience that allows them to get their results and other parts of their record. It doesn’t really, right now, serve up the entire medical record because I don’t think that’s what most patients need to see. It gives them some instructional materials that help them understand the data. So, it welcomes you to NYP. We tried to create it in a way so that it’s like coming into the hospital and an avatar comes up and speaks to you, and then it gives you the opportunity to pull up your medical record. It brings over what is really a CCR document. HealthVault uses the CCR document. It allows them to view their record and the components that are part of the CCR document, read them online, see them, and then, if they want to, to store them in HealthVault. So, the front-end, even in terms of how the CCR appears to them, is changed from what is on mynyp, which is what it is when you look at it generically in HealthVault. I think ours is a little more aesthetically pleasing at this point.
AG: So, this information in HealthVault and in mynyp.org, it’s essentially some clinical information, some financial information, some ability to interact.
AG: Do they have the ability to add on information that may be of interest to the physician?
AB: They can. That is then a HealthVault function, so the HealthVault profile is then accessible to them, and they can add information there.
AG: And the information that’s presented to them is locked; they can’t get in and alter it?
AB: That’s correct.
AG: So that’s secure, and then they can enter information in HealthVault that may be of interest to the physician at the next visit.
AB: Right, and they have the ability to not put the information in HealthVault, not share it if they choose. I know people fuss around that. For example, if you’re looking over your EKG, when you hover over it, we pop up information that tells you what the normal value is. There are also additional instructional videos about what is an EKG, so there’s a lot of other educational materials in there.
AG: Let’s say I deal with New York Presbyterian and, for whatever reason, I also deal with Hackensack Hospital in New Jersey. Tell me how I might have my health information stored? What I can do through mynyp.org and then, if I had other information obviously from Hackensack, would I put it into the HealthVault personal version part? Would I have some other application where I aggregate the New York Presbyterian information with the Hackensack information? Take it from a patient’s point of view. Tell me how they might navigate all this.
AB: Right. So I think that’s exactly where you can hope that the industry can get, so that a patient would also be able to go not only to Hackensack, but to their physician or their pharmacy or a standalone lab, and if Hackensack were to enable HealthVault, then the patient could do the same thing from Hackensack and say, ‘Okay, here’s my NYP record and here’s my Hackensack record,’ and I would have them together in one place. If at this point in time your physician’s not automated or Hackensack is not HealthVault enabled, you as the patient, have the opportunity to put that data in in different ways, the easiest of which is to scan in printed records.
For example, my EKG record was created in a physician’s office, not here at the hospital, because I was having surgery in a physician’s office, and I scanned my EKG in there so that that’s always available now in my baseline because that was my normal one. I did that in case I have chest pain when I’m somewhere else. There are multiple ways to get that data in there, so I think depending on who enables HealthVault, over what point in time, and how motivated the patients are, we’ll see how that evolves. It would keep that information as CCR records at this stage.
One of the things that I think is important about using something like Microsoft or Google is I’m not going to write the PHR, for example, so rather than every hospital create a PHR, the patient now has the ability, and I’m relying on HealthVault? There’s already a bunch of PHRs on the market. A bunch of them are already HealthVault enabled. If that patient likes ‘that’ particular PHR, then they can use whichever one they like, and they can interact with other tools. So, if the American Heart Association has the best tool available for me to monitor and control my blood pressure once I go home, then the patients get the best of everything that’s out there instead of each of us creating a tool for them to graph their blood pressures against over time. So, I think that gives the patients a lot of choice.
AG: Just to be clear, HealthVault is not a PHR, correct? It works with a PHR?
AB: I think that Microsoft would say it’s not technically a PHR.
AG: Right. I believe you’re correct.
AB: With a lot of people who don’t understand the industry, it’s hard to get them to see that distinction, but it really is not a fully functional PHR. It allows you to use whichever one you want.
AG: Right. So it sounds like you’re pleased with how far you’ve come with mynyp. Tell me about going forward, the direction you see this moving in.
AB: We are pleased. We were able to do quite a bit in a relatively short period of time which was very exciting, particularly in healthcare IT, where sometimes these clinical system implementations take years upon years. So it was pretty exciting to do something where within six months of really creative work, we were able to do this. We worked with a group of clinicians who said, ‘This is what we think it should be, and this is what we think it should look like,’ so we did have a small clinical taskforce that worked with us on designing what this would look like. So, we’re all pleased. We’ve enrolled our first patients to get feedback. They were thrilled. I couldn’t have been happier watching the patients react to it, and they immediately say, ‘Oh, you mean I don’t have to carry all these files around with me anymore?’ We’re a referral center, so we have a lot of that. So they really related to it. In fact, one patient said, ‘Oh, so that’s what Obama has been talking about.’ I thought that showed we were hitting the mark here.
We’re going to test-run it between now and June, primarily with cardiac surgery patients, to make sure that it’s robust and does what we want it to do. We built an infrastructure that really is robust enough that I could turn it on for everybody if we so desired. I don’t think we want to do anything quite that brazen right out of the gate since this is pretty new territory, but I think we will work with groups of physicians and roll it out over the summer and see. We may have to add a few more clinical results as we go, but I think we’ve got most of it ready to go. So once you do these things, the discharge medications are already in there. Once you’ve done that, it’s there for everybody.