SHIN-NY 2020 Roadmap Seeks to Address ‘Perfect Storm of Reduced Support’ | David Raths | Healthcare Blogs Skip to content Skip to navigation

SHIN-NY 2020 Roadmap Seeks to Address ‘Perfect Storm of Reduced Support’

October 10, 2017
| Reprints
Operations to be re-examined with an eye toward improved efficiency, affordability

Healthcare Informatics has been closely following the pace of change at regional and state health information exchanges over the past few years as they seek to become increasingly relevant to hospitals, clinics and physicians.

In September our editor-in-chief, Mark Hagland, did some excellent reporting from annual conference of the Strategic Health Information Exchange Collaborative.

From Mark’s news story:

“At a time when some in U.S. healthcare are prematurely writing a collective obituary for HIEs, the reality behind the scenes is both brighter and far more complex than the announcements of HIEs forming and breaking apart. And that complexity and nuance were on full display at the SHIEC annual conference. On the one hand, no one attempted to gloss over the fact that HIEs face challenges going forward — challenges around funding, policy issues, and above all, sustainability. On the other hand, the leaders of numerous HIEs are developing strategies that are putting them on more and more solid ground.

For instance, many HIEs are building on the trust they have established to help physicians with their MIPS reporting under the Center for Medicare & Medicaid Services' Quality Payment Program (QPP), under the Medicare Access and CHIP Reauthorization Act (MACRA).

In a recent interview, Deb Bass, executive director of the Nebraska Health Information Initiative (NeHII), told me: "When the MACRA legislation first rolled out, I thought, here is our opportunity to step up to the plate." The HIE set out to become a qualified clinical data registry (QCDR) and offer MIPS calculator tools to allow providers to report to the QPP through NeHII in 2018.

I was reminded of all this when I came across the new strategic plan for the Statewide Health Information Network for New York (SHIN-NY). Its SHIN-NY 2020 Roadmap echoed many of the things people at the SHIEC conference told us about how they were aligning with stakeholders in the shift to value-based care.

The decade-old SHIN-NY is comprised of eight regional health information networks connected together to share patient information. The ultimate vision, according to Valerie Grey, executive director of the New York eHealth Collaborative, is that the SHIN-NY will create a 360-view of a patient’s health, empowering them and their care team to create a treatment plan that addresses not only an illness or injury, but underlying conditions, medical history, and social determinants of health.

The roadmap stressed that organizations using the SHIN-NY are already seeing a significant impact: fewer hospital readmissions and emergency department visits and reductions in unnecessary lab tests and x-rays.

But the roadmap also acknowledges the financial pressure SHIN-NY is under. It notes that virtually all Affordable Care Act (ACA)-related proposals at the federal level would have negative fiscal implications for providers and create immense challenges for New York State's Budget. “New York will likely face reductions in federal Health Information Technology for Economic and Clinical Health (HITECH) funding in the near future and the enhanced HITECH match expires in 2021. While all stakeholders will strongly advocate for maximum funding, the SHIN-NY will potentially face a perfect storm of reduced support over the next several years.”

• Other Headwinds HIEs Are Facing?  New and potential advancements such as Fast Healthcare Interoperability Resources (FHIR), Blockchain, machine learning, and natural language processing could have significant impacts on the traditional forms of HIE, the strategic plan notes. In addition, “some argue there are alternatives to state HIEs given several EHR vendors’ efforts to connect different systems through private exchanges and the availability of national HIEs.”

The roadmap identifies several key strategies to address the challenges it faces, including:

• Ensuring a Strong HIE Foundation Across the State: Partly due to initial design and rollout, statewide SHIN-NY participation is strong for hospitals, federally qualified health centers, and public health departments, but not as robust for physician practices (especially small ones), home care agencies, nursing homes, behavioral health providers, and others. There is also wide variation across the regions in terms of participation, data completeness, consent, and usage of core services. As more community-based organizations are involved in care teams and population health efforts, it will be necessary to develop additional participation targets and determine appropriate levels of data viewing and data contribution.

Supporting Value-Based Care: An independent statewide assessment of provider input is underway to further inform prioritization of potential enhancements. Based on earlier stakeholder discussions, some functionality enhancements that could be undertaken to improve workflows and help providers include, but are not limited to:

• Single sign-on for DOH’s Health Commerce System (e.g. prescription drug monitoring, immunization registry, etc.)

• Advanced alerts with action-oriented information or results delivery with flags for abnormal results

• Documentation of upload and view/download of summaries of care to demonstrate compliance for MACRA/MIPS

• Increased integration with EHRs

• Ability to exchange care plans among teams

• Potential expansion of available data related to national patient centered data home

The statewide assessment will also seek to better understand provider interest in the types of data currently not available through the network.

Based on stakeholder feedback, examples of additional data and services that could help support value-based care and initiatives such as Medicaid’s DSRIP value-based payment, Medicare’s alternative payment models (APMs) & MIPS, include but are not limited to:

• Medication fill data

• Quality measurement reporting

• Claims data (potentially via the All Payer Database and eventually inclusive of ICD-10 z-codes, i.e. social determinants of health)

•  eMOLST (Electronic Medical Orders for Life-sustaining Treatment in New York State)

• Variety of registries (cancer, electronic death registration system, etc.)

•  Housing, hunger, and other social determinants of health indicators

NYeC estimates that about half of adult New Yorkers have provided the necessary written affirmative consent to allow their clinical data to flow to at least one provider. Recommended changes to consent policy to facilitate the use of HIE to improve healthcare delivery include:

•  Patient alerts without written consent to those with treating relationships, and

•  SHIN-NY consent incorporated into other consents (such as health insurance enrollment forms).

Promoting Efficiency and Affordability. Given the financial pressures that are likely on the horizon, SHIN-NY operations will need to be re-examined and value-engineered with an eye toward improved efficiency and affordability. “This is especially true when considering the stress that will be placed on the system through the increased number of SHIN-NY participants and demands for additional services and data,” the report notes. The effciency opportunities can take many forms


• Group purchasing

• Specialization by regional HIEs

• Standardization

• Shared services

• Potential mergers between the regional HIEs

The report notes that the pressure will become more intense if total funding is reduced and underscores the need for market analyses to inform sustainability discussions.

The current system sometimes supports duplication and non-standardized approaches (e.g. high-cost EHR interfaces). Moving forward, a new “wire once/pay once” strategy will be employed. Given that the SHIN-NY network allows the regional HIEs to provide information statewide, payments will be made only once rather than multiple times for connections to multiple HIEs or NYeC. This strategy would apply to various statewide data, certain services, and provider / EHR connections.

Clearly, the SHIN-NY stakeholders have a lot to keep them busy over the next three years! And perhaps other states can learn some lessons from the things SHIN-NY has chosen to prioritize. We’ll keep an eye on their progress.



2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


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

September 17, 2018
by Heather Landi, Associate Editor
| Reprints

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.

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.”


More From Healthcare Informatics


The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
| Reprints
The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) 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—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”

Related Insights For: HIE


Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018
by David Raths, Contributing Editor
| Reprints
Earlier effort failed because HIE was not self-sustaining

The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

An earlier statewide HIE effort, the Connecticut Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream. (The State of Montana also recently decided to take a second try at creating a statewide HIE.)

The grant, awarded by the Center for Medicare and Medicaid Services (CMS) to the Connecticut Office of Health Strategy (OHS), supports efforts to develop a secure, modern HIE that facilitates the sharing of health data to further patient care, improve proper efficiency, and rein in the high cost of healthcare. The HIE is expected to be operational by early 2019.

The grant follows a $5 million federal investment the state received in 2017 that facilitated HIE planning. To qualify for the additional resources, states outlined how their health technology plan would improve disease management, serve the Medicaid population (over 800,000 Connecticut residents), combat the opioid epidemic, and improve overall healthcare through the use of clinical data.

The new round of funding launches a pilot program for the health information exchange, which was one of the nine recommendations made by the Health Information Technology Advisory Council, a statutory body tasked with a comprehensive examination of Connecticut’s current health technology needs.

“The health information exchange will improve care. Providers will be able to exchange clinical and diagnostic data in real time – efficiencies that will save time and resources for healthcare systems and patients,” said OHS Health Information Technology Officer Allan Hackney, in a prepared statement. “We engaged nearly 300 providers and consumers and 75 organizations across the health sector in Connecticut to help us understand the issues and opportunities for improving care delivery and outcomes. Technology can and should be a great partner in health reform.”

Another goal is for the HIE to enable a platform for measuring clinical quality and more quickly analyzing population health – one of the keys to improving healthcare accessibility and correcting racial, ethnic, and gender health inequities. Currently, analysts most commonly use insurance claims data, which is only a proxy for real-time clinical information. This use of the HIE dovetails with the work of OHS’s State Innovation Model Office and the Health Systems Planning Unit in their efforts to better address gaps in healthcare, improve community health, and evaluate the performance of Connecticut’s healthcare providers.


See more on HIE