SHIN-NY, which is run by the New York eHealth Collaborative (NYeC), is making great strides as it works toward the integration of New York State’s existing HIEs and RHIOs in a single statewide network. SHIN-NY's proposition to the functioning HIEs and RHIOs is to provide the infrastructure in a utility model and also develop standards that will enable HIE vendors to interface with the statewide HIE.
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That proposition is a win-win situation for all stakeholders, according to Tom Check, interim CEO and president of Healthix. As one of seven RHIOs serving downstate New York, Healthix has the largest membership in patients and providers, with records of 7.7 million patients, and 165 participating healthcare facilities, including 40 hospitals and a large number of long-term care providers, physician practices and other providers throughout New York City and Suffolk and Nassau counties.
Several Barriers to Value
"There has been a lot of HIE infrastructure built downstate and a lot of patient records are being accumulated, but we haven't yet achieved the value from HIE that we could potentially achieve," Check pointed out. Any given patient can go from one RHIO to another RHIO, but the physician can only see patient records accumulated from providers participating in that one RHIO. "The doctor doesn't get as complete a picture of the patient as would be ideal," he said.
The RHIOs have built their own infrastructure and their own way of physicians using their EMR to get a quick window into the data of the HIE for a seamless workflow. They also have their own patient consent.
Downstate RHIOs are now either collaborating with or in discussions with NYeC to determine where consolidation of infrastructure, services, database software and operational support are feasible in order to address some of these barriers.
The next step will be the creation of more consistent policies among the RHIOs and the development of a standardized or common infrastructure. "Having a common infrastructure consolidated at NYeC should make it easier, once the RHIOs work through their policies, to access data that comes from multiple RHIOs, because the data would be in a common repository, or multiple repositories but managed by one entity, with appropriate permissions required to provide linkages among the RHIOs," Check explained.
This model should help engage electronic medical record (EMR) and other software vendors more fully to participate in HIEs, because HIE vendors would only have to deal with one set of standards to be able to interface with HIE in the state of New York, instead of configuring different technical requirements for interfaces to individual RHIOs. "NYeC has done a lot working with federal standards and EMR vendors, to come to understandings with the vendors as to how the federal standards need to be implemented in a concrete way so that they can interoperate more efficiently in an HIE," Check said.
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While the technical structure of those interfaces are similar to the one Healthix has developed over time, having one set of interface standards for EMR vendors to use when accessing and interfacing with HIE across the downstate area will be "very attractive to EMR vendors and it will really accelerate adoption of HIE, because physicians and hospitals that use EMRs will find it much easier to hook their EMRs into the HIE," he said.
In addition, the accumulation of more data from more data sources, which can potentially bring about better health outcomes from more complete patient records, will make HIE a more broadly valuable component in the healthcare system, according to Check. "We have the platform in place and the data largely accumulated, and now this consolidation should be a help to get more value to the participating organizations and their patients," he said.
Healthix entered into an agreement with NYeC effective July 30, and the transfer of its infrastructure to NYeC has been completed.
