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Stony Brook PPS PAC
State of the SHIN-NY Strategic Planning Update
Val Grey
Executive Director
March 21, 2017
DSRIP Project Milestones Include SHIN-NY
Suffolk Care Collaborative Projects with SHIN-NY Requirements:
• 2.a.i: Create an Integrated Delivery System Focused on Evidence-Based Medicine / Population Health Management• 2.b.iv: Care Transitions Intervention Model to Reduce 30-Day Readmissions of Chronic Health Conditions• 2.b.ix: Implementation of Observational Programs in Hospitals• 3.b.i: Cardiovascular Health Evidence-Based Strategies for Disease Management in High-Risk / Affected Populations
SHIN-NY
Direct Exchange
Alerts
Patient Record Lookup
Integrated Delivery System
Care Coordination
Transitional Care
Disease Management
HIE ValueDSRIP VBP
3
Hospitalization Event Notifications and Reductions in Readmissions of Medicare Fee-for-Service Beneficiaries
in the Bronx, New York
Journal of the American Medical Informatics Association
October 7, 2016
An Empirical Analysis of the Financial Benefits of Health
Information Exchange in Emergency Departments
Journal of the American Medical
Informatics Association June 27, 2015
Improve patient outcomes
Less time testing and more on patient care
Shared savings opportunities
(MACRA, DSRIP, APC, Commercial)
Improve accuracy and speed of
diagnosis
Value Based Care
SHIN-NY Update
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SHIN-NY: A Network of Networks
Qualified Entities (QEs) Core Services (funded by government, free to providers) include:
• Secure messaging
• Notifications & alerts
• Results delivery
• Patient record lookup & clinical viewer
• Consent management
• Public health access
QEs offer value added services (for a charge)
Why Do We Need SHIN-NY & NYeC? Patients Are Mobile & EHRs Are Not Interoperable
QE% of PatientsOverlapping
other QEs
HEALTHeLINK 13
Rochester 12
HealtheConnections 19
Hixny 11
HealthlinkNY 34
Bronx 41
Healthix 12
NYCIG 46
6
Statewide Patient Record LookupImplemented in 2015 & Working
Allows QEs to query and get important clinical information from other QEs to share with providers
Cross QE AlertsBeing fully implemented in 2017
Allows QEs to receive, without querying, important clinical information from other
QEs to share with providers
Wave 2
• HealthlinkNY
• HealtheConnectionsQtr. 2
Wave 1
• Healthix• Hixny• NYCIG
Live and working
Wave 3
• Bronx• HEALTHeLINK• Rochester
Qtr. 3
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Statewide AdoptionSignificant Progress But More Work to Do
We need to focus on increasing adoption
92% providing complete minimum data
97% of FQHC
98% of Hospitals
47% of Home Care Agencies
81% of Public Health Departments
55% of Long Term Care Facilities
57% of Physicians
New expanded DEIP program designed to help
*All are current adoption rates as of March 18, 2017
Statewide UsageCore Services in Past Year
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SHIN-NY Service Utilization is Growing
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• This chart shows how often a SHIN-NY user has interacted with SHIN-NY patient data by service utilization type.• Hixny corrected the way they calculate Results Delivery, resulting in a higher count for January. Historical corrections are pending. *Updated January 20, 2017
10
SHIN-NY Services Used Differently Across Regions
January 2017
• In January, HIXNY altered their method of measuring results delivery which resulted in increase of volume. It may be adjusted historically for future reports.
*Updated January 20, 2017
Consent Distribution By County
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NYeC is recommending changes to consent policy to facilitate the use of HIE to improve healthcare delivery including:
• Patient alerts without consent to those with treating relationships
• SHIN-NY consent could be incorporated into other consents
Longer-term: Exploring opt-out system like used by 38 other states
18 counties representing total population of 12 million people have less than ½ their population consented
NYeC’s Memo regarding Consent Recommendations: http://www.nyehealth.org/nyec16/wp-content/uploads/2016/04/SHIN-NY-Proposed-Consent-Recommendations_Board-Memo-003.pdf
NYeC’s Consent White Paper: http://www.nyehealth.org/nyec16/wp-content/uploads/2017/02/SHIN-NY_consent_white_paper_022817.pdf
*Updated January 20, 2017
Innovation is HappeningA Sampling
Some QEs are piloting integration of clinical data with Medicaid claims
GNYHA coordinating pilot to facilitate sharing of care plans
Some QEs are testing quality reporting via extraction from network
Work being done to integrate public health registries and cancer registry
Image exchange across the state is expanding
Statewide patient portal is being tested
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Strategic Planning
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Game Plan & Target Timelines
THROUGH SEPTEMBER2017
THROUGH OCTOBER 2017
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Multi-Year Roadmap
Long-Term Vision
What’s In It
• Mission
• Vision
• Guiding Principles
• Long-Term Objectives
Operational Plan
What’s In It
• Strategies
• Action Plan
• Metrics & Measurement
• Budgeting
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Listening & Seeking Customer and Stakeholder Input
Stakeholder Focus Groups
• All Provider Types
• Health Plans
• Consumers
• Qualified Entities
• DOH Workgroups
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• What are the most significant barriers to adoption?
• If you are using QE / SHIN-NY services today, what do you find most valuable?
• How integrated is your usage of the SHIN-NY into your current workflow?
• Are there ways to better integrate SHIN-NY data within your current workflow?
• Are there changes that could be made to make the functionality more useful and easier to use?
• Are you able to receive, share, and use the data you and your partners need?
• Is there other statewide data that you would find beneficial?
• How can we be most helpful for value-based care and population health work?
• What is the best way to maximize SHIN-NY benefit and build-in a way that is flexible and evolving?
Our Burning QuestionsSHIN-NY & “Finishing the Job”
What Providers Are Asking For
Simplicity & ease of use
(SSO)
Speedy relevant
information
Better quality & complete
data
“Search –ability”
Finish the basics
Information that goes
across borders
Alignment & Standardization
Easy reporting
Output that matters
EHR integration
Highest privacy & security
Consent policy
changes
Help educating patients
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Driving Forces
Health System & HIE
Contraction in Funding
Care Delivery Changes
Consolidation
Competition
(Opportunity?)
Consumer Expectations
Continuous Technology Advances
Future Considerations & Trends
Data Quality Assurance
Patient Engagement &
Customer Needs
Quality Reporting
All Payer Database
Social Determinants
of Health
Population Health
20
Health IT Quality Reporting
US Physicians spend > $15.4B to report quality measures; 785 hours per doc; > $50K per PCP; and,
this doesn’t count insurer costs
WHY?
• Make providers & payers lives easier
• Simplify/align measures
• Continuous quality improvement for patients &communities
Healthcare Association of NYS (HANYS)
“Measure Madness” & “Quality Reporting Madness”: Hospitals are very frustrated and
eager to simplify and streamline
Integrating Social & Medical Data
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• Opportunities to connect and integrate data
• Newer ICD-10 claims data contains z-codeso Z-codes, eventually,
should capture social determinants of health information that could help provide more holistic care and support
• NYS All-Payer Database
WHY?
• Supports value based care
• Helps patients and allows holistic approach based on consistent information
• Promotes healthy communities
Vision & Mission
SHIN-NY
Our mission is to improve healthcare through the
exchange of health information whenever and
wherever needed
NYeC
Our mission is to improve healthcare by collaboratively
leading, connecting, and integrating health
information exchange across the State
Shared Vision
Our vision is a dramatically transformed healthcare
system where health information exchange is
universally used as a tool to make lives better
23
Some Planning Assumptions
• Pressure on government funding
• Need to supplement with other funding and work toward sustainability
• Current “network of network” approach will be retained but will likely change
• Better integration and alignment with State and Federal health reform initiatives
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• Stakeholders will demand improvements
• NYS will set clearer (fundable) priorities
• More competition to create tools for providers and plans
• Roles and responsibilities will shift and change, sometimes significantly
Proposed Guiding PrinciplesPassionate Beliefs
• Patient-centered
• Public benefit
• Support reform initiatives
• Stakeholder inclusive
• Consensus building
• Customer-focused
• Regional markets
• Statewide good transcends individual interests
• Operational excellence• Trust, security and transparency• Efficiency--value engineering• Leverage private investment• Highest quality, integrated data• Leading technology• Standardization• Influence & alignment with federal
standards
Strong advocacy and using all levers at federal, state and local level to promote robust SHIN-NY
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DRAFT SHIN-NY Long-Term Objectives
Work toward
sustainability
Integration &
accessibility
Reach maximum potential
• Adoption close to 100%• Full data contribution by all (CCDA)• Highest data quality• Info shared for 95% of patients• Enhance functionality/customer satisfaction• Highest level security & system reliability• Effective, efficient, affordable
• Data standardized and normalized• Data both pulled and pushed• Useful tools for VBC (including care plans)• Clinical & other useful data can be integratedo Claimso Registrieso Social determinantso Consumer reported
• Data used for quality reporting• Integrated with APD• Data available to patients/consumers
• Because the SHIN-NY is of high-value, and used by virtually everyone, users will enthusiastically support via user fees or other mechanisms
27
DRAFT NYeC Long-Term Objectives
Connect HIE &
Ensure Access to Statewide
Data
Advocacy &
Education
Lead SHIN-NY Efforts*
*in partnership with New York State
• Provide thought leadership & collaboration• Recommend policy, governance, operations,
functionality• Contract for SHIN-NY enterprise including QE core
services• Ensure oversight, performance & consistent
measurement• Achieve maximum SHIN-NY potential• Create self-sustainability options when maximum
potential reached
• Advocate on behalf of SHIN-NY for funding & policy• Promote best practices & learning systems• Support federal efforts for interoperability• Present united voice & force with EHR vendors• Help providers transform, use EHRs, and connect to
the SHIN-NY
• Successfully connect QEs to facility data sharing (sPRL)• Create master provider index• Ensure access to statewide data (“wire once”)• Ensure technical standards & system performance
• Continue stakeholder engagement on Operational Plan
• Develop recommendations and priorities
• Goal of Operational Plan is for completion by July
• Then … on to QE performance-based contracting
• And implementation and execution of the Roadmap
• To support providers, plans, and communities achieve the “Triple Aim”
Next Steps . . .
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The Road Ahead
40 Worth Street, 5th Floor New York, New York 1001380 South Swan Street, 29th Floor Albany, New York 12210
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