Statewide Health Information Network of New York (SHIN-NY) and Regional Health Information Organizations (RHIOs) Institute for Implementation Science in population health at cuNY CUNY Graduate School of Public Health and Health Policy September 2016 Disclaimer: The information in this slide set was assembled by the The Institute for Implementation Science in Population Health at CUNY to inform the work of the NYC DSRIP HIV projects. The content of these slides is based on publicly available information as of September 2016. For detailed SHIN-NY inquiries, see the resources and contact information slides.

OUTLINE Background Content How to use the data Strengths and limitations Resources

BACKGROUND (1) What are SHIN-NY and RHIOs? Network allowing exchange of patient clinical records between participating providers via patient lookup, alerts, secure messaging, and lab result delivery Implemented in 2008 Aim to streamline patient care, improve patient safety and experience, lower readmission rates, support public health activities, and improve emergency response SHIN-NY is comprised of eight independent regional health information organizations (RHIOs) and 59,676 participating providers within them (and growing) 3 RHIOs serving NYC: New York eHealth Collaborative, Bronx RHIO, and Healthix RHIOs offer a variety of additional services such as analytics

BACKGROUND (2) Focus on cross-sectional interoperability: people, data, systems

BACKGROUND (3) SHIN-NY adoption level Adopted by 91% of NYS hospitals, 83% of health departments, 40% of long term care facilities, 21% of clinical practices

BACKGROUND (4) SHIN-NY population and geography State-wide (with 3 NYC-specific RHIOs) Consenting adults (8.3 MM New Yorkers) Not HIV specific Timeframe of available data Undefined start (retrospective data, provider-specific) – present Accessibility of data Restricted use data, accessible to qualified entities “involved in [patient’s] care” Depends on circumstances and patient’s level of consent Full consent, for use of data for circumstances “… including emergency care, quality improvement, care management, and pre-authorization activities…” Partial consent, only for use “in a medical emergency”

BACKGROUND (5) Sample consent form

CONTENT What’s in the SHIN-NY data HIV-related indicators Provider name, type, address Patient sociodemographics Visit / service dates (in/outpatient) Tests, diagnoses, and procedures Laboratory results Immunizations Prescriptions (limited) Behavioral health data Insurance claims data Extent depends on RHIO: e.g. Bronx RHIO has over 95% of borough’s hospital discharges, over 600,000 annual ER visits, 4.5 million annual ambulatory care visits HIV-related indicators HIV testing, diagnosis Labs: CD4, viral load, CBC, serum chemistry Opportunistic infections, AIDS-defining conditions Antiretroviral treatment prescriptions (limited)

How to use the SHIN-NY and RHIO data

HOW TO USE THE DATA (1) Access data about specific patients (via web portals, alerts) Monitor patients, improve care coordination with information on health services across the RHIO or NYS Identify patients at high risk of encounters, including ER services, hospital admissions and readmissions Subscribe to notifications about clinical events E.g. in August 2016, Healthix delivered 126,143 real-time notifications, 60% of which went to organizations providing HIV care

HOW TO USE THE DATA (2) Analyze population-level data (via web portals) View and stratify population disease prevalence and risk Access predictive analytics with population risk models, e.g. on risk of chronic conditions, heart failure, or mortality; future service use Create RHIO-level HIV care continua Lookups and reports can be integrated into institutional EMR Healthix web portal

HOW TO USE THE DATA (3) Examples of RHIO data use by HealtheConnections

HOW TO USE THE DATA (4) Healthix RHIO collaboration with the AIDS Institute (Ending the Epidemic) to enhance the NYS DOH ability to monitor the health and treatment of HIV+ individuals and retain them in care

HOW TO USE THE DATA (5) Potential use of SHIN-NY and RHIO data to further DSRIP PPS work Collaborate on tracking patients shared within the systems to improve efforts aimed at HIV care engagement and viral load suppression Look up consenting facility patients to obtain their HIV care and viral suppression status information from other participating NYS providers; get clinical event notifications for subscribed patients Create HIV-care continua Predict risk of chronic conditions and service use by PLWH Analyze volume of activity by county, zip code, and facility Assess summary data with respect to DSRIP metrics and targets for readmission rate, mortality rate, length of stay etc.

STRENGTHS Standardized data sharing across the state Growing network Additional functionalities and data points being introduced (e.g. immunizations) Increased efficiency in accessing data from multiple RHIOs via single source

LIMITATIONS What to keep in mind: Despite the system’s growth, most clinical practices don’t participate, potentially excluding large volumes or primary and specialist care data, including HIV care Different levels of consent: some patients only consent for data access in medical emergencies, others don’t consent at all Because of ongoing, incomplete adoption by providers, as well as lack of consent from a proportion of patients, the data should not be treated as NYS population representative Medicaid Eligible Providers may be not participating at a high rate, due to limited funding to support interface connections Patient health information can be looked up, but not downloaded as a dataset Different formatting of records across regions Different extent of services and data provided by individual RHIOs

RESOURCES AND REFERENCES Publications and reports RHIO analytics example – HealtheConnections RHIO analytics example – Healthix collaboration with AIDS Institute Guides/guidelines and general information Bronx RHIO Healthix NY Care Information Gateway SHIN-NY background SHIN-NY background (2) SHIN-NY webinar Video SHIN-NY services Joining SHIN-NY – qualified entities

CONTACT INFORMATION New York eHealth Collaborative: info@nyehealth.org Bronx RHIO cscaglio@bronxrhio.org Healthix info@healthix.org NY Care Information Gateway al.marino@interbororhio.org

CUNY Institute for Implementation Science IN population health Thank you! CUNY Institute for Implementation Science IN population health cunyisph.org