HITEC: Evaluating the Economic Effects of Health Information Exchange Programs across New York State Rainu Kaushal, MD, MPH Associate Professor, Weill Medical College Director of Pediatric Quality and Safety at KCCH/NYPH Executive Director, HITEC

2 Background Clinical decisions are data driven Health information technology (HIT) with health information exchange (HIE) has been embraced as one strategy to improve health care quality and reduce costs by improving access to data Regional clinical data exchanges are occurring, with unknown effects

3 HEAL NY ( Healthcare Efficiency and Affordability Law for New Yorkers Capital Grants Program) $200 million investment Implementation grants of $50,000 - $10,000,000 per grant (for capital investments) Supporting multi-stakeholder HIE initiatives Grantees are required to provide matching funds and dedicate some funds for evaluation Evaluation efforts are likely to vary in quality and be non-standardized

4 Why Evaluate? Demonstrate value of HEAL initiative –Demonstrate uptake and usage Encourage future HIT and HIE adoption –Demonstrate economic benefits –Demonstrate consumer and provider satisfaction –Demonstrate quality and safety benefits Iteratively refine HIT and HIE –Understand what is working well –Understand what can be improved Disseminate lessons learned and successes broadly

5 HITEC Not for profit, multi-institutional academic collaboration –Based at Weill Medical College –With collaboration from Columbia University, SUNY- Albany, University of Rochester and others Aims to ensure robust evaluations of HEAL NY and other HIE initiatives in NY State –Provides expertise in evaluation methodology, health information technology, health economics, survey methodology and biostatistics –Conducts analyses across active HIE initiatives

6 CMWF Grant: Financial Methods Specific aim: Determine the ROI for providers of HIT/HIE implementation Methodology: Will include costs, benefits, and usage measures Design: Pre-post studies with concurrent controls Participants: 7 HEAL NY grantees –Diverse in terms of clinical setting, geography, and type of HIT/HIE intervention –Community based interventions –Evaluation team has no control over type or timing of HIT/HIE implementation

7 Progress to Date 1.Developed a financial framework at the level of HIT/HIE functionalities a.104 functionalities b.5 settings c.Each rated on likelihood of successful implementation and use, magnitude of financial benefit, ability to measure benefit 2.Validated by an expert panel

8 Progress to Date (cont) 3. Each participating grantee determined which HIT/HIE functionalities they were implementing and prioritized their studies of interest 4. Mapped against HITEC framework 5. Now engaged in planning 7 studies

9 Challenges 1.Varied HIT implementations for varied purposes 2.Varied perspectives on what is important to evaluate 3.Variable timing of implementations 4.Community based studies, network effects 5.Confounders 6.Rapid time-frame for studies 7.Data source challenges a.Availability b.Uniformity c.Metric definition d.Importance of numerators and denominators 8.Financial constraints for data collection