1. 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.

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

3. 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

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

5. 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

6. 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”

7. BACKGROUND (5)
Sample consent form

8. 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)

9. How to use the SHIN-NY and RHIO data

10. 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

11. 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

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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. CONTACT INFORMATION
New York eHealth Collaborative:
Bronx RHIO
Healthix
NY Care Information Gateway

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