HEAL NY: Promoting interoperable health information technology in New York State

Article (PDF Available)inHealth Affairs 28(2):493-504 · March 2009with15 Reads
DOI: 10.1377/hlthaff.28.2.493 · Source: PubMed
Abstract
Through a novel, ambitious program called HEAL NY, New York State plans to invest $250 million in health information technology (IT) that can be linked electronically to other health IT systems. In contrast to high rates of closure by other organizations attempting health information exchange (HIE), 100 percent of HEAL NY Phase 1 grantees still existed two years after awards were announced, 85 percent were still pursuing HIE, and 35 percent had actual users. The number of grantees meeting basic criteria for regional health information organizations (RHIOs) increased. Although it is early, lessons learned can inform state-based initiatives nationwide.
In the Literature
Highlights from Commonwealth Fund-Supported Studies in Professional Journals
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HEAL%NY:%Promoting%Interoperable%Health%Information%
Technology%in%New%York%State%
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March 10, 2009
Authors: Lisa M. Kern, M.D., M.P.H., Yolanda Barron, M.S., Erika L. Abramson, M.D., Vaishali Patel, M.P.H., Ph.D., and
Rainu Kaushal, M.D., M.P.H.
Journal: Health Affairs, March–April 2009 28(2):493–504
Contact: Rainu Kaushal, M.D., M.P.H., Chief of the Division of Quality and Clinical Informatics, Weill Cornell Medical College,
rak2007@med.cornell.edu, or Mary Mahon, Senior Public Information Officer, The Commonwealth Fund, mm@cmwf.org
Full text is available at:
http://content.healthaffairs.org/cgi/content/full/28/2/493?ijkey=5gQUFsHX9E8I.&keytype=ref&siteid=healthaff
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Synopsis
A program in New York has changed the
state’s health care landscape by providing
grants to regional alliances seeking to
implement interoperable health information
technology (IT). All alliances that received
grants in 2006 remain operational, in
contrast to the high failure rate found among
similar groups in other states.
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The Issue
Three-quarters of U.S. states are developing
the capacity for electronic health information
exchange (HIE) among health care organizations. HIE makes it possible to integrate health care
information, improve the quality of care, and decrease costs. States have focused on implementing HIE
through regional health care information organizations—alliances of physician practices, hospitals,
pharmacies, and laboratories, and other stakeholders—but a national study found that one-quarter of
these entities closed within a year of startup. With funding from the Healthcare Efficiency and
Affordability Law for New Yorkers Capital Grants Program (HEAL NY) New York State plans to invest
$250 million in health IT, the largest state-based public investment of its kind, by awarding grants
to health care stakeholders committed to implementing HIE, interoperable electronic health records,
or electronic prescribing. Currently, $160 million in HEAL NY funds has been granted and $230 million
in private sector dollars committed to health IT infrastructure, bringing New York’s investment to
$390 million.
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Key Findings
HEAL NY grantees—typically community hospitals and physician practices—were distributed across
all six regions of New York State and received an average of $1.8 million.
All grantees still existed and were implementing or attempting to implement interoperable health IT
at follow-up. Half had reduced the number of projects they were pursuing.
More than three-fourths of grantees were still pursuing HIE, half were still pursuing EHRs, and half
were still pursuing e-prescribing. Only one-third of grantees had users, reflecting the newness of the
initiatives and the difficulties of implementation.
At follow-up, the most commonly cited barriers to sustainability were the need for stakeholder buy-in,
lack of alignment of financial incentives, and funding concerns.
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Addressing the Problem
Financial sustainability is a concern for communities implementing
interoperable health IT. Robust reimbursement models are needed,
including those that propose sharing costs and benefits across
stakeholders. Newer-generation software applications that result in
fewer workflow and other difficulties also will be necessary.
Policymakers should be aware that it takes time for such technologies
to produce positive clinical and economic outcomes, and that they
must be aligned with health care delivery and reimbursement reforms
to do so.
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About the Study
The study included 26 grantees encompassing community hospitals, physician practices, health plans,
long-term care facilities, home care agencies, and local public health departments from across the state.
These received a total of $53 million in HEAL NY grants. A baseline assessment included 26 open-ended
questions intended to characterize grantees’ progress in developing HIE, electronic health records, and e-
prescribing; structural issues, such as governance and sustainability; and expected impact. A follow-up
assessment examined the proportion of grantees still pursuing initial projects.
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The Bottom Line
HIE is a viable strategy for improving the quality and efficiency of care, but it requires policy support,
technological building blocks, and clinical capacity, as well as financial and time commitments. HEAL NY
represents a public-good funding model that can help offset communities’ upfront cost to implement HIE.
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Citation
L. M. Kern, Y. Barron, E. L. Abramson et al., “HEAL NY: Promoting Interoperable Health Information
Technology in New York State,” Health Affairs, March–April 2009 28(2):493–504.
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This summary was prepared by Helen Garey and Deborah Lorber.
HEAL NY has already
changed the health care
landscape in New York by
creating novel
alliances that are
changing health
care delivery at
the local and
regional levels.”
    • "Since 2010, the State Health Information Exchange Cooperative Agreement Program has committed nearly $550 million to HIE [37], and funding through the Meaningful Use Program represents a $30 billion investment in health IT242526. Additionally, several states, including New York, have invested significant amounts of public dollars in HIE [38,39]. These investments have been made with expectations of gains in quality and improved efficiency in health care [40]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: The aim of this study was to quantify the association between health information exchange (HIE) use and cost savings attributable to repeat imaging. Methods: Imaging procedures associated with HIE were compared with concurrent controls on the basis of propensity score matching over the period from 2009 to 2010 in a longitudinal cohort study. The study sample (n = 12,620) included patients ages 18 years and older enrolled in the two largest commercial health plans in a 13-county region of western New York State served by the Rochester Regional Health Information Organization. The primary outcome was a continuous measure of costs associated with repeat imaging. The determinant of interest, HIE use, was defined as system access after the initial imaging procedure and before repeat imaging. Results: HIE use was associated with an overall estimated annual savings of $32,460 in avoided repeat imaging, or $2.57 per patient. Basic imaging (radiography, ultrasound, and mammography) accounted for 85% of the estimated avoided cases of repeat imaging. Advanced imaging (CT and MRI) accounted for 13% of avoided procedures but constituted half of the estimated savings (50%). Conclusions: HIE systems may reduce costs associated with repeat imaging. Although inexpensive imaging procedures constituted the largest proportion of avoided repeat imaging in our study, most of the estimated cost savings were due to small reductions in repeated advanced imaging procedures. HIE systems will need to be leveraged in ways that facilitate greater reductions in advanced imaging to achieve appreciable cost savings.
    Article · Dec 2015
    • "However, that approach may have reached its limits of effectiveness, or at least may be in a period of diminishing returns. Users in this study wanted more providers participating, but that is within the context of numerous forces that should increase participation: providers generally wanting the information made available by HIE systems [44], extensive state and federal funding for practices to implement EHRs [9, 45], Meaningful Use criteria that require exchange capabilities [46] , and (at least in New York) RHIOs that have been operational for multiple years. Currently, providers have multiple options to meet Meaningful Use requirements that do not require the on-going exchange of data with a wide-variety of community providers as in the RHIO model. "
    [Show abstract] [Hide abstract] ABSTRACT: Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.
    Full-text · Article · Oct 2014
    • "Fountain's technology enactment framework builds on enactment theory and considers that technical factors and organizational structures are embedded within each collaborating organization, and that the relationship between multiple factors is critical [60]. Others have suggested that while technical performance is a crucial element in any resulting information exchange between organizations, successful interorganizational data exchanges frequently hinge on organizational and governance factors [56,616263. However, other research notes that motivational factors and context can be the true underpinnings of collaboration [64,65]. "
    [Show abstract] [Hide abstract] ABSTRACT: Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders' perspectives across technical, organizational, and governance dimensions. Several challenges, successes, and lessons learned during the implementation of a health system to the statewide HIE were found. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged, and early communication with the electronic health record vendor so that they have a solid understanding of the undertaking was critical. An HIE implementations evaluation framework was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations. This case study illuminates five critical success factors for implementation of a health system onto a statewide HIE. This study also reveals that organizations have varied motivations and value proposition perceptions for engaging in the exchange of health information, few of which, at the early stages, are economically driven.
    Full-text · Article · Aug 2014
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