Qual-IT - August 2005 | Archived

In October 2004, the United Hospital Fund provided funding to the eHealth Initiative (eHI) Foundation to launch the New York State HIT Policy Summit Initiative.  Working in partnership with the Health Policy and Strategy Group at Manatt, Phelps & Phillips LLC, eHI set out to engage a broad range of health care leaders across the state to determine what steps could be taken to improve health care in New York through broader adoption of HIT and health information exchange. 

While there is strong support across the state for advancing HIT adoption and use, there are also major obstacles.  Summit participants expressed the need for leadership in defining the vision, goals, and principles of HIT policy in New York. Collaboration across diverse stakeholder interests is also required, to equitably distribute the costs and benefits of widespread HIT use.  Financing is a major concern, and there is general agreement that a variety of funding sources will be needed, including government-sponsored grants as well as health plan incentive payments.  Several innovative regional initiatives are developing practical strategies and tools to advance HIT implementation, but coordinated strategies are also needed to drive the adoption of standards and ensure interoperability among health information systems across the state.

Having established some broad areas of agreement through the first phase of the summit initiative, eHI and the Fund have identified several concrete steps that will further define and advance the HIT policy agenda in New York: 

• eHI will draft an HIT policy framework that defines how priorities to improve health and health care in New York will be addressed through broad HIT adoption; these priorities include improving health care quality and efficiency, improving patient safety, and improving the prevention and management of chronic diseases.
• The Fund will conduct additional research and consult with the summit participants on options for establishing an ongoing statewide HIT leadership organization. 
• eHI will develop the prototype for a New York State HIT policy Web site that could serve as a vehicle to support ongoing communication and coordination across communities in New York and around the country.
• eHI will also identify specific strategies for estimating HIT value and for developing business models to sustain HIT adoption and use, building on the New York State analysis conducted by the Center for Information Technology Leadership (described below).

That analysis, “The Value of Healthcare Information Exchange and Interoperability,” was summarized by Center staff in the January 2005 issue of Health Affairs (Walker 2005).  The Center developed its model to estimate the benefits and costs of fully standardizing six categories of health care transactions – health information exchanges between providers, and between providers and laboratories, radiology centers, pharmacies, public health agencies, and payers – and to determine how those benefits and costs would be allocated across stakeholders.  The model projects a ten-year phase-in for HIT adoption and its attendant costs and benefits, as well as annual “steady-state” figures that would apply after widespread uptake of the technology. 

The benefit of such full-scale, "Level 4," seamlessly integrated, standardized health care information interoperability would be considerable: $77.8 billion nationally each year, $4.54 billion of that in New York alone, the Center estimates.  Perhaps more importantly, the analysis shows that all categories of providers and payers would benefit, suggesting great opportunities for standards-based HIT adoption and use to generate a “win-win” proposition for health care in New York.  The Fund is now exploring opportunities to refine and apply this value model to specific New York HIT initiatives.

Focusing on opportunities for HIT policy coordination, the New York State Department of Health has established an HIT Working Group as a vehicle to communicate and coordinate across a wide variety of state agency components – Medicaid, public health, professional licensure, technology procurement, and capital financing, to name a few.  Several funding opportunities directly or indirectly related to HIT are in process:

• HEAL-NY funds were approved in the state's 2005 budget, and additional federal waiver funds may soon be available as well.
• An RFP for disease management demonstration projects has been published, and the budget also established a new “pay for performance” demonstration program.
• Additional funds were appropriated to support physician HIT adoption. 

The state health department's coordinated approach will address both the general purposes of these funds and specific criteria relating to them, including allocation of funds by broad category and then among specific projects, and managing the formal grant application and awards process.  It is also exploring opportunities to promote broad adoption of electronic prescribing as a means to improve quality and safety, while maintaining the state's stringent regulatory provisions relating to controlled substances.   

While national and statewide policy agendas are still in the early stages of formation, numerous HIT collaborations are forming locally throughout the state.  The New York Health Plan Association (NYHPA) has convened the New York State Coalition for Health Information Technology, comprising numerous health care associations and organizations and serving as a forum to identify opportunities for HIT collaboration. In June 2005, the Coalition organized an educational conference, “Health Information Technology Adoption: Benefits and Barriers,” which drew almost 200 attendees representing a variety of health care interests in New York.  NYHPA has also convened several forums focusing on opportunities for collaboration on electronic prescribing initiatives.

The Greater New York Hospital Association (GNYHA) recently published a profile of ten regional health information exchange projects (GNYHA 2005).  These cover almost every region of the state – from New York City to Buffalo – and represent a diverse range of stakeholders in each of these communities.  They address a number of distinct issues, with several projects focusing on the same areas: 

• Taconic Health Information Network and Community focuses on physician adoption of electronic medical records, and the transmission of prescribing and performance measurement information through a Web-based data exchange portal.
• Several projects are focusing on access to patient information at the point of care, in both emergency rooms (New York Clinical Information Exchange, or NYCLIX, which is being organized by GNYHA) and elsewhere in the community (Capital District Region Task Force).
• Personal health records are the focus of the Queens Health Connection Card Program and one of the components of the Upstate New York Professional Healthcare Information and Education Demonstration Project (UNYPHIED).

Additional information about regional health information exchange activities in the state is also contained in the New York State Health Information Technology Policy Summit Initiative Interim Report and in the complete briefing paper and addendum compiled by eHI and Manatt, Phelps & Phillips for the Initiative (eHealth Initiative Foundation 2005).

Federal and state policies governing HIT funding and implementation efforts are evolving rapidly.  There are early signs of convergence – for example, the concentrated focus on physician adoption and use of electronic medical records – and also much diversity in terms of strategies to promote interoperability.  State policy coordination has great potential both to support regional HIT collaborations and to articulate specific priorities for HIT that will address New York's most pressing health care challenges.  The Fund will continue to monitor and report on these activities in future editions of Qual-IT.

eHealth Initiative Foundation.  2005.  New York State Health Information Technology Policy Summit Initiative: A Briefing Paper.  Available online at www.uhfnyc.org/pubs-stories3220/pubs-stories_show.htm?doc_id=292246 (pdf – 739k).

———  2005.  New York State Health Information Technology Policy Summit Initiative: Addendum to the January 2005 Briefing Paper.  Available online at www.uhfnyc.org/pubs-stories3220/pubs-stories_show.htm?doc_id=292255 (pdf – 369k).

———  2005.  New York State Health Information Technology Policy Summit Initiative Interim Report.  Available online at www.uhfnyc.org/pubs-stories3220/pubs-stories_show.htm?doc_id=292260 (pdf – 69k).

Greater New York Hospital Association.  2005.  GNYHA members initiate clinical data exchange project.  Skyline News (Health Care News In-Depth supplement), p5.  Available online at http://www.gnyha.org/pubinfo/skyline/sky20050725.pdf

Walker J, E Pan, D Johnston, J Adler-Milstein, DW Bates, and B Middleton.  2005.  The value of healthcare information exchange and interoperability.  Health Affairs.  Available online at http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.10v1