By Sarah C. Shih, MPH, Executive Director, Program Evaluation and Planning, Primary Care Information Project
It was a great privilege to take part in a recent Philanthropy New York session on New York State’s overall health information technology strategy and share some thoughts on how we can move this project forward for the benefit of all New Yorkers.
I’ve been working with the Primary Care Information Project (PCIP), a Bureau of the New York City Department of Health and Mental Hygiene, for almost four years. PCIP was established in 2005 to implement electronic health records (EHRs) to improve the delivery of clinical preventive services and population health.
PCIP has helped over 3,000 primary care providers representing over 600 independent practices adopt and use EHRs, targeting communities with high Medicaid or uninsured patients. The challenge we face with providers that have adopted EHRs is accessing and using a health information exchange, a necessary infrastructure to improve care coordination for the chronically ill and potentially bring substantial savings in costs to the healthcare system.
Technology can be magical—such as the ability to search through millions of patient records and identify subgroups in need for follow-up care within seconds. Through millions of dollars, the state has laid the starting infrastructure to accomplish this. Yet, the efficiencies we seek aren’t available to all healthcare providers.
A major barrier facing providers in non-hospital settings is the ability to distill information for proactive management of patient populations. Current connections to a regional health information exchange organization allow providers to request information on an individual from other locations, such as diagnoses, lists of drugs and dosages, procedures, dates of visits, etc. This is useful if practices are seeking information for a specific patient. But patient-centered medical homes and Medicaid health homes (NYS programs launched to improve the health of the highest-cost Medicaid patients) increase the stakes for usable information exchange.
Providers now need to be able to track groups of patients across settings and “stitch” together a comprehensive history in order to anticipate what’s needed next. Maimonides Medical Center is one hospital system that has successfully established processes and resources to accomplish this. Other health centers are well on their way to doing the same.
For smaller primary care practices, the reality of population health management will require additional efforts, which will likely include:
- Assisting providers in digesting the numerous information streams they will have access to
- Developing dashboards or summaries that quickly list higher-priority issues for groups of patients
- Hiring new or retraining existing staff in order to routinely track patients
- Paying for the extra effort needed to proactively manage patients, such as increasing capitation, establishing a “management fee,” or including primary care providers in new payment models such as an accountable care organization
At PCIP, primary care providers in smaller settings are on their way to improving the delivery of clinical preventive services and working towards meaningfully using the EHRs they have adopted. We already oversee the NYC Regional Electronic Adoption Center for Health, which helps New York City physicians adopt EHRs and other technology and methods and makes sure they don’t get left behind.
The path to improved population health and cost savings is still a work in progress. I’m sure there will be setbacks where technology will have glitches and cause delays that exceed proposed timelines. It’s also likely revolutions in technology (e.g., new apps) will improve providers’ access to information from other settings, but even that is difficult to foresee, as thousands of providers work with the currently available technology. We’ll also continue to evaluate their interventions, which can help redirect the course we’ve plotted to reach our goals.
Though it’s expected that more challenges, planned and unplanned, will occur, judging from where we are now, I imagine we’ll look back in 5 years to see persistent progress in driving the improvements we need for a contemporary and continually improving healthcare system.
Sarah Shih oversees several program evaluation projects at PCIP, including use of health information technology for improving the quality of healthcare, pay-for-performance pilots, trends in healthcare utilization and provider experiences with PCIP activities. In addition, she is responsible for guiding new projects, funding proposals and activities with multiple stakeholders, including academic institutions and healthcare purchasers.
Prior to joining PCIP, Shih was a Research Scientist at the National Committee for Quality Assurance, in the Research and Performance Measurement unit. She was involved in several research projects assessing the use of practice systems and their association with higher healthcare quality and validation of data sources for reporting and recognition.