The Brooklyn Health Information Exchange (BHIX), incorporated in mid-2007 and operational since mid-2009, continues to add new stakeholders and data, gaining momentum and reaching critical mass. But 2011 will see the veteran HIE going beyond basic data exchange to create value-added services for its stakeholders.
BHIX has been collaborating with providers who jointly take care of mental health patients to deliver continuity of care and wraparound services – including medical, mental, housing, transportation and therapy – in New York City. "We're trying to build technical services that will help coordinate the care of that population," said Irene Koch, executive director since 2007.
The mental health community project is benefitting from the HIE's scalable and continuously enhanced infrastructure. Users can access data through BHIX, but they can also leverage the secure platform to send clinical messages and referrals to relevant healthcare providers, and to receive event notifications, or proactive alerts – for example, to inform them that a patient from their patient-centered medical home (PCMH) has been admitted to an emergency department or other facility.
BHIX also contributed to an R&D effort, which included the Indiana HIE and CareSpark, for the Center for Medicare & Medicaid Services' Physician Quality Reporting Initiative (PQRI). As a result of its participation, BHIX enables reporting of the Quality Reporting Document Architecture through its HIE infrastructure and NHIN Gateway, which is an advancement over the traditional methods of getting the PQRI report into a registry or downloading reports from a healthcare provider's electronic medical record (EMR).
Healthcare providers have been able to send messages and quality reports to CMS for the program in the past, but the bidirectional capability from the R&D project will allow healthcare providers to receive feedback from CMS. The feedback, which had been a missing critical component of the program's quality improvement goals, will now give healthcare providers a more reliable and timely way to adjust care treatment plans and improve patient care.
In April, BHIX anticipates going live with advanced clinical decision support (CDS) and care management functionalities in support of deeper advanced PCMH projects. Offering CDS and analytics through the HIE instead of through one EMR leverages the power of aggregated data across the community, Koch said. BHIX's infrastructure will also support patients' personal health record portal.
These services were built to support the goals of patient-focused grants and to meet the needs of its various stakeholders, which include nursing homes, home care, in-patient and out-patient facilities, and so on, said Koch.
"The core infrastructure that powers the ability to satisfy grant projects can also be leveraged for other stakeholder strategy projects," she said. "BHIX has been working independently with various stakeholders to better understand their different priorities and internal readiness to weave in BHIX services to where they want to take their organizations."
BHIX's infrastructure, which comprises InterSystems' HealthShare HIE platform and Initiate Systems/IBM technology, is flexible enough to support stakeholders' unique needs once those needs are defined, she said. "We're beginning to see now – in a way that we haven't before – people are understanding more how HIE can help them, or will need to help them, get there in very short order," Koch said.
BHIX is also involved in a larger project that may have far-reaching impact in the industry: working with EMR vendors to improve healthcare provider workflow. BHIX is in final tests with a couple of vendors that will enable healthcare providers to simply push a button within their EMR and access data through the HIE. Authentication, patient identification, consent and other requirements will have already been processed through web services in the backend. "We’re really committed to a more seamless workflow because it will be important for promoting adoption," Koch said.
BHIX's philosophy of EHR integration meshes with the vision of New York State Dept. of Health's Office of Health Information Technology Transformation's Statewide Health Information Network for New York.
"New York State had a vision early on, when the HEAL 5 (Health Care Efficiency and Affordability Law for New Yorkers) grants were announced, in which HIE wasn't best thought of in a vacuum but rather as connected to EHRs because those are the vehicles on the ground that get data in and consume data," Koch said. "The Holy Grail is taking the data that flows between providers and through the HIE and using that data to do analytics, reporting and to improve patient care."
BHIX, recipient of three HEAL grants, pushed hard to accommodate legacy systems and legacy integration in order to have data flow through the HIE, Koch explained. The not-for-profit corporation, however, wanted to focus on demonstrating and pushing out as soon as possible a truly integrated workflow that allowed providers to reap the benefits of HIE services, she said.
New York State is working towards ensuring that the different regions can connect and share data seamlessly. "Hopefully over the next several months we can put together a project in which the RHIOs can start to share data," Koch said.
BHIX has been successful through the years because of stakeholders' level of engagement and commitment to improving care through HIE, she said. "Even in the absence of a clear reimbursement structure that rewards this immediately, everyone sees this as the way of the future," Koch said. "They're financially committed so far to support BHIX and working towards weaving our services into their strategic plans."