New York Beacon sees progress, pitfalls
Three years after procuring a $16.1 million HHS grant to bolster local health IT initiatives and diabetic care management, the Western New York Beacon Community has chronicled mixed success - at least in the quantifiable sense. Anecdotally, however, its success becomes much more striking, officials say.
Nevertheless, the numbers do talk, says Dan Porreca, executive director of HEALTHeLINK - the health information exchange spearheading the Beacon project. WNY Beacon has forged partnerships with heavy hitters such as the Veterans Administration and Blue Cross Blue Shield, and has already helped 82 of 98 area practices develop, manage and participate in EHR-based patient registries, which represent data on more than 57,000 diabetic patients. To date, more than half a million patients have given their consent to have their data accessed.
Moreover, 325,000 patient queries from providers occurred in 2012, representing an explosive 197 percent increase from 2011. Now, Porreca says they're tracking a whopping 50,000 queries per month. Those, one might say, are numbers to write home about.
"Being able to analyze the registry data from a specific practice and compare it to the other 81 practices that we were getting the data from," Porreca explained, "shows a practice where they stack up," - and oftentimes that's all it takes.
After participating in the registry, Southtowns Family Practice in Hamburg, N.Y., for example, learned their vaccination rates for diabetic patients were only 27 percent.
The practice initiated intervention efforts after seeing the numbers, including adding a vaccine alert to specific patients' EMR. Within the first quarter, the practice's pneumonia vaccination rate increased to 47 percent. By the third quarter it had reached 67 percent.
The Beacon's telemonitoring initiatives also deserve a mention, says Porreca. The pilot enrolled more than 100 high-risk diabetic patients to use telemonitoring for improved care management. "The objective was to try to identify these patients before they were hospitalized and put devices in their home to help their care coordinators and primary care physicians better manage their care," said Porreca.
Kenneth Wilson was one of these patients. He had been living with uncontrolled diabetes for more than 10 years, so when he enrolled and had to log into the program each day and measure his weight, blood pressure and blood glucose levels, he eventually saw some big changes.
Before being enrolled, his A1C levels - a number measuring average glucose control - ranged from 8 to 9 percent. Since participating in the pilot, Wilson has reported average A1C levels of 6.8. Similarly, before the pilot Wilson's morning blood sugar level ranged from 180 to 240 mg/dL. Now, the level stays typically around 109 mg/dL.
"The benefits were tremendous," Wilson said. "They'd call every day... saying 'I heard you had some kind of issue today. You got this going on, or you got this going on. What's the story? What can we do to help you?'"
Other wins include successfully building up the technology infrastructure, which has been a priority for the Beacon. "We have virtually every hospital in our community connected (to the HIE)," Porreca said. Ninety-eight percent of the beds; 95 percent of the labs and between 85 to 90 percent of radiology practices are connected.
In terms of goals achieved, the Beacon didn't hit the bull's eye on every target. One of those originally set in 2010 was to demonstrate cost savings resulting from a 5 percent decrease in emergency department visits, 30-day readmission rates for specific diabetes patients and specific ambulatory care hospitalizations.
The Beacon's most recent annual report, however, found that these readmissions and hospitalization measures actually increased overall.
The report does cite that the upward trends could be "an artifact of coding trends" instead of an actual utilization increase.
One important concept to understand, as Porreca explained, is nothing ever goes as smoothly as you anticipate it will go: "You start to encounter the realities, the complexities of the things that we're trying to achieve."
In terms of the biggest challenges faced, he first cited the difficulty getting patient consent, particularly in their collaboration with the Department of Veterans Affairs.
Last year, VA linked up with HEALTHeLINK allowing VA providers, hospitals and medical practices across Western New York access to health information for their veteran patients through the HIE. But because two separate consents are needed - one required by VA and the other needed by the HIE - they haven't yet seen the numbers they want.
"Nothing goes as fast as I want it to," Porreca said. "I'm sure it's going to happen; it's just a matter of getting to the tipping point."
Another ongoing challenge for the Beacon community as a whole, as Porreca pointed out, is monetizing the value of the exchange. "We know anecdotally that what we're doing is making a difference because doctors tell us," he said, "because they had access to the patient's information through the patient query function, (or) they didn't order an unnecessary CT scan. Those are things that are hard to measure - what didn't happen as a result of the technology being in place."
When looking ahead to the future, the WNY Beacon Community just might be the most sustainable and, possibly, one of the most successful. HEALTHeLINK HIE was incorporated in 2006 and was sustainable long before the $16.1 million came into sight, Porreca explained.
"We were not reliant on the federal dollars for our operational expenses. We used the federal dollars to build incrementally and to act as a bit of a laboratory on certain technologies to see what the impact might be."
One area the Beacon is focused on building up for 2013 is continuity of care documents. Last year, they had 188,000 CCDs from primary care to specialists, representing more than a 100 percent increase from 2011.
If they continue to check off items like this from their to-do lists, thereby continuing to demonstrate value, Porreca anticipates they will continue into the foreseeable future.