NEW YORK  -  In the second half of 2011, the New York eHealth Collaborative (NYeC) shifted its role from a policy convener to a service provider that runs the health information exchange (HIE) infrastructure for the local HIEs and regional health information organizations (RHIOs) like a public utility. That shift was the "biggest necessary change" that is propelling the Statewide Health Information Network of New York (SHIN-NY) forward, according to Irene Koch, executive director of the Brooklyn Health Information Exchange (BHIX).

"Instead of allowing SHIN-NY to develop organically through just policy and have the RHIOs maintain their infrastructure independently, NYeC being able to offer a centralized, efficient model made a lot of sense to those of us who have patients who can really benefit from a deeper, more integrated system," Koch said.

While BHIX has a lot of data and value, it sits in New York City and serves a population that can easily access multiple HIEs and RHIOs. "The data needs to travel across a wider geography than just any one borough or region can achieve right now," Koch explained. Also, despite the handful of RHIOs in New York City, there's still a lot of fragmentation in terms of provider affiliation with different RHIOs, which impacts data flow. For example, some providers in Queens may have data flowing in BHIX, or some Brooklyn providers may have data flowing in another RHIO. 

"It was always important for us to move along the path toward inter-regional interoperability. For us, we want to be right at the lead for that," Koch said. BHIX is indeed at the forefront in NYeC's first step toward connecting New York State, as one of the first three RHIOs (along with e-Health Network of Long Island and THINC) in the downstate region to participate in the SHIN-NY. Part of BHIX's decision to participate was predicated on NYeC being able to combine and take over the infrastructure, which includes financing the operation of the infrastructure. Once more RHIOs come on board, SHIN-NY would evolve to a collective business model. Taking this step furthers BHIX's mission to deliver a product at better price points in order to benefit its members, Koch said.

"We knew from the start that things had to be flexible and that things would evolve," she said. "We're so pleased that the work we've done over these past several years is the kind of flexible infrastructure that will form a key component of the SHIN-NY going forward and we're very pleased at the same time to be among the first to partake from that and get the benefit of what shared data will mean for our providers and their patients."

On the technical side, BHIX is consulting with NYeC to assist the organization in the transition to maintain the infrastructure and to share best practices and lessons learned. BHIX's infrastructure, which combines InterSystems HealthShare and IBM Initiate software, and internally built applications on top of the software within a privacy framework, is forming the reference implementation for the SHIN-NY. "NYeC is looking to us to help them understand and help them take over and run what we've built to support the entire SHIN-NY," Koch said. As RHIOs and newly formed local HIEs join SHIN-NY, having the reference implementation in place will allow for interoperability more quickly. At the same time, as NYeC builds on the infrastructure and makes it available for supporting interoperability with many different RHIOs, BHIX will have flexibility to do innovative projects with its stakeholders.

The RHIO is continuing its patient and community education about the benefits of HIE, as well as growing its membership through the build-out of connections and interfaces to new providers and discussions with payers regarding both support for the exchange and new reimbursement models such as Medicaid health homes and accountable care organizations. "This is what health information exchange was made for," she said.

When BHIX was established, the focus was on aggregating data to deliver patient-centric views for care coordination. HIE is now being used to support new reimbursement models that are looking to coordinate care across organizations. Maimonides Medical Center in Brooklyn, a BHIX participant, is an early leader in this area, using HIE features as a tool for coordinating care. For example, event notifications  -  ED admissions, discharges and so on  -  are being sent in real time to care coordinators who are responsible for tracking and managing a panel of patients with mental health issues so they can follow up in a timely manner.

For the Maimonides project, BHIX is expanding those event notifications to a broader panel of patients who are suffering from schizophrenia and bipolar disorders. "These event notifications are just the tip of the iceberg," Koch said. "We can trigger alerts for abnormal lab values for a particular panel of patients and really help these care coordinators get the information that they need at the right time so that they're able to follow up more efficiently."

BHIX is also involved in New York State's Medicaid Health Homes program. The RHIO got a head start, getting some functionalities live, thanks to Brooklyn being named to begin in the early round and Maimonides being named one of the four health home provider leads in Brooklyn. "As they refine and grow their clinical and technical program, we will support them every step of the way," Koch said.