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16.05.16

Lessons from New York for NHS integration

Source: NHE May/Jun 16

As the NHS accelerates integration ambitions and new models of care, could New York City offer any lessons? Tom Moore, vice-president for innovation at Healthix, New York’s regional health information exchange, explains how information on 16 million patients has been joined-up across the city.

Devo Manc, the Five Year Forward View, NHS vanguards and an abundance of integration projects across the UK signal vigour in the determination to join-up health and care.

Look across the pond and commitment to the same interconnected healthcare ambition is equally as strong, with parallels to be drawn in understanding how underpinning information can be shared.

New York’s vision to create regional health information exchanges (HIEs) started as far back as 2005, with the recognition that access to information from across the continuum of care is the crucial enabler for effective clinical decisions and interventions.

With hundreds of millions of dollars since invested by New York State, and a great deal of work in negotiating data-sharing policy and deploying supporting technology, millions of people now benefit from the better co-ordinated care that results today across New York.

A fabric of trust

Healthix, the present day amalgamation of several publically-funded HIEs in New York, is now the largest HIE anywhere in the United States, delivering joined-up information on 16 million patients to hundreds of healthcare organisations and more than 1,350 facilities across New York City and Long Island.

The creation of a genuine fabric of trust with stakeholders, privacy groups and patients has been essential. Importantly, the latter must provide their consent before their information is shared with providers.

Trust to share information has been created through collaboration. Stakeholder committees have shaped information sharing policy together, rather than being told policy by New York State. Resulting consent models, built into workflows at the point of care, have seen north of 90% of patients agreeing to share their information, when the reasoning and details surrounding the sharing process are presented and well explained.

We are now moving to a community consent model in New York, where the patient provides consent to every participating organisation in the Healthix HIE. With one answer the patient can give consent to all 267 organisations to access their health information, including hospitals, small and large primary care practices, health plans, behavioural health organisations, and community-based organisations.

Consent forms specifically detail the sensitivity of information included, and professionals accessing information from substance abuse and mental health facilities are not permitted to repeat it to other individuals, something made very clear when viewing data.

Technology too has played a central role, with InterSystems’ HealthShare technology meeting the phenomenal data requirements of one of the world’s most populated cities. The platform has given us an interoperability mechanism to connect health systems across an entire region, something now also being achieved in the UK with the technology.

The impact on care

Benefits are significant. Care is co-ordinated, direct alerts are made for appropriate intervention, and predictive analytics will soon maximise New York’s immense data to enable preventative risk stratification.

A community health record now allows professionals working in practices, hospitals, nursing homes, substance abuse centres and any of our participating organisations to see the entire patient journey – as well as lab results, radiology reports, history of diagnoses and visits, procedures, discharge summaries, prescribed medications and more.

The challenge was to make this as fluid as possible for busy doctors. But by far the most beneficial service is enabling real-time interventions at the point of care. Healthix proactively detects when a patient with conditions like HIV, heart failure, or diabetes has an important event, such as a hospital admission, and informs their primary care practitioner, so that they can take action. This is not about creating a passive giant repository, but alerting professionals to intervene when patients need them most.

And as we move to prevention, mathematical algorithms will help predict serious conditions like diabetes before they develop.

The HIE is even prepared for response to city and state-wide emergencies. In the event of a mass casualty incident, an NYC Emergency Patient Search Portal queries real-time patient data through Healthix to reunite missing family members.

Joined-up information has taken significant investment, but the cost of not having safer and better co-ordinated care is much higher.

Financial benefits aside, our greatest return is the impact for our most at risk patients: people with comorbidities, mental illness, social issues like homelessness and for the frail and elderly. That is where we have the biggest impact. That is where any healthcare system in the world must be focused.

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