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.


There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

Lancashire County Council to pay £200k in legal costs after trust legal battle

17/08/2018Lancashire County Council to pay £200k in legal costs after trust legal battle

Lancashire County Council has agreed to pay £200,000 in legal costs to two NHS Trusts after their decision to hand a £104million cont... more >
Former inadequate West Midlands maternity unit upgraded by CQC

17/08/2018Former inadequate West Midlands maternity unit upgraded by CQC

Walsall Manor Hospital’s maternity services have been given an improved rating from the health inspectorate following assessments made in J... more >
Major hospital stalled by Carillion collapse will go ahead under government funding deal

16/08/2018Major hospital stalled by Carillion collapse will go ahead under government funding deal

The construction of a major Midlands hospital that had its future cast into doubt following the collapse of infrastructure giant Carillion has be... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

The NICE impact on falls and fragility fractures

10/08/2018The NICE impact on falls and fragility fractures

Falls should not be an inevitable part of ageing – and their snowball effect means the consequence of falls are far from limited to just hospital admissions, says Professor Gillian Leng, deputy chief executive and director of health and social care at NICE Almost a third of over-65s in the UK have a fall at least once a year, with around 500,000 people presenting at hospital with fragility fractures. This is estimated to cost the ... more >
read more blog posts from 'the scalpel' >


Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus