Using Health Info Tech To Improve Quality of Care in New York City

Using Health Information
Technology to Improve Quality

of Care in New York City
Brent Stackhouse, Executive Director

Primary Care Information Project
NYC Department of Health & Mental Hygiene
March 12, 2013
Primary Care
Information Project 1
Agenda
Primary Care Information Project (PCIP)
PCIP Quality Improvement
PCIP Population Health Analysis
Lessons Learned
Primary Care
2005: Palm Pilots are the wave of the future!
PALM PILOTS !
800+ distributed to improve:
Disease Management
Quality of care
Ongoing education and training
Emergency Preparedness
Remote access to the HAN during
emergencies
Primary Care
Primary Care Information Project
PCIP, a bureau of NYC DOHMH, was founded by

Mayor Bloomberg in 2005
Mission
Improve the quality of care in medically
underserved areas through health information
technology (HIT)
Success
Over 9,055 providers receiving EHR and
Meaningful Use assistance
1,118 small practices
75 community health centers
26 hospitals & outpatient clinics
Primary Care
PCIP Programs Today
NYC DOHMH: PRIMARY CARE INFORMATION PROJECT
EHR Adoption & Quality Pay for Quality & Public Health
Meaningful Use Improvement Research Monitoring
Federal Regional Practice Program Public Health
Extension Consulting Evaluation and Informatics/
Center Group Planning Development
Outreach Clinical Quality Healthcare
Specialists Quality
Implementation
Billing Consulting Information
Training Network
Diabetes
Registry
Primary Care
EHR Adoption Technical Assistance
Go Improved
Outreach Implementation live Meaningful Use
Outcomes
Provider Project Standard Coordinated,

education management documentation patient-cantered
care
Budgeting Workflow redesign Customized clinical
alerts
Vendor selection Staff preparation
Quality measures
Privacy & security

of patient data
Health information
exchange
Primary Care
Impact of Technical Assistance
Primary Care Source: Andrew M. Ryan, Tara F. Bishop, Sarah Shih and Lawrence P. Casalino. Small Physician Practices In
New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records. Health
Affairs, 32, no.1 (2013):53-62
Data Collection and Analytics
Data type Method Practice Provider

level level
Quality Monthly transmissions of the PCIP-defined quality measures from X X

Measures eClinicalWorks practices
Utilization Monthly transmissions of PCIP-defined utilization measures from X X
measures eClinicalWorks practices
Meaningful Monthly transmissions of meaningful use metrics from X X

Use eClinicalWorks practices Meaningful Use Adoption and Quality
measures dashboards
Procedure Monthly transmission of aggregate CPT counts X X
data
Syndromic Daily transmissions of ILI and GI from eClinicalWorks practices on X
Surveillance days the practice operates
Hub data Daily transmissions in response to specific queries X
Salient data Medicaid claims X X
SHIN-NY Healthcare data from NYC facilities connected to a Regional X

(Pending) Health Information Organization (RHIO)
Primary Care
The Hub Query Model of Data Collection
By borough, zip code, gender, age,

Send messages diagnosis, vital signs, medications, etc
Pull Data NO patient level data
3000 providers We can pull data/ask questions of the
3,000,000 patients EHRs such as:
EHR
How many patients in each borough have
EHR
practice
practice
1
EHR
practice
high blood pressure (or asthma, or) ?
500 2
EHR EHR
practice
499
practice
3
What % of women in the Bronx over the
age of 65 with diabetes have controlled
blood sugars?
EHR EHR
practice practice
4
Hub
EHR
practice
EHR
practice
What % of New Yorkers by zip code are
10 5
obese?
EHR EHR
practice practice
9 6
EHR EHR
practice practice
8 7
Primary Care
Operationalizing Data
Assessment We help providers adopt

and implement EHRs
Over 9,055 providers
receiving EHR and
Meaningful Use CHCs Hospitals Practices
assistance
Practices send health care

quality data to us directly
from their EHR
Aggregate Data Hub

Daily & monthly data transmissions
PCIP Uses of Data
Quality Utilization Meaningful Population Syndromic
Assurance measures data Use Health data surveillance
We analyze that data
Data analysis for program evaluation Public Health
Feedback to providers monitoring
shared w/
Policy Pay for Performance programs
external DOH
Development Public Health monitoring PH Partners We develop and implement
Data-driven resource allocation programs to improve health
Shared w/ internal DOH PH Partners care quality for NYC
Primary Care
Feeding Data Back to Providers Quality-of-care
measurement
10 EHR Use Measures

What % are
eprescribing
10 Quality-of-care measures
Diabetes control
Flu-like Blood pressure control
Illness Smoking status
Mammography
Recommendations
Flu-like illness
Primary Care
Impact of Provider Dashboards
Introduction of dashboards led to overall improvement across measures displayed on the

dashboard
Providers that reach out to PCIP for help improve their performance more quickly
Improvement across all quality measures was observed for low and higher performing
practices
In 2012, PCIP developed special edition dashboards focused on Immunization (sent to 639
providers) and Sexual Health (sent to 897 providers), delivered Take Care New York
dashboards to an average of 750 providers per month, and developed a Meaningful Use-
focused dashboard, which is currently being piloted with 145 providers.
On The Dashboard
Smoking Status Quit Intervention BP Control Cholesterol Screening
100%
100% 100% 100%
50% 50%
50% 50%
0% 0% 0%
0%
Oct Mar Oct Mar Oct Oct Mar Oct Mar Oct Oct Mar Oct Mar Oct
Oct Mar Oct Mar Oct
'09 '10 '10 '11 '11 '09 '10 '10 '11 '11 '09 '10 '10 '11 '11
'09 '10 '10 '11 '11
HbA1c Testing HIV Screening Sexual History

Breast Cancer Screening
100%
100% 100%
100%
50% 50% 50%
50%
0% 0%
Oct Mar Oct Mar Oct Oct Mar Oct Mar Oct 0%
0%
'09 '10 '10 '11 '11 '09 '10 '10 '11 '11 Oct Mar Oct Mar Oct
Oct '09 Mar '10 Oct '10 Mar '11 Oct '11
'09 '10 '10 '11 '11
= at/above benchmark/average at time of first DB
Primary Care
Influencing Policy (BMI Analysis)
Primary Care
Using Health IT for Public Health Alerts (Metronidazole Recall)
Distributed patient specific alert accessible via CDSS right pane.
Primary Care
Overall Progress - Delivery of Clinical Preventive Services Across 56
Practices
46.3
A1c Screening* 62.4
65.5
Body Mass Index recorded* 78.3
45.9
Blood Pressure Control* 55.0
45.6
Aspirin Therapy*
53.2
77.4
Smoking Status recorded* 83.9
27.8
Breast Cancer Screening*
32.3
20.5
Influenza Vaccination* 24.0
76.6
Cholesterol Control 77.9
31.3
Smoking Cessation Intervention
31.0
31.3
A1c Control 30.4 *p<.05
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
Pre EHR Upgrade

% eligble patients recieving CPS Post EHR Upgrade
Primary Care
Overall Progress in PCIP 2 year trend
80
74.8
% Average Practice Performance Rate
70 66.7
58.4 64.1
60 59.6
55.3 57.7
50
48.9 46.2
46.4
40
35.0
30
29.30
20
Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11
T1 T2 T3
Antithrombotic Tx BP Control in HTN Hemoglobin A1c Testing Smoking Cess Intervention
Time Antithrombotic Blood pressure Hemoglobin A1c Smoking Cessation

therapy control Testing Intervention
Oct 2009 (T1) 58.4 55.3 46.4 29.3
Oct 2010 (T2) 66.7 58.5 50.6 34.5
Oct 2011 (T3) 74.8 64.1 57.7 46.2
Difference between T1 and T2 8.3* 3.1 4.2 5.2
Difference between T2 and T3 8.1* 5.5* 7.1* 11.7*
Difference between T1 and T3 16.4** 8.8* 11.3* 16.9**
*: p<0.05; **: p<0.001
Primary Care
Lessons Learned and Policy Obstacles
o Being first has advantages but also requires a lot of work, and lessons learned the hard way
o EHR vendor collaboration easy but provider interest was limited
o Locally hosted servers require regular maintenance and result in data transmission
issues, but are preferable when broadband access is limited
o Tablets better for patient engagement
o Lab Company buy-in essential for small practice integration and compendium updating
o Obstacles
o Health information exchange functionality in systems not standardized federally
o Payers not incentivized to subsidize adoption although main beneficiary
o Diversity of payer population reduces interest in supporting practices directly
o Quality Measures are a moving target
o HEDIS/QARR, PQRS, Meaningful Use
Primary Care
Learning Collaboration
o Large practice learning collaborative
o NYC REACH Resource Library
o NYC REACH wiki: http://nycreach.org/reach_wiki/index.php/Main_Page
o Regional Extension Center Health Information Technology Resource Center

(HITRC)
o www.HealthITxChange.org
Primary Care

Using Health Info Tech To Improve Quality of Care in New York City

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Using Health Information

Technology to Improve Quality

Brent Stackhouse, Executive Director

Primary Care Information Project (PCIP)

PCIP Quality Improvement

PCIP Population Health Analysis

PCIP, a bureau of NYC DOHMH, was founded by

NYC DOHMH: PRIMARY CARE INFORMATION PROJECT

Provider Project Standard Coordinated,

Privacy & security

Data type Method Practice Provider

Quality Monthly transmissions of the PCIP-defined quality measures from X X

Meaningful Monthly transmissions of meaningful use metrics from X X

Salient data Medicaid claims X X

SHIN-NY Healthcare data from NYC facilities connected to a Regional X

By borough, zip code, gender, age,

Assessment We help providers adopt

Practices send health care

Aggregate Data Hub

10 EHR Use Measures

Introduction of dashboards led to overall improvement across measures displayed on the

HbA1c Testing HIV Screening Sexual History

= at/above benchmark/average at time of first DB

Distributed patient specific alert accessible via CDSS right pane.

Pre EHR Upgrade

Antithrombotic Tx BP Control in HTN Hemoglobin A1c Testing Smoking Cess Intervention

Time Antithrombotic Blood pressure Hemoglobin A1c Smoking Cessation

o Large practice learning collaborative

o NYC REACH Resource Library

o NYC REACH wiki: http://nycreach.org/reach_wiki/index.php/Main_Page

o Regional Extension Center Health Information Technology Resource Center

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