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The Primary Care Information Project: Helping NYC use HIT for Health Care ABCS. Mat Kendall PCIP Director of Operations New York City Department of Health and Mental Hygiene firstname.lastname@example.org. www.nyc.gov/pcip. Agenda. PCIP Background The New Federal HIT Agenda
PCIP Director of Operations
New York City Department of
Health and Mental Hygiene
Percentage of American GDP spent on health care – 15 %!!
“Health information technology….is a potential game-changer. That’s what we’re finding in New York City, where we’ve created the nation’s largest primary care electronic health record network. It links more than 1,100 doctors with more than a million patients in low-income communities with a prevention-focused EHR. … EHRs also allow doctors to actually understand how many patients they’re treating and how well they’re doing in preventing illness. With that data, EHRs also create the potential to reward doctors for actually keeping people healthy.”
- Mayor Bloomberg, “Address to US Conference of Mayors.” March 2009
Public Health Priorities
that are oriented toward prevention
that rewards diseaseprevention and the effective management of chronic disease
that highlights prevention
that Maximizes Health
To increase the quality of care in medically underserved areas through health information technology (HIT)
NY City: $30 million (staff, software, hardware, services)
City Council: $6 million (CHC infrastructure)
Clinic/practice contributions: >$15 million
NY State HEAL: $11 million (expansion)
Federal: $5 million (research and evaluation)
Robin Hood Fund $4-6 million (pay for performance)
Wellpoint Foundation $500,000 (additional licenses)The New York CityPrimary Care Information Project
Pay for Quality
EHR Development and Implementation
Strategy and Procurement
2005 2006 2007 2008 2009 2010 2011
The bill provides:
Adoption of HIT in Physician Practices, by size2
Delivery of ambulatory care in the US by size of practice1
> 11 physicians
Number of physicians in a practice
Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of Preventive Services to Older Adults by Primary Care Physicians. JAMA. 2005; 294:473-481.
* Model controls for practice size, years in practice, hours a week in direct patient care, salary status, physician type (primary care vs. specialist), certification status in specialty, and use of EMR.
Audet AMJ, Doty MM, Shamasdin J, Schoenbaum SC. Measure, Learn, And Improve: Physicians’ Involvement In Quality Improvement. Health Affairs. 2005; 24: 843-853.
“Obtaining real value from unprecedented federal investments will require local support organizations that help doctors install these systems and use them to achieve improved quality, efficiency, and continuity of care1.”
Compares provider performance on quality measures to citywide averages
Allows one-click ordering of recommended preventive services
COMPREHENSIVE ORDER SETS
Displays best practice recommendations (e.g., for meds, labs, patient education)
Identifies patients through structured data elements (e.g., diagnoses, drugs, labs, demographics)
With patient consent, displays 90-day history of all Rxs filled by Medicaid patients
AUTOMATIC VISUAL ALERTS
highlights abnormal vitals
Automatically displays preventive service alerts that disappear once addressed
CIR and School Health
Sends information to City Immunization Registry and generates school health forms
We have secured signed commitments from:
- 1,804 providers in 331 practices, 425 sites*
- including over half of the 280 eligible small practice providers located in underserved neighborhoods:
~ 1 new practice goes live on the EHR every day
Leadership & Vision
Is leadership committed? How informed and involved are clinical staff? Are there clinic-level champions? Are patients being engaged in the initiative?
Has the CHC established measurable goals for HIT adoption? Does it typically budget for IT? Has it estimated ongoing costs likely to accompany adoption?
Policies & Procedures
Does the CHC have formal policies for clinical, business, and administrative practices that support HIT implementation? Is HIT use built into HR tasks and standards?
Are end-users computer proficient? Can the CHC identify a multidisciplinary project management team? Will IT staff resources be adequate?
Is there adequate bandwidth? Are there contingency plans for network failure? What additional hardware/software will be required?
Draft Practice Results: ABCS and Comparison to NYC Average
Blood Pressure Control (Overall)
Cholesterol Control (Overall)
Preliminary QI data for PCIP practices showing improvement in BP control from January 2009 to April 2009 for most practices
PCIP has launched a pilot incentive program (eHearts) to reward providers for delivering excellent preventive care for cardiovascular health
Practice Essays (N = 130)
Completed Patient Surveys – Pre-EHR (N = 736, representing 10 sites)
Completed Provider Surveys - Pilot Post 6 months (N = 97)
Productivity Analysis before and after EHR (N = 70 providers, 1 site)
Policies and Procedures and Training
We brings the Bloomberg approach of data-driven decision-making to health care
We seek to equip providers with exactly the information they need, exactly when they need it
We employ this data-driven approach internally, using metrics to keep focus and enforce accountability
We are an implementation success story
and a high-profile national model for HIT initiatives
We are changing health care delivery in NYC
We are well-positioned to use federal payments
Uncertainties exist, but there are many paths to sustainability after 2011