New York: State and City Innovations to Scale Up Health IT

Since 2006, New York State has awarded $226 million in public funds to develop and implement a comprehensive health information infrastructure—more than in all other states combined. Most of these funds are distributed through a grant program that was created by the 2004 Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY). The state enacted HEAL NY to reform and reconfigure New York's health care delivery system, including projects to accelerate the adoption of health information technology (HIT) and interoperable electronic health records. In addition to the state's investment, the federal government and private-sector organizations have contributed an additional $226 million since 2006, bringing New York State's total HIT investment since 2006 to a remarkable $453 million from all sources (Figure 4).

Figure 4. Health Information Technology Investments in New York Since 2006

Sources: New York Department of Health, Health IT Investment in New York, accessed October 1, 2009 and New York Department of Health, Phase 10 Awards by Region, September 25, 2009).

New York State has established a sophisticated governance structure for its HIT efforts, led by the Office of HIT Transformation within the New York State Department of Health (Figure 5). The state is essentially working to create an HIT "interstate," says Rachel Block, deputy commissioner for HIT transformation at the Department of Health—a system through which all providers could connect and interface under common practices and guidelines. Once fully established, the Statewide Health Information Network for New York (SHIN-NY) is expected to serve as the backbone for HIT in New York and make electronic health information exchange much easier for providers. Building the system, says Block, involves much complexity, and success depends on aligning the work of multiple stakeholders through collaboration and consensus-building. 

Figure 5 (click to view)

Source: New York eHealth Collaborative

The New York eHealth Collaborative is a public–private organization designated by the state to develop statewide HIT policy guidance through an open, transparent, and consensus-driven process. This collaboration process is largely driven by workgroups that recommend policies and procedures, standards, and technical approaches related to clinical priorities, privacy and security, and the adoption of electronic health records. The state has committed $5 million to the eHealth Collaborative over the next two years to manage the collaborative process and set priorities for future HEAL NY awards.

New York also supports a Health Information Technology Evaluation Collaborative (HITEC) to evaluate and develop evaluation instruments for HIT initiatives across the state. HITEC is a multi-institutional, academic collaborative of New York State institutions including Cornell University, Columbia University, the University of Rochester, the State University of New York at Buffalo, and the State University of New York at Albany. HITEC has been charged with providing evaluation services for HEAL NY grantees in a consistent and objective manner across all funded projects. The state has committed $5 million to HITEC over the next two years.

Underlying the Statewide Health Information Network for New York and central to its successful implementation are Regional Health Information Organizations (RHIOs). New York's RHIOs are multi-stakeholder collaborations that enable the secure interoperable exchange of health information with a mission of governing its use in the public's interest and for the public good by supporting improvements in health quality, affordability, and outcomes. Currently, there are nine state-designated RHIOs, which are part of the statewide governance structure and connect to the Statewide Health Information Network.

The eHealth Collaborative also supports Community Health Information Technology Adoption Collaboratives (CHITAs) which are similar in concept to the Regional HIT Extension Centers that were created and funded in the American Recovery and Reinvestment Act of 2009. New York's CHITAs, which predate Extension Centers, are collaborations of clinicians who are committed to adopting and using EHRs to improve patient care for specific populations within a community (called a "care coordination zone"). As one example, a Primary Care Health Information Consortium comprised of 29 community health centers and other ambulatory care providers, the New York City Department of Health and Mental Hygiene, the Community Health Care Association of New York State, and the Primary Care Development Corporation are creating a CHITA with HEAL NY funding to implement an interoperable EHR system among community health centers and other primary care providers in a care coordination zone in Brooklyn. Unlike RHIOs, which must be independent nonprofit entities, CHITAs are informal collaborations of provider participants in a care coordination zone for the purpose of sharing software, technical services, and clinical services and ensuring groups of clinicians realize upfront and consistent value from interoperable EHRs. There is no limit on the size or number of CHITAs that can operate within the state. Nine CHITAs have been awarded HEAL NY grants specifically for the purpose of ensuring that EHR adoption and use results in patient care improvements.

New York City Primary Care Information Project
The New York City Primary Care Information Project (PCIP) provides an example of how HEAL NY grants support regional HIT initiatives. PCIP, which is led by the New York City Department of Health and Mental Hygiene, is the largest community EHR project in the country, with 1,557 providers, including 605 at 254 small private practices, using EHRs as of May 2009. PCIP has partnered with eClinicalWorks to provide an EHR software package to community providers who serve underserved populations or those with Medicare, Medicaid, or no insurance. Participating providers receive EHR applications and licenses, extensive training for all levels of staff, interfaces to common laboratory and billing systems, and EHR customization to support public health functions. In addition to helping physicians adopt an EHR, PCIP also provides technical assistance on how to use an EHR to improve patient outcomes. Quality improvement consultants offer on-site support for office redesign to improve efficiency, coaching on EHR preventive-health features and how to use them for quality improvement, and a forum for discussing performance feedback and sharing best practices on quality improvement efforts.

Over the past four years, New York State has awarded $11 million in HEAL NY grants to PCIP. In September 2009, it announced that it will award an additional $7 million in HEAL NY grants to support additional work to establish patient-centered medical homes. PCIP's current goal is to help providers adopt and use EHRs in a way that improves the effectiveness of chronic disease care, especially diabetes care. PCIP will work to connect all participating practices to New York's Statewide Health Information Network and ensure they receive technical assistance to become certified as a patient-centered medical home through Level II or III accreditation from the National Committee for Quality Assurance. This level of accreditation would put New York's providers in a strong position to receive bonus payments that will be available in 2011 through Medicare and Medicaid for health care providers that demonstrate "meaningful use" of EHRs.