Health Information Technology Evaluation Strategy: An Overview
Mission | Objectives | Structure| Operational Framework
Mission
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The Primary Care Information Project seeks to improve population health in disadvantaged communities through the use of health information technology. In order to accomplish this transformation, EHR adoption is not enough. We must re-orient EHRs, practice workflows, and healthcare reimbursement towards prevention with an emphasis on clinical interventions with the greatest potential to save lives.*
2010 Objectives
- • Extend prevention-oriented EHRs to 2,500
primary care providers and 2 million patients
- • Provide a million patients with
self-management tools including patient portals
- • Support EHR-enabled primary care providers in
standardized health information exchange
- • Implement a quality improvement collaborative
tied to the “Patient-Centered Medical Home”
- • Provide participating practices with clinical
quality scorecards for evidence-based best practice
- • Pilot a reward and recognition program for high-performing providers
Structure
Seeded by $30 million in City Tax Levy funds. Currently operating on $60 million in City, State, federal, and private funding. Located in DOHMH's Division of Healthcare Access and Improvement. Approximately 60 staff members led by Acting Assistant Commissioner Amanda Parsons.
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Operational Framework
In March 2007, following rigorous and competitive procurement, the City registered a $20 million contract with a commercial EHR vendor (eClinicalWorks) and embarked on a year-long collaborative development process. The “Take Care New York” EHR includes standardized clinical data elements, registry functions for patient recall and anticipatory care, automated clinical quality measurement, decision support tools, and patient self-management tools. The City is granting eligible practices (primary care providers with over 10% Medicaid and uninsured) a package of software and services, including licenses, onsite training, data interfaces, and 2 years of maintenance and support. High volume Medicaid providers can receive additional subsidies for hardware purchase and installation. Practices must contribute $4k per provider to a quality improvement fund and bear the costs of hardware, network infrastructure, and productivity loss during training, go-live, and evaluation.
These sponsors have provided support for hardware, software or technical assistance directly or indirectly to providers:
Outreach:
Recruits providers in solo/small practices, community health centers and hospital ambulatory facilities, with a focus on Medicaid providers and practices in Harlem, the South Bronx, and Central Brooklyn. As of July 1, 180 practices in 285 sites with over 1000 providers have signed agreements with PCIP.
Implementation Support:
Assists health care facilities throughout NYC to successfully implement EHRs by sharing best practices in IT infrastructure assessment, project management, workflow analysis, and vendor relations. As of July 1, 2008, nearly 500 providers were using the system. By the end of 2008, over 1,000 will be using the system, making it the largest community EHR extension project in the country.
Development:
Defines and designs required EHR functionality for improving population health, such as population-level preventative health measures, clinical decision support tools and public heath interfaces.
Health Information Exchange:
Supports secure standardized electronic data exchange between EHR-enabled primary care providers and laboratories, hospitals, insurers, and public health (immunization registry, school health, disease reporting). PCIP is also investigating the potential of EHRs to foster bilateral communication between public health and clinical providers, improving situational awareness.
Quality Improvement:
Enhances practices' capacity to use EHR-enabled tools to maximize quality of care. Key training topics include use of registries for planned care, effective use of provider performance feedback, team-based care strategies, and patient education and self-management support.
Quality Reporting, Rewards, and Recognition:
Measures physician performance using summarized clinical quality measures reported by practices using eClinicalWorks and other EHR systems in NYC. The system will provide benchmark reports for a core set of cardiovascular measures (“ABCS”- Aspirin, Blood Pressure, Cholesterol and Smoking) which will serve as the basis for physician recognition and reward program.
Evaluation:
Undertakes comprehensive evaluation of the project through funding by the CDC and AHRQ. Main objectives include identifying factors that predict successful EHR adoption, measuring impact on provider and patient satisfaction, and evaluating the quality and efficiency of care.
* Frieden TR, Mostashari F. Health Care as if Health Mattered. JAMA. 2008 Feb 27; 299(8):950-2.
