Three health information exchanges serving the greater New York City metropolitan area have integrated with each other to expand their reach to providers.
The vendors include Healthix, the nation’s largest HIE serving New York City and Long Island, and the private HIEs of two major integrated delivery systems, Northwell Health and Mount Sinai Health System.
Combined, these HIEs serve 22 million patients, says Todd Rogow, senior vice president and chief information officer at Healthix. “We see 10,000 new patients daily across the three environments.”
All of the exchanges were built on the HealthShare HIE platform of InterSystems, making data exchange relatively easy.
For Healthix, the biggest benefit is being able to pick up a lot of ambulatory practices in the Northwell and Mount Sinai health systems and get them on the HIE, according to Rogow. “That was one of the primary goals. As they grow, Mount Sinai and Northwell will be adding new patients and more clinical data, including structured data for a common clinical data set.” Having this common set, he adds, will help identify social determinants of health to focus on patients with the greatest needs.
More than 20 types of patient information are in the common data set—they include patient name, sex, date of birth, race, ethnicity, preferred language, smoking status, problems, medications, medication allergies, lab tests, lab values/results, procedures, care team members, discharge instructions and all major vital signs.
The transition enables Northwell to reduce its dependence on interfaces between its records and other EHR systems. It previously maintained 40 different interfaces to EHRs, but with the new integration, it now is down to one.
Originally, the plan for three-way HIE integration was to offer a full longitudinal record, “but the logistics of making that work were just too hard,” Rogow recalls. Consequently, the project started with encounter and visit messages.
As three HIEs were being integrated, participants had concerns on whether adequate performance could be achieved, and but the HealthShare platform can handle 600,000 daily encounter and visit messages from Northwell Health and Mount Sinai, Rogow says.
Rogow advises other stakeholders looking for richer HIE to focus on building out and supporting a core file format that can support future standards. “All documents received into HealthShare are converted to Structured Document Architecture (SDA), which enables the transformation to any of the 20-plus recognized document standards. SDA also is considered future-proof because you have the ability to create new file formats as the standards change.”
The biggest lesson from the integration effort may be that the three HIEs were able see past individual proprietary perspectives and work with each other, and Rogow urges other data exchange entities to follow suit. “Partnering with aggregators of clinical data makes perfect sense,” he concludes.