Hixny Offers Snapshot NY Data Aggregation Application Statewide

Earlier this year, the New York eHealth Collaborative (NYeC) made an application developed by Hixny, one of the state’s six health information networks, available to all providers in New York. Hixny CEO Mark McKinney recently sat down with Healthcare Innovation to describe the data access and workflow integration provided by the SMART-on-FHIR app called Snapshot NY.

Hixny says that since 2020, its patient record Snapshot has delivered insights and data points to connected healthcare providers in an easy-to-navigate format, surfacing actionable information within existing workflows. In the past year, Hixny has introduced new capabilities, including direct access to the state’s prescription drug monitoring program query tool and a health-related social needs (HRSN) screening tool that meets all the requirements of the state’s 1115 Medicaid waiver amendment.

Healthcare Innovation: Mark, before we talk about applications and workflow integration, can you remind our readers of Hixny’s geographic region and its origins?

McKinney: Hixny serves the upstate region, from the Hudson Valley north to the Canadian border and then west to the Mohawk Valley. We've been around for almost 26 years. We started off as a joint venture between the New York State Health Plan Association and Iroquois Healthcare Association, which is a group of upstate hospitals. Hixny stands for Healthcare Information eXchange of New York.

HCI: What are the regional HIEs in New York called? I have seen them referred to as Qualified Entities and QHINs….

McKinney: Originally, they started out being called RHIOs for regional health information organizations. Then when the state formed, the SHIN-NY [Statewide Health Information Network for New York], it decided that all the RHIOs needed to have certification, so they started to call them Qualified Entities. Now they’ve started to refer to everybody as health information networks (HINs). But we are still Qualified Entities, because that's what we're defined as under the state regulation, so any one of those is appropriate.

HCI: I wrote something recently about another New York health information network called HealtheConnections beginning to offer ADT feeds statewide. Hixny also provides a notification service. Is it a home-grown solution or do you partner with a third-party vendor on that? 

McKinney: Ours is more of a homegrown solution, The state decided to award statewide alerting to two providers, us and HealtheConnections. Our solution is slightly different from theirs in that we're really focused more on workflow integration. We’ve had a regional alerting service available for at least a dozen years. And in that time, what we've learned is that providers really want that data pushed to them in their EHR. In August, prior to going live on the statewide system, we did something like 700,000 alerts that month locally.

HCI: We’re going to talk about your Snapshot NY application in a moment, but do you think other health information networks will look to innovate and offer statewide services that they've developed in their region?

McKinney: I would say yes. As an HIE, you need to be innovative. And I would suspect that most of the other QEs in the state are thinking about different types of innovation. The biggest question is how well those translate to statewide services. Is it something that's uniquely tailored to their community, or is it something that is more generally applicable to providers anywhere?

HCI: Let's talk about Snapshot NY. Is this something Hixny developed and has been in use in your region for a while and you are now making it available statewide? Could you talk about how it works and what it brings into the provider's workflow? 

McKinney: Just before the pandemic, we created a project we called a hackathon, where we let employees bid on the idea of getting two weeks to just focus on a project. What came out of it was a prototype for a SMART-on-FHIR application that was meant to make it easier to bring all the data together. 

When I first got here, when we were able to finally bring the data together, and we had a provider portal, we'd release the data to the portal, and I thought people would love it, right? People had been saying they just  wanted access to all this data in one place, so we gave it to them, and guess what happened? Nobody used it. Because it was not right in their EHR workflow. 

So one of the big problems that Snapshot solves is it eliminates a lot of user management capabilities or concerns. It provides some additional levels of security, because we don't have to have a user configured inside both the patient provider portal and also then in an EHR. Just by being provisioned in the EHR, you're automatically in this system. The other thing is we realized that not only can the EHR open a window to enable our app to run inside it, we also realized we could open a window to enable other apps to operate inside our window. So essentially, it's like a window in a window inside the EHR. What that gives us the opportunity to do is to bring in other data sources. We’ve had some success working with the New York State Department of Health to bring some of their applications into our application and then make them available.

HCI: Like the state's prescription monitoring program query tool and an 1115 Medicaid waiver approved screening tool?

McKinney: Exactly. It's a way for the state to extend what it has without giving up the control and it puts it all in one place, right? So one of the big complaints we get from providers is, well,I have to go and check five different sources from DOH, and that's five different logins and passwords. This gives us the ability to make things a little bit easier for the users by putting everything there in one place.

HCI: Have you had some experience in your region with the Snapshot tool and received some feedback from providers that gave you the confidence to offer this statewide?

McKinney: We've taken a very business model approach to this, where we took this prototype, and convened a number of focus groups from across the community and asked them to help us refine it into something useful. What came out of it on the interface side and the utility side was what the provider said that they needed. Through that process, we've come up with some innovative, simple functions that we wouldn't have thought of on our own that make a big difference. If you think about it, our application is embedded inside a hospital's EHR, so you're looking at the data we get from that hospital, as well as from 11 other hospitals in our region. So now you either want to see your data alongside everybody else's data, or you're already seeing your data in your EHR, and you want to hide your own data. So they came up with a very simple little button that allows you to toggle and turn off your own data. Honestly that is something that I don't think we would have come up with on our own.

HCI: I saw that Hixny was the first validated data stream for health-related social needs recognized by NCQA. What was involved in earning that recognition, and what does it allow the organization to do?

McKinney: We have another one for data aggregation validation. Well, NCQA’s big focus is on primary source verification. What they want to know is the data at the source matches the data that Hixny has and provides to the end point. 

That gives us two benefits. One is that we're able to tell everybody that an independent third party with an outstanding reputation for scrutiny and focus has validated that everything that is in our system matches what was in the system we sourced it from. In the specific case of the HRSN tool, they wanted to validate that the data that was incorporated into that tool made it all the way through the system and then out of the system without any kind of modification.

HCI: I wrote about a presentation in 2020 by someone from NYeC about shifting to a FHIR foundation to enable participants to access discrete pieces of clinical information through open APIs. Is that happening? 

McKinney: It's happening, but not as quickly as some had thought. FHIR was introduced maybe a dozen years ago, but it's really only now that we are finally getting to a point where it is becoming an alternative to the standard ways of moving data. But we are using it quite a bit. I'll give you a couple of quick examples. As part of New York State's 1115 waiver, we're collecting all the HRSN screening data around the state. Each of the QEs is collecting some of the screening data coming directly from the EHRs. When that occurs, the QE takes it, formats it, converts it to FHIR, and then sends it to a central repository so that that data is available to providers around the state for a variety of different use cases. 

We are also working on some other projects with NYeC where we are supplying them data in a FHIR format. We've done some programs where we've been successfully able to connect to and retrieve data from EHRs directly using FHIR. What we're finding is that the technology is still evolving in terms of its ability to be used, but it has great promise for all of those purposes. 

HCI: Anything else you want to mention about current projects? 

McKinney: We know that what is happening in our community is really all about value-based care, and we're focused on working with providers to understand what it is that makes them successful in value-based care, and ensure that our tools are doing those things. As data becomes easier to move and interoperability becomes less of a barrier, now the problem is just the volume of data, so we're really focused on how we can turn that firehose into a water fountain, or whatever cliche you want to use and ensure that we can make it easier for folks to do the things that they need to do.