The trend of health information exchange consolidation continues with the announcement that New York City-based Healthix, the largest publicly funded HIE in the nation, plans to merge with NY Care Information Gateway (NYCIG), a regional health information organization serving communities in New York City and Nassau and Suffolk Counties on Long Island.
Healthix said the planned merger will result in operating efficiencies, upgraded services, a vast expansion of available data and cost effectiveness to better serve the hundreds of organizations, providers and patients that span both RHIOs. Currently under review by the New York State Attorney General’s office, the merger is expected to be approved approval during the first quarter of 2020.
Healthix, a regional health information organization (RHIO), provides services in metro New York City to millions of patients and thousands of providers from hospitals, physician practices, home health agencies, nursing homes and managed care organizations. It manages records of over 17 million individuals, with data coming from over 1,200 participating organizations across New York State. Todd Rogow is its president and CEO.
Last November, only a few days after health IT interoperability organizations in Michigan announced a merger, Indiana Health Information Exchange (IHIE) and Michiana Health Information Network (MHIN), two Indiana HIEs, announced they plan to consolidate on Jan. 1, 2020.
Indiana’s third HIE, HealthLINC based in Bloomington, is also part of this statewide consolidation. HealthLINC began transitioning its customers to IHIE in mid-2019. The consolidation of the respective customer bases of Indiana’s three health information exchanges results in one HIE serving nearly all the state.
Indianapolis-based IHIE pointed to the changing national landscape of health IT. There has been a growing trend of consolidating HIEs to produce stronger value in overlapping markets and more dollars and resources dedicated to innovations that benefit customers.
In the case of the Michigan organizations uniting, they mentioned the need to be more strategically aligned for ongoing national efforts and regulations being announced, such as the Trusted Exchange Framework and Common Agreement (TEFCA).
“The evolution of national interoperability is driving the need for HIEs to adapt, but also creating opportunities for new HIE value propositions,” said John Kansky, IHIE’s president and CEO, in a prepared statement. “To deliver this new value, HIEs need to make significant investments and operate on a larger scale.”
In a webinar last year, Tom Moore, Healthix’s senior vice president of innovation, described how Healthix has started sending participants “smart alerts” triggered by changes in diagnoses or lab values. Like most HIEs, Healthix has been offering clinical event notifications for a while. These are the admission, discharge and transfer (ADT) feeds it gets from thousands of participants at 7,000 different facilities. Through SHIN-NY, the statewide RHIO network, Healthix also pulls in data from other organizations from across the state. “We have a repository on 17 million patients,” he said.” That data is used by a clinical alert engine to generate alerts that go out to providers triggered by healthcare transactions or encounters, including those involving the New York City jail.
Clinicians can choose to receive the smart alert messages in several different modes: as an HL7 message sent to the EHR; through a clinical message center on Healthix’s portal; or as a secure e-mail using the Direct protocol. The majority use HL7 messages, he said.
Healthix customers get a lot of mileage out of these standard alerts triggered by encounters,” Moore said, “but we are leaving it up to them to make something useful out of that.” Healthix is now being smart about sending the alerts as well. “What we have learned from talking to participants over the years is that there is more we can do,” he added. “There are more interesting things happening with their patients outside their organizations they want us to help them understand — not just about transitions, but something that requires looking across the clinical record and determining something of significance has happened with this patient that they wouldn’t know about because it happened outside their organization.” Healthix is sitting in the right spot to pull that data together.
Here are some of the examples he gave of smart alerts:
• Changing diagnosis. A patient might have a diagnosis of COPD. “If we then got a new diagnosis that the patient had congestive heart failure or something that is not COPD, that would trigger an alert,” he said.
• Significant change in lab value: If hemoglobin A1C lab value changes significantly or hits an abnormal threshold, that could trigger an alert.
• Patients who visit ED frequently: More than three visits in 90 days or more than one visit in a 72-hour period can trigger alerting.
• Chronic disease area: If a patient with HIV has a viral load that is above normal, that will trigger an alert. In a clinic setting, you would want to know if the patient's viral load is out of control and if they are getting primary care anywhere else, he said.
Healthix also is working on predictive analytics offerings, Moore said. All of these alerts are enhancing care coordination efforts in New York City. “We also work with participants to help support their population health initiatives,” he said. “Recently we have gotten involved in exchange with social service agencies, which is a key growth area.”
