Making Headway With Data Exchange in the Big Apple

Sept. 5, 2014
In advance of the Health IT Summit in New York, to be held September 16-17, Gil Kuperman, M.D., Ph.D., director, interoperability informatics at New York Presbyterian Hospital, talks to HCI about the key issues around exchanging data in new models of care.

For patient care organizations of all sizes, sharing data in the new healthcare environment is critical to taking on more risk and also improving quality of care delivered. Undoubtedly, as the healthcare landscape changes, and accountable care organizations (ACOs) and other new care delivery models emerge, the traditional health information exchange (HIE) structure will change to realize the value-based world.

At a panel discussion entitled “Exchanging Data in New Models of Care,” industry leaders will ponder a variety of issues around data exchange, effective data governance strategies, and examples of sharing clinical and claims data. That discussion will take place at the Health IT Summit in New York, to be held September 16-17 at the McGraw-Hill Conference Center. The summit is sponsored by the Institute for Health Technology Transformation, or iHT2. (Since December 2013, iHT2 has been in partnership with Healthcare Informatics through HCI’s parent company, the Vendome Group LLC.) For further information on the Summit, please click here.

On the above-mentioned panel will be Gilad Kuperman, M.D., Ph.D., director, interoperability informatics, at the Manhattan-based New York Presbyterian Hospital. Kuperman recently talked with HCI Associate Editor Rajiv Leventhal regarding a variety of issues centered around exchanging data in new models of care. Below are excerpts of that interview.

Tell me how your organization is progressing with data sharing.

We are actively moving forward with various data sharing initiatives, with different sets of activities targeted at that. We have very tight business partners, emerging business partners, and then more regional types of activities going on. Our tight business partners are the two medical schools we are affiliated with, Columbia and Weill Cornell (both in New York City). We have a fairly long tradition of exchanging data with them in support of business activities, patient flow and things like that. We continue to enhance those over time with more structured data types, more standard data communication, and initiatives such as Direct.

Regarding our emerging business partners, we are partnering with organizations as part of new care coordination models of care and accountable models of care. This doesn’t mean ACOs, necessarily, but for organizations such as health homes, we are making our data accessible.

And then, we are also taking part in a regional HIE, Healthix. That will become more important over time as we start exchanging data with several other organizations—we really think it will play an increasingly important role. To date, data sharing has been on a smaller scale with a small number of providers. It’s been very targeted, but as data exchange with others grows, we will rely more extensively on Healthix.

How are HIE models changing in this new era of accountable care?

New York State has committed some funds out of the Health Care Reform Act (HCRA)—I believe it’s around $50-60 million in funding per year for the next three years. That’s the plan at least, as it needs to be renewed annually. The idea is that the state will continue to support HIE in a substantial way. Funding has been going on for close to a decade now, and it’s continuing, so the state can use this is an important piece of infrastructure that it needs to prop up at least for the time being, if not longer.

Over the next three years, as accountable care models become more prevalent, these programs will find value in the HIE and the accountable care models may start paying an increasing share of the cost of the HIE activities. We’re not there yet, as the HIEs can’t yet stand on their own, but they are increasingly a part of the landscape, especially in New York City where there are so many providers and so much provider fragmentation. There are four medical schools, each with its own medical center, in addition to other large provider organizations that are unaffiliated. And of course there are a number of non-acute providers too, such as nursing homes and home health agencies. There are very few places with this sort of density of fragmentation. So you can’t really rely on private HIEs to do the whole thing. We think the regional HIE, almost as a public utility, is an important part of the landscape environment.

What are your organization’s main challenges associated with data exchange?

One challenge is that the new care delivery models—be it ACOs or health homes or other specialized arrangements—are still emerging.  So in some ways you don’t know exactly where the puck is going to be, and you need to prepare for several eventualities. No one knows exactly what they will look like, who exactly you’ll be partnering with, what the payment arrangements will be, and where the risks will be. So knowing exactly what to design for is still murky.

Another set of challenges arise even when you do know who you will be partnering with. Getting an aggregation of data—so that you can do analytics and understand what the patient overlaps are and what the patient flows are—from different sources to do requisite analytics for current state analysis is very difficult. And even if you can get that data together, you sometimes don’t know the data quality. We have our databases—we understand them and we know where all the idiosyncrasies of the data exist. But when we’re dealing with data from another institution, we might not understand their idiosyncrasies of how they capture and represent data.

What are some data governance strategies that you would recommend?

Data governance is very challenging. In some ways, data governance is a subsidiary activity of the overall programmatic governance. So if you will be entering into a new care delivery model and you’re going to have various stakeholders involved in that new program of care, then there should be a governance model to oversee the programmatic aspects of the new model, new arrangements, and new relationships. That’s one principle—the data governance is part of a larger governance structure, to go along with clinical and financial governance.

The principles are that the data access should be what’s necessary to s support the programmatic goals, and that appropriate privacy and security frameworks are followed. With privacy, there are state and federal laws that govern what is allowable or not, so there are ways to address that. Data governance requires a meticulous and thoughtful approach. It can be burdensome, but following the principles will make the process better.

 So what are the key questions organizations should be asking themselves when it comes to data sharing?

First, what are the programs the organization is trying to support with data sharing? Data sharing, in the absence of some kind of context, is very difficult, so it’s much easier if you know the programs of care you’re trying to support. There is going to be murkiness as things evolve and basic capabilities that you will want no matter what. Exchange with key business partners, adhering to standards whenever available, and understanding what’s going on in your local region in terms of a community HIE are the really important things organizations should be considering.

These and other topics will make for a lively discussion in New York, as these panelists and others discuss key topics around this important subject. To learn more, please check out the Health IT Summit in New York, September 16-17, sponsored by the Institute for Health Technology Transformation.

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