I spoke with Nick VanDuyne, Executive Director of the New York Care Information Gateway, a regional health information organization (RHIO) operating in the New York City and Long Island region. RHIOs have had a bumpy ride in general, and not many have been able to find a sustainable business model. The NYCIG is one regional component part of the State Health Information Network of New York, aka the SHIN-NY (yes, it’s pronounced “shiny”). There are actually three RHIOs in the New York City area, given the population density, and several more spread out across upstate New York. The SHIN-NY is supported by state appropriations thus far, which has allowed it to mature without facing the financing challenges that so many other similar enterprises have faced. That day of reckoning is likely to come in the not-too-distant future, but, as I discussed with Nick, the SHIN-NY may be well-prepared for that day given its diverse value propositions for its various constituencies.
So what is the SHIN-NY, really? As Nick says,
[The SHIN-NY is] really the core piece that allows all the RHIOs to speak to each other. We have the ability to transact data from one area to another. And we have the ability to move clinical event notifications throughout the entire state regardless of where a patient shows up. That’s, again, facilitated by the SHIN-NY, and the fact that we have a master patient index at the state level that we all contribute our patient identifiers to.
In addition to the consolidated CCD information that one might expect to see coming through a RHIO, a provider can subscribe to ADTs for particular patients anywhere in the state and receive them in real time. This allows for better statewide care management efforts than may be available in many other parts of the country. (Commonwell and CareQuality do not offer this functionality.)
The overall infrastructure is funded by the state, and local connections are the responsibility of each participating institution. But state funding is slated to run out at the end of March 2021, at which point the SHIN-NY and the RHIOs will likely have to face the music, and justify the costs to their constituencies or risk obsolescence.
Nick described some of the SHIN-NY’s use cases, which he thinks will offer a cost-effectiveness justification for continued funding.
As one example, the SHIN-NY allowed clinicians to pick up the trail, so to speak, of thousands of patients – in one particular cohort, tracking hemoglobin A1C levels of nearly 10,000 patients without the need for incurring the cost of staffing up a care coordination program, and ultimately tracking forty discrete data elements for a plan with a patient population of about 20,000, and closing up gaps in care and yielding improved value-based payments.
Other diseases and chronic conditions may also be better managed using the tools at the RHIO’s disposal (e.g., CHF, COPD, pediatric asthma).
While there is recent movement inside the Beltway away from continuing the ban on federal dollars for development or implementation of a UPIN, NYCIG has started using innovative patient matching tools that have allowed it to eliminate 500,000 duplicate patient records (and that’s a significant portion out of a total of seven million patients). This allows for improved patient tracking across care settings, which allows for sharing clinical event notifications from one health system to another (since the density of providers is so high in NYCIG’s geography, and patients tend to receive care at multiple providers). One pilot project saw an increase in readmission avoidance payments on the order of 300%.
These examples and others all speak to the tremendous potential of the SHIN-NY, and it seems that its future should be secure, given the tremendous improvements in care coordination and reduction in costs that this health IT network has brought to New York State.
I spoke with Nick as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. Listen to our radio station online, or ask your smart speaker (Amazon Echo or Google Home): “Find Tune In station HealthcareNOW Radio.” You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.
David Harlow
The Harlow Group LLC
Health Care Law and Consulting