Earlier this yr, the New York eHealth Collaborative (NYeC) made an utility developed by Hixny, one of many state’s six well being info networks, out there to all suppliers in New York. Hixny CEO Mark McKinney not too long ago sat down with Healthcare Innovation to explain the information entry and workflow integration offered by the SMART-on-FHIR app referred to as Snapshot NY.
Hixny says that since 2020, its affected person document Snapshot has delivered insights and knowledge factors to linked healthcare suppliers in an easy-to-navigate format, surfacing actionable info inside present workflows. Prior to now yr, Hixny has launched new capabilities, together with direct entry to the state’s prescription drug monitoring program question instrument and a health-related social wants (HRSN) screening instrument that meets all the necessities of the state’s 1115 Medicaid waiver modification.
Healthcare Innovation: Mark, earlier than we discuss functions and workflow integration, are you able to remind our readers of Hixny’s geographic area and its origins?
McKinney: Hixny serves the upstate area, from the Hudson Valley north to the Canadian border after which west to the Mohawk Valley. We have been round for nearly 26 years. We began off as a three way partnership between the New York State Well being Plan Affiliation and Iroquois Healthcare Affiliation, which is a bunch of upstate hospitals. Hixny stands for Healthcare Info eXchange of New York.
HCI: What are the regional HIEs in New York referred to as? I’ve seen them known as Certified Entities and QHINs….
McKinney: Initially, they began out being referred to as RHIOs for regional well being info organizations. Then when the state fashioned, the SHIN-NY [Statewide Health Information Network for New York], it determined that every one the RHIOs wanted to have certification, in order that they began to name them Certified Entities. Now they’ve began to consult with everyone as well being info networks (HINs). However we’re nonetheless Certified Entities, as a result of that is what we’re outlined as beneath the state regulation, so any a type of is acceptable.
HCI: I wrote one thing not too long ago about one other New York well being info community referred to as HealtheConnections starting to supply ADT feeds statewide. Hixny additionally gives a notification service. Is it a home-grown resolution or do you companion with a third-party vendor on that?
McKinney: Ours is extra of a homegrown resolution, The state determined to award statewide alerting to 2 suppliers, us and HealtheConnections. Our resolution is barely totally different from theirs in that we’re actually centered extra on workflow integration. We’ve had a regional alerting service out there for a minimum of a dozen years. And in that point, what we have discovered is that suppliers actually need that knowledge pushed to them of their EHR. In August, previous to going reside on the statewide system, we did one thing like 700,000 alerts that month regionally.
HCI: We’re going to speak about your Snapshot NY utility in a second, however do you assume different well being info networks will look to innovate and supply statewide providers that they’ve developed of their area?
McKinney: I’d say sure. As an HIE, it’s worthwhile to be revolutionary. And I’d suspect that a lot of the different QEs within the state are fascinated with various kinds of innovation. The largest query is how nicely these translate to statewide providers. Is it one thing that is uniquely tailor-made to their group, or is it one thing that’s extra usually relevant to suppliers anyplace?
HCI: Let’s discuss Snapshot NY. Is that this one thing Hixny developed and has been in use in your area for some time and also you are actually making it out there statewide? May you discuss the way it works and what it brings into the supplier’s workflow?
McKinney: Simply earlier than the pandemic, we created a challenge we referred to as a hackathon, the place we let workers bid on the concept of getting two weeks to only give attention to a challenge. What got here out of it was a prototype for a SMART-on-FHIR utility that was meant to make it simpler to carry all the information collectively.
After I first acquired right here, after we had been in a position to lastly carry the information collectively, and we had a supplier portal, we would launch the information to the portal, and I assumed folks would find it irresistible, proper? Folks had been saying they only needed entry to all this knowledge in a single place, so we gave it to them, and guess what occurred? No person used it. As a result of it was not proper of their EHR workflow.
So one of many huge issues that Snapshot solves is it eliminates a number of person administration capabilities or considerations. It gives some extra ranges of safety, as a result of we do not have to have a person configured inside each the affected person supplier portal and in addition then in an EHR. Simply by being provisioned within the EHR, you are mechanically on this system. The opposite factor is we realized that not solely can the EHR open a window to allow our app to run inside it, we additionally realized we may open a window to allow different apps to function inside our window. So basically, it is like a window in a window contained in the EHR. What that offers us the chance to do is to usher in different knowledge sources. We’ve had some success working with the New York State Division of Well being to carry a few of their functions into our utility after which make them out there.
HCI: Just like the state’s prescription monitoring program question instrument and an 1115 Medicaid waiver authorized screening instrument?
McKinney: Precisely. It is a manner for the state to increase what it has with out giving up the management and it places it multi functional place, proper? So one of many huge complaints we get from suppliers is, nicely,I’ve to go and test 5 totally different sources from DOH, and that is 5 totally different logins and passwords. This provides us the flexibility to make issues just a little bit simpler for the customers by placing every little thing there in a single place.
HCI: Have you ever had some expertise in your area with the Snapshot instrument and acquired some suggestions from suppliers that gave you the arrogance to supply this statewide?
McKinney: We have taken a really enterprise mannequin strategy to this, the place we took this prototype, and convened a lot of focus teams from throughout the group and requested them to assist us refine it into one thing helpful. What got here out of it on the interface facet and the utility facet was what the supplier mentioned that they wanted. By means of that course of, we have provide you with some revolutionary, easy features that we would not have considered on our personal that make an enormous distinction. If you consider it, our utility is embedded inside a hospital’s EHR, so that you’re wanting on the knowledge we get from that hospital, in addition to from 11 different hospitals in our area. So now you both need to see your knowledge alongside everyone else’s knowledge, otherwise you’re already seeing your knowledge in your EHR, and also you need to cover your individual knowledge. So that they got here up with a quite simple little button that permits you to toggle and switch off your individual knowledge. Truthfully that’s one thing that I do not assume we’d have provide you with on our personal.
HCI: I noticed that Hixny was the primary validated knowledge stream for health-related social wants acknowledged by NCQA. What was concerned in incomes that recognition, and what does it enable the group to do?
McKinney: Now we have one other one for knowledge aggregation validation. Properly, NCQA’s huge focus is on major supply verification. What they need to know is the information on the supply matches the information that Hixny has and gives to the tip level.
That offers us two advantages. One is that we’re in a position to inform everyone that an impartial third occasion with an impressive popularity for scrutiny and focus has validated that every little thing that’s in our system matches what was within the system we sourced it from. Within the particular case of the HRSN instrument, they needed to validate that the information that was integrated into that instrument made it all through the system after which out of the system with none type of modification.
HCI: I wrote a couple of presentation in 2020 by somebody from NYeC about shifting to a FHIR basis to allow members to entry discrete items of scientific info by means of open APIs. Is that occuring?
McKinney: It is occurring, however not as shortly as some had thought. FHIR was launched possibly a dozen years in the past, however it’s actually solely now that we’re lastly getting to some extent the place it’s changing into an alternative choice to the usual methods of shifting knowledge. However we’re utilizing it fairly a bit. I am going to provide you with a few fast examples. As a part of New York State’s 1115 waiver, we’re accumulating all of the HRSN screening knowledge across the state. Every of the QEs is accumulating a few of the screening knowledge coming immediately from the EHRs. When that happens, the QE takes it, codecs it, converts it to FHIR, after which sends it to a central repository in order that that knowledge is offered to suppliers across the state for a wide range of totally different use circumstances.
We’re additionally engaged on another initiatives with NYeC the place we’re supplying them knowledge in a FHIR format. We have performed some packages the place we have been efficiently ready to connect with and retrieve knowledge from EHRs immediately utilizing FHIR. What we’re discovering is that the expertise continues to be evolving when it comes to its skill for use, however it has nice promise for all of these functions.
HCI: Anything you need to point out about present initiatives?
McKinney: We all know that what is occurring in our group is basically all about value-based care, and we’re centered on working with suppliers to know what it’s that makes them profitable in value-based care, and be certain that our instruments are doing these issues. As knowledge turns into simpler to maneuver and interoperability turns into much less of a barrier, now the issue is simply the amount of information, so we’re actually centered on how we will flip that firehose right into a water fountain, or no matter cliche you need to use and be certain that we will make it simpler for people to do the issues that they should do.