The Primary Care Information Project

1. The Primary Care Information Project Sarah Shih, MPH Exec. Dir. Healthcare Quality Information New York City Department of Health and Mental Hygiene sshih@health.nyc.gov http://www.nyc.gov/pcip

2. NYC’s Health Agenda Take Care New York • Have a Regular Doctor or Other Health Care Provider • Be Tobacco-Free • Keep Your Heart Healthy • Know Your HIV Status • Get Help for Depression • Live Free of Dependence on Alcohol and Drugs • Get Checked for Cancer • Get the ImmunizationsYou Need • Make Your Home Safe and Healthy • Have a Healthy Baby

3. HEALTH INFORMATION SYSTEMS that are oriented toward prevention REDESIGNED PRACTICE WORKFLOWS PAYMENT that rewards diseaseprevention and the effective management of chronic disease Health Care that Maximizes Health PATIENT ENGAGEMENT that highlights prevention

4. Focused on Medically Underserved Patients in NYC We have secured signed commitments from 2,100 providers in 379 practices and at 480 sites ~ 1 new provider goes live on the EHR every day *Practice with sites both live and in implementation

5. BRINGING THE RESOURCES OF LARGE NETWORKS TO INDEPENDENT SMALL PRACTICES - A “VIRTUAL NETWORK” NYC PCIP Kaiser Permanente 5

6. PCIP, eCW & Practice team structure

7. 8 Key Features of the TCNY Build MEASURE REPORTS Side-by-side provider comparisons of performance on quality measures QUICK ORDERS One-click ordering of recommended preventive services 5 1 COMPREHENSIVE ORDER SETS Displays best practice recommendations (e.g., for meds, labs, patient education) ENHANCED REGISTRY Identifies patients by structured data (e.g., diagnoses, drugs, labs, demographics) 2 6 eMedNY With patient consent, displays 90-day history of all Rxs filled by Medicaid patients AUTOMATIC VISUAL ALERTS Highlights abnormal vitals 3 7 CDSS Automatically displays preventive service alerts that are suppressed when addressed CIR and School Health Sends information to City Immunization Registry and generates school health forms 4 8

8. SmallPractice ConsultingApproach

9. Following Medical Home and Chronic Care Models Useful framework for organizing QI work • Actionable curriculum consisting of a collection of discrete activities and achievable goals • Focus on “whole-practice” redesign (e.g. teamlet care – C. Sinsky) • Provide actionable and meaningful feedback • View EHR-derived quality measure data on a routine basis • Provides incremental recognition “BOOTS ON THE GROUND” • Assist practices through the process and lower the “activation energy” • Software, QI, EMR consulting, Pay for Performance, relationships • Partnership with NCQA- multi-site survey • Keep practices focused on care & and reduce administrative burdens • Average physician spends $68,274 per year interacting with insurance plans* • Focus practices on areas to have the highest impact for health • Provide share resources to practices (care coordinators, nurses, panel managers) • Conduct patient outreach using the data from HER *J. A. Sakowski, J. G. Kahn, R. G. Kronick et al., "Peering into the Black Box: Billing and Insurance Activities in a Medical Group," Health Affairs Web Exclusive, May 14, 2009, w544–w554 9

10. How do we know whether providers are meaningfully using the EHR? • PCIP staff • Scheduled on-site visits • Demo of registry query functions • Data Transmissions from EHR • Encounter information from PM • Utilization of EHR metrics • Quality Measures (EoC)

11. Average Encounters Per Month by Practice Size* *Limited to small practices that have been on the EHR for 6 months or more. Data available on ~116 small practices

12. PCIP Contractual Expectations with Providers Selected Measures for Demonstrating Use of EHR • Visits where office visit CPT codes were entered into the progress note. • Visits where an order set was used as part of the progress note. • Visits where a smart form was used as part of the progress note. • Visits where blood pressure was entered into the progress note. • Visits where allergy data was entered in a structured format • Insurance claims created over total number of insurances for patients that month • Visits where medications were prescribed through the EHR • Prescriptions entered into the EHR that were sent via fax or electronic interface • Labs reviewed over labs ordered • Current medications were entered or verified in the EHR • Months in a 6 month period when required data files were transmitted to the DOHMH • Months in a 6 month period when all core utilization measures were reported to the DOHMH

13. Proposed Meaningful Use MeasuresOverlapping with Data Transmitted to PCIP

14. EHR Utilization Transmitted to PCIP • Snapshot of monthly activities • Number of practices with EHR use data • 133 practices in July and August 2009 • 85 have been using EHR for 8 months or longer *limited to practices on the EHR for 8 months or longer

15. Proposed Meaningful Use MeasuresCurrently within PCIP Quality Measures Note: Quality Measures are collected at the provider level and stratified by insurance type. For some practices, stratified by race/ethnicity, though few providers are completing the field for race/ethnicity

16. Preliminary Data – Quality Measures *A population estimate was derived by summing across practice denominators per measure

17. Questions? Contact: sshih@health.nyc.gov Visit: http://www.nyc.gov/pcip