The NYC Primary Care Information Project A Model for Improving Quality in Small Practices

1. The NYC Primary Care Information ProjectA Model for Improving Quality in Small Practices?

2. Background Medical care and clinical preventive services increasingly important to population health Medical care not structured to deliver public health benefit, particularly in small practices How can we make a structural change?

8. Quality of Care With and Without EHR Use

10. Primary Care Information Project Mission Increase the quality of care in medically underserved areas through health information technology (HIT) Resources NYC: $27 million and 40 staff NYS: $11 million Feds: $5 million Vision: To improve population health through appropriate health information technology and health information exchange. Program Areas: eRx Expansion EHR Adoption Health Information Exchange Vision: To improve population health through appropriate health information technology and health information exchange. Program Areas: eRx Expansion EHR Adoption Health Information Exchange

11. 8 Key Features of the TCNY Build

21. EHR Extension- Where to Start?Community Health Centers All NYC Community Health Centers to have EHRs by 2009 648 providers 500,000 patients 50% Medicaid, 20% uninsured $3.2 million HEAL-NY 1 state grant Up to $5.6 million City Capital match Up to $9 million CHC match New EHRs, or preventive functionality in existing EHRs (n=4)

22. EHR Extension- Other Practices Focus on small practices Deliver 85% of primary care Lowest EHR adoption rates Greatest challenges in quality and financing Need convening and support Medical Societies QIO (IPRO) Hospitals Health plans

23. Eligibility/ Commitment Primary Care Underserved populations (30% Medicaid, uninsured) Quality Measure Reporting (summarized, confidential) Financial Commitment Hardware and Internet $4k per provider QI fund PCIP Package Licenses to TCNY Build of eClinicalWorks On-site training Common interfaces 2 years software maintenance and support ($1500/yr) Participating Practices

24. Small Practice Implementation Lessons It�s harder than you think Not just early adopters Lack of resources IT Hardware and Support Unreliable internet connections Functional interoperability not easy to come by Lab interfaces requested ? In place Lab A 85 ? 4 Lab B 70 ? 6 Lab C 38 ? 2 Quality Improvement experience/ culture can be lacking

26. Panel Management Planning Who, What, When, How Who is responsible for generating registry reports? Measure reports? Who will oversee this process? What action will be taken for each type of reports? When will staff make phone calls or generate letters for follow-up? How will it be incorporated into workflows?

27. Return on Investment to Providers?

28. Medical Home Certification Practices would Fully adopt and utilize TCNY build of eCW Complete quality improvement curriculum organized around PCMH domains DOHMH would Generate summarized EHR utilization reports pertaining to PCMH criteria Oversee quality improvement/ technical assistance NCQA would Facilitate PCMH designation for PCIP practices

29. EHR-Based Recognition and Incentive Programs

30. Thanks!