The New York City Health and Hospitals Corporation (NYC HCC) Patient Registry:

1. The New York City Health and Hospitals Corporation (NYC HCC) Patient Registry: Information to Enable the Management of Chronic DiseaseKatie (Mackle) LeMoyneEngagement ManagerTELUS Health Solutions Katie.Mackle@telus.com

2. NYC HCC Patient Registry – Measures and Indicators • The NYC HHC Patient Registry contains chronic disease data for over 65,000 patients; diagnoses include: diabetes, asthma, CHF, and depression • Data are pulled from seven separate data warehouses populated by separate instances of the QuadraMed EMR • Data from 1650 fields are aggregated into 45 measures used to populate 32 indicators, e.g. Diabetes indicators (subset):

3. Test Patient 12 Test Patient 5 Test Patient 1 Test Patient 11 Test Patient 2 Test Patient 14 Test Patient 9 Test Patient 10 Test Patient 8 Test Patient 13 Test Patient 7 Test Patient 4 Test Patient 6 Test Patient 3 666666 (BHC) 333333 (BHC) 444444 (BHC) 222222 (BHC) 141414(BHC) 111111 (BHC) 999999 (BHC) 101010(BHC) 131313 (BHC) 111111 (BHC) 777777 (BHC) 888888 (BHC) 555555 (BHC) 121212 (BHC) 09-23-64 11-12-09 12-17-40 10-02-79 01-01-46 03-04-45 08-25-67 03-04-76 03-04-45 11-11-11 03-04-45 03-04-45 06-23-50 05-30-81 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 555-555-5555 Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes Dr. Diabetes NYC HCC Patient Registry – Patient Lists By clicking on the ‘Uncontrolled’ patients the user is brought to a list of the patients who do not meet the indicator criteria

4. Objectives of the Patient Registry • Provides physicians and healthcare administrators with access to real-time indicatorsfor chronic disease patient populations at the care team, facility and organization level • Enables users to drill into the data to identify high-risk (uncontrolled) subpopulations and follow up with patients • Ensures patients are receiving best practice care and are being seen at recommended intervals • Provides users with indicator trends over time to understand whether interventions are having a positive impact on patient populations • Enables healthcare administrators to compare performance across care teamsto identify high and low performance teams

5. Patient Registry Challenges • The separate QuadraMed EMR implementations were not standardized resulting in significant data mapping and normalization efforts (e.g., 160 separate fields were mapped to ‘Blood Pressure’) • Many measures were not captured in the EMR and therefore could not be pulled into the Patient Registry (e.g., diabetes self management plan) • Physicians initially resisted taking ownership of the patients assigned to their care team and therefore did not believe the indicator values were accurate • NYC HHC is planning to implement a new EMR but the Patient Registry is custom developed for the QuadraMed data warehouse; it will require significant rebuild to convert the Registry

6. Patient Registry Lessons Learned • A strong senior-level champion is key to gaining momentum • Mapping and aggregating data can be very complicated, especially if source systems are not standardized • Physician buy-in and support are critical – physicians must believe that the data are complete and accurate • Positive incentives, rather than penalties, provide the motivation needed to convince physicians to be openly compared to one another • Celebrate small successes – moving from 15% to 20% of patients having their blood pressure controlled should be celebrated, even if the target is 80%!