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NewYork-Presbyterian System SelectHealth – an HIV Special Needs Plan (SNP). The Challenge.... 1400 people living with HIV and receiving care from a multitude of different providers, institutions, and agencies
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NewYork-Presbyterian SystemSelectHealth – an HIV Special Needs Plan (SNP) • The Challenge.... • 1400 people living with HIV and receiving care from a multitude of different providers, institutions, and agencies • unstable housing, complex co-morbidities (mental health, chemical dependency, HCV) result in care and services routinely being provided in a critical ‘information vacuum’ • HUGE opportunity to do better, to reduce errors, to effect improved care coordination! • The Solution (?)…. “My Health Profile” • Adopt an evolving standard for Health Information Exchange, the Continuity of Care Record (CCR), for all individuals • Provide easy access for patients, their designees, and their providers • Utilize Health Information Exchange network(s) as the ‘backbone’ of the overall program
NewYork-Presbyterian SystemSelectHealth HRSA Special Projects of National Significance Information Technology Networks of Care Initiative (2007-2011) My Health Profile: a Member Continuity of Care Document (CCD)* • Core Elements of CCD • CCD Identifying Information • Patient’s Health Status • Diagnoses • Medications • Laboratory results • Procedures/Imaging • Allergies/adverse reactions • Social history/Family history • Advanced Directives/Life Documents • Care Documentation • Practitioners *Offers patients and providers access to key elements of their clinical, psychosocial, and administrative record over a secure, web-based portal. For more information email pgg2@columbia.edu or call 212-305-3272 PI - Peter G. Gordon, MD & Co-PI - Eli Camhi, MSSWRon Hesse, Project CoordinatorSuzanne Bakken, RN, DNSc, Evaluator
My Health Profile project Success Stories#1. Patient Empowerment! • Over 120 patient users have logged in >500 times • Each has received an Internet 101, My Health Profile training session, unique passwords, and emergency access cards • Adoption of service (technology) has been rapid • Structured feedback has been overwhelmingly positive • Security and privacy concerns have been addressed
My Health Profile project Success Stories #2. Improved Coordination of Care Community Based Case Management Pharmacies Social Service Agency Laboratories Patient ‘Centered’ Care Primary Care Site Hospitals
Patient Centric Patient Centric Patient Centric Patient Centric The SHIN-NY Public Health Other NYS DOH Databases CDC Medicaid Biosurveillance Immunization and Child Health Multiple RHIOs* NYS DOH UPHN SHIN-NY** NYC Health Dept. Local Health Depts. Diagnostic Centers Home Health Care and Telemedicine Patients’ Personal Health Records SHIN-NY** Pharmacies and PBMs Managed Care Physicians Offices and Clinics Hospitals, Nursing Homes, IDNs, etc *RHIOs = Policy **SHIN-NY = Technology