The NYC Primary Care Information Project Successes, Challenges, Future Efforts

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The NYC Primary Care Information
ProjectSuccesses, Challenges, Future Efforts
Jesse Singer, DO, MPH, Executive Director
Development, PCIPjsinger_at_health.nyc.govwww.nyc.g
ov/pcip
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OVERVIEW OF PCIP - Largest EHR Extension Project
in the Nation

• A bureau of NYC DOHMH, founded in 2005
• Mission
• Improve the quality of care in medically
  underserved areas through health information
  technology (HIT)
• Resources
• Current funding NYC, NY State, Federal, private
• Future funding Extension center stimulus funding
  (fingers crossed)
• Success
• Over 1500 providers are using the EHR at
• 16 CHCs
• 3 hospital outpatient
• 246 small practices

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Increase the quality of care in medically
underserved areas through health information
technology (HIT)

• Goals
• Extend EHRs that support prevention to 2,500
  Medicaid PCPs, over 1.5 million patients
• Provide practices with clinical quality
  scorecards and practice redesign technical
  assistance
• Design and implement pay-for-performance
  incentive program that supports and recognizes
  preventive measures
• Support EHR-enabled PCPs in standardized health
  information exchange

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PCIP EHR Extension Approach

• Eligibility/ Commitment
• Primary Care
• Underserved populations (10 Medicaid, uninsured)
• Quality Measure Reporting (summarized,
  confidential)
• Financial Commitment
• Hardware and Internet
• 4k per provider QI fund
• PCIP Package
• Licenses to eClinicalWorks TCNY integrated EHR
• On-site training Billing, EHR superuser, QA, QI
• 2 years software maintenance and support
  (1500/yr)

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Healthcare that maximizes health
Our Vision
ARRA Stimulus funds
ELECTRONIC HEALTH RECORDS oriented to prevention
PCMH, Stimulus workforce (panel mgmt?)
Health reform? PCMH?
CARE MANAGEMENT an practice workflows to support
prevention
PAYMENT that rewards disease prevention chronic
disease management
Frieden TR, Mostashari F. JAMA. 2008 Feb
27299(8)950-2.
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Health Information system oriented toward
prevention
QUICK ORDERS One-click ordering of recommended
preventive services
MEASURE REPORTS Side-by-side provider comparisons
of performance on TCNY quality measures
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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)
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AUTOMATIC VISUAL ALERTS Highlights abnormal
vitals
eMedNY With patient consent, displays 90-day
history of all Rxs filled by Medicaid patients
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CDSS Automatically displays TCNY preventive
service alerts that are suppressed when addressed
CIR and School Health Sends information to City
Immunization Registry and school health forms
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Point of Care Alerts on Patients status with
measure compliance
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Can select any of the TCNY Measures
Can refine the results by Facility, PCP, PCG,
Insurance, and/or Race/Ethnicity
Reflects current percent by each Cross Tab
selected
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Select desired row of interest
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By selecting a particular row you can get a
breakdown of patients in the numerator (green)
vs. those not (black)
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Care Management Practice Workflows that Support
Prevention and Population Health

• Bring large, integrated, health care delivery
  system to our disparate providers
• Panel Management
• Small practices lack the resources to perform
  tracking outreach activities without additional
  resources or funding.

Using EHRs, we believe at-risk patients can be
identified and managed in a more strategic
proactive way, helping to improve health outcomes
primary care capacity, reduce costs, and create
jobs
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Payment that rewards disease prevention and
effective chronic disease management NYC Health
eHearts Rewards

• 3-6M Grant from Robin Hood Fund
• EHR serves as basis for rewards and recognition
• Prevention as a top priority
• Focus on an area with maximum potential for
  saving lives (cardiovascular health)
• Reduce disparities
• Incentive amounts are meaningful
• Pay on ALL patients
• Higher rewards for harder to treat patients

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eHearts Incentive Payment
Example 1 Patient A is commercially insured, a
smoker and received smoking cessation
intervention.
Example 2 Patient B is uninsured, a diabetic
and BP managed to lt130/80.
Example 3 Patient B is also a smoker and
received smoking cessation intervention.
REWARD 20
REWARD 80
REWARD 20
TOTAL REWARD for Patient B 80 20 100
? Total available funding for incentives 1.6
million Average incentive per provider 10,000
to 20,000 Maximum incentive per practice
100,000
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Challenges

• Providers have competing practice priorities and
  limited resources
• Early adopters faced biggest hurdles
• Data required for quality measures reporting not
  uniformly recorded
• Lack of engagement of providers in QI activities
  and quality measures
• Health plans reluctant to commit funds to
  untested clinical quality incentive program

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How Can We Get Value From HIT? (and avoid
wasting a lot of money for no public benefit)

• Ensure that EHRs are implemented where they will
  do the most good
• Ensure that EHRs focus on prevention
• Facilitate EHR adoption
• Support distributed data networks
• Design incentives to protect health and reduce
  disparities
• Foster a new workforce for prevention in primary
  care