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Success Story: eCW & Chronic Disease Management Program in New York

Written by Kaitlyn Houseman | April 29, 2012

(From Dark Daily)

Chronic Disease Management Program in New York City Uses EHRs to Help Physicians Improve Patient Care

As part of NYC’s PCIP, physicians utilize clinical laboratory testing more effectively to diagnose disease and monitor patients

Seven years into a targeted program to use clinical data to drive measurable improvement in the health of patients with chronic diseases, health officials in New York City are declaring the effort to be successful at meeting several important goals. Some healthcare experts say NYC’s innovative project provides valid insight into the future of American healthcare.

Some pathologists and clinical laboratory managers are already familiar with what is called the Primary Care Information Project (PCIP), organized and manage by the New York City Department of Health and Mental Hygiene (NYDOHMH).

The Primary Care Information Project was the subject of a recent story in Healthcare Informatics. It reporter characterized the New York PCIP initiative as “extraordinary,” noting that it continuously leverages clinical IT to support population health management, care management, and enhanced communications among all participants, including physicians and public health departments.

“Health information from this project not only helps us identify City-wide public health issues, it provides physicians with unprecedented feedback about the health of their patients,” said New York City Health Commissioner Thomas Farley, M.D., M.P.H.

The New York PCIP was launched in 2005. “Our mission was to improve health through the use of health information technology,” declared NYDOHMH’s Jesse Singer, D.O., M.P.H. The program supports the adoption and use of electronic health records (EHRs) and data exchange among primary care providers in New York City’s underserved communities through a wide-range of services, explained the City’s PCIP webpage.

Singer and other department leaders took first-place honors in this year’s Healthcare Informatics Innovator Awards.

Study Shows Patient Outcomes Improve with PCIP Data-driven Care

A bureau of NYDOHMH, PCIP is improving patient outcomes as it reaches more neighborhoods. Since 2007, it has extended EHRs to over 2,900 practices. “[W]e’ve been doing go-lives with physicians across New York City,” Singer confirmed.

According to a Healthcare Information and Management Systems Society (HIMSS) news release, PCIP’s virtually integrated healthcare system includes 541 independent small practices, 38 community health centers, and three hospitals. The practices were selected for their high volumes of Medicaid and uninsured patients.

“We estimate that we cover about 2.5 million patients in New York, with 400,000 encounters per month,” Singer elaborated in the HI.com article.

Early findings from PCIP have demonstrated improvements in quality across multiple clinical preventive services. It reported the following improvement statistics under PCIP among patients with various conditions, compared to outset of program:

  • Effective management of high cholesterol: 52%, up from 39%.
  • Effective control of high blood pressure: 56%, up from 49%.
  • Effective control of A1c among diabetes patients: 20%, up from 14%.

Other changes spurred by the program include increased medical laboratory testing. After implementing EGHs, participating primary care physicians increased the number of hemoglobin A1c screenings by an average of 2.4%, along with an increase of 0.1% in primary care visits.

Under PCIP, New York City now has more than 100 sites recognized as patient-centered medical homes (PCMHs). This makes it the largest concentration of PCMHs in the U.S.

Primary care physician, Michael Richter, M.D., who serves about 2,000 patients and went live with his NYDH-facilitated EHR in 2009, affirmed the program’s value to physicians and to public health. Richter called the syndromic data collection fantastic. “It’s totally changed the way I practice,” he declared.

The program offers shared resources that directly contributed to these improvements in patient health. They include clinical quality and technical staff, a unified public health hub, quality dashboards, and group trainings. Leveraging the PCIP EHR network data enables NYC DOHMH to conduct programs in a more strategic, data-driven way.

Watching Chronic Disease through Data Reporting and Physician Alert Infrastructure

Helping physicians implement EHRs is phase one of a broader population health management effort, Healthcare Informatics noted. PCIP, in tandem with co-developer, eClinicalWorks of Westborough, Massachusetts, established a data reporting and physician alert infrastructure grounded in an electronic hub platform. It allows the NYCDH to gather information on the prevalence of acute disease, as well as levels of chronic disease, across different neighborhoods in New York City.

Singer explained that there was a clear need to focus on three specific types of data. These include

  1. clinical data from the EHR, such as blood pressure control;
  2. utilization data, such as rates of e-prescribing; and,
  3. syndromic surveillance data.

“Because we have very limited funds, we wanted to know what neighborhoods to target for certain things, such as, neighborhoods with high diabetes rates,” he stated. Additionally, he explained that the hub allows PCIP to securely do three different things:

  1. Push electronic messages directly to provider inboxes.
  2. Securely query all program EHRs.
  3. Provide patient-specific clinical support.

Clinical laboratory managers and pathologists will note two important takeaways from this story. First, New York’s PCIP program is another successful initiative in the drive to adopt EHRs and health data-exchange networks in ways that improve patient outcomes and population health. Second, the program shows that more effective, IT-based management of chronic disease can mean an appropriate increase in how physician utilize clinical laboratory testing.

—Pamela Scherer McLeod