Health information technology and health information exchanges have long held promise as a powerful tool for improving health care costs, delivery, and most importantly, outcomes. The story of the Western New York (WNY) Beacon Community, which just completed an ambitious three-year project focusing on diabetes care management, is the story of that promise being realized.
ScrollA collaboration between HEALTHeLINK, Catholic Medical Partners, P2 Collaborative of Western New York, and more than 40 other health care organizations, WNY Beacon was one of 17 Beacon Communities nationwide tasked with building and strengthening local health IT infrastructure and testing innovative approaches to make measurable improvements in health, care, and cost.
While meaningful use of electronic health records (EHR) served as the foundation of the program, implementing and integrating available technology at the practice level was key to achieving improved care management.
Building and strengthening the health IT infrastructure
Improving health, quality of care, and cost
Testing innovative approaches
The program was funded by a $16.1 million grant from the Office of the National Coordinator for Health Information Technology (ONC), which has defined three strategic pillars essential to facilitating and accelerating the effective use of health IT. By building on the foundation established by HEALTHeLINK, WNY Beacon made strong progress in each.
Real, measurable improvement in the quality of care and outcomes for diabetics has been documented as a direct result of the program. WNY Beacon has helped improve provider communication, established a focus on preventative care, and significantly enhanced patient engagement. In addition to improved care coordination, many of the technologies used facilitate effective monitoring of participating patients’ health, which can mean healthier patients and decreased costs.
The HEALTHeLINK clinical information exchange, established by the region’s major hospital systems and health plans with the support of the New York State Department of Health, served as the foundation of the WNY Beacon initiative and was, in turn, strengthened by it. HEALTHeLINK consolidates patient information from hospitals, independent radiology centers, independent laboratories, home health agencies, and long-term care facilities and then makes it available to participating providers. Building on an already strong infrastructure, WNY Beacon connected additional partners and data sources, developed additional technology, and introduced new functionality to increase HEALTHeLINK’s ongoing value to users.
27 hospitals
HEALTHeLINK has 47 datasources including:
8 regional radiology providers
3 independent laboratory practices
4 home health care agencies
3 long-term care facilities
2 surescripts
98% of laboratory results generated in WNY are available through HEALTHeLINK
90% of radiology reports generated in WNY are available through HEALTHeLINK
reports available in healthelink: >102 million
reports added monthly: approximately 1.9 million
Results delivery into the EHR system
More than 550,000 patient consents have been received
percent granting physicians access to their data within the HIE: 95%
Participation in the U.S. Department of Veterans Affairs’ Virtual Lifetime Electronic Record (VLER) Health Communities Program improves the quality of care and delivery of medical treatment to veterans.
Over 188,500 Continuity of Care documents have been transmitted for referrals from primary care physicians to specialists.
Prescription written electronically:
19% in 2009
70% in 2012
Learn more about the HEALTHeLINK functional
architecture as employed by WNY Beacon.
Effective technology is essential for a project like WNY Beacon, but it’s nothing without effective implementation and integration with existing clinical workflows. WNY Beacon’s success in this regard was a key factor in improving both diabetes care management and costs at the practice level.
Working with Catholic Medical Partners and P2 Collaborative of Western New York, WNY Beacon helped practices improve their individual process and workflow. By doing so, they were positioned to make the most of health IT features, including clinical reports delivery, clinical decision support tools, and EHR interoperability.
Perhaps most importantly, electronic health records were used to generate diabetes registries to better track lab values, vitals, and necessary tests. This registry can also be used to generate personalized reminders and guidance for patient care. Quarterly reports drawn from the registry have helped physicians identify opportunities to improve care and reduce cost and made the process of meeting federal Meaningful Use guidelines more manageable. Finally, ongoing refinement and improvement of the registry prepared the tool for the best possible future use.
Clinical transformation of 98 practices
WNY Beacon assisted with the clinical transformation of 98 practices by developing workflows that use health IT to improve practice performance in terms of both quality and cost.
“Our facility initiated the use of an electronic health record three years ago and we have seen the benefits that technology can provide to increase communication, quality of care, and to prepare us for the digital future of health care.”
Ann Briody-Petock
Administrator, Briody Health Care Facility LLC
Registries implemented at independent practices: 85
Approximately 40,000 diabetic patients
238 primary care physicians
increase in Frequent use of registries among participating practices:
12%
49%
Use of registries led to improved interactions with patients and ultimately improved their diabetes measures.
the number of Beacon practices that used diabetes registries consistently for at least 4 quarters: 57
the overall percentage of diabetic patients who were considered ‘uncontrolled’ (HbA1c>9 or not done): 34% (Down from 38%)
reduction in % uncontrolled
29 practices down 5% pts
14 practices down >10% pts
Practice 1: 500 diabetic patients in 15 months. 44% decrease. 31% decrease.
Practice 2: 1000+ diabetic patients in 11 months. 56% decrease. 32% decrease.
Compared to the overall trend in the WNY community, early-adopter Beacon practices prevented three hospitalizations for every 100 diabetic patients in 2012. This translates to a savings of approximately $600* per diabetic patient per year. This savings potential is significant – if only 20% of the diabetics in Western New York were impacted, the estimated reduction in hospital charges would be $18 million* per year.
*Estimates based on 2008 hospital charge data for diabetics with ambulatory care sensitive conditions from the New York Statewide Planning and Research Cooperative System (SPARCS).
The rate of hospitalization for these patients decreased by 26%, from 6.2 to 4.6 per 100 diabetic patients per year between 2009 and 2012.
The Emergency Departments of four hospitals, comprising 255 staff and providers, were also trained on proper HIE usage and how best to integrate it into their workflows. All four hospital EDs are now using HEALTHeLINK for patient information.
“we put together a comprehensive team from the hospital side and the practice side to make sure we were accurately capturing the flu shots at every point of entry into our system. It’s been a neat foray into registry to understand and value that piece of the tracking mechanism that EHR gives us.”
Julie Hart
Jones Memorial Hospital
In addition to shoring up an already solid infrastructure and helping practices learn to take full advantage of it, WNY Beacon has introduced some important ongoing innovations. Below are several of the evidence-generating approaches designed to improve health care performance measurement, technology integration, and delivery for diabetes care management.
WNY Beacon worked with home health and visiting nurse organizations to deploy telemonitoring devices that allow patients at home to remotely submit their glucose, blood pressure, and weight readings. The focus was on high-risk diabetic patients with a goal of reducing preventative emergency room visits and hospital re-admissions. Where appropriate, the data was also made available to primary care providers via HEALTHeLINK, giving physicians the ability to adjust their patients’ treatment quickly and proactively.
Results:
Diabetic patients participated: 144
Enrolled for a two-year timeframe: 105
“I see all of this as one big puzzle and without all of the pieces it falls apart. I have maintained better blood sugar control, blood pressure control, and weight loss since beginning on telemonitoring.”
Ken Wilson
Telemonitoring participant
To improve transitions of care for diabetic patients, WNY Beacon launched a medication history pilot featuring a real-time alert system. Often, high-risk diabetic patients require changes to their medications after visits to emergency rooms or other facilities. This program ensured that upon discharge, a comprehensive medication review would be performed and primary care providers would be notified of any and all recommended changes to a patient’s medication regimen.
Results:
A patient portal enables physicians to forward data directly to a personal health record that providers and patients control. Working in conjunction with its clinical transformation partner, Catholic Medical Partners, WNY Beacon focused on assisting practices in setting up their patient portals through their EHR systems.
Results:
“It’s a nice way to reach out to the patients through a different medium to improve the one-on-one connection that we have where they can ask us questions and we can send them helpful information that may be good tools for the patient.”
Dr. Chad Szymanski
Wheatfield Family Medicine
To help patients take a more active role in their health care, a kit that kept their health information and medication together was developed. Patients were asked to bring this HEALTHeHISTORY kit, which included a tote bag and folder to store visit summaries and lab results, to each doctor visit and any trip to the hospital.
Results:
Each tote = 100 kits
WNY Beacon has been a success. The program serves as the basis of a new health IT workforce development program connected to the Master’s degree program in health IT now offered by Canisius College.
Every full-service hospital participates in HEALTHeLINK, and the example of the work done by WNY Beacon will lead to the participation of new long-term care facilities, home care agencies, radiology centers, and dentists.
Building on WNY Beacon’s work, HEALTHeLINK has also launched communitywide electronic secure messaging, allowing providers to share clinical records and other health information to improve the coordination of care, even if they do not have an EHR system. In addition, a framework for quality improvement analysis has been created within HEALTHeLINK for the Western New York community.