New York’s Digital Health Revolution

There’s a quiet revolution going on in New York State. While the national debate continues about Obamacare and how to reduce healthcare expenditures, New York has already taken action. Thanks to a significant investment in technology and operational capacity, New York State is building a digital network of electronic medical records that will literally transform how patient care is provided and deliver major cost savings.  It’s called the Statewide Health Information Network of New York or SHIN-NY.  And, it puts New York State far out ahead of all other states when it comes to Health IT.

In a tech-savvy world, consumers want healthcare to be as easy to manage as banking, shopping and all their other utilities. They want to be involved and proactive about their own health.  In fact, a recent survey indicated that 41% of consumers said they would switch doctors if theirs did not use electronic medical records.  Now, the SHIN-NY will give patients safe and secure access to all of their records, eliminating the hassle of faxing medical records between providers, remembering their health histories and keeping track of prescriptions.

Physicians and healthcare providers will be able to make better, more informed medical decisions for their patients.  They will be able to reduce medical errors, avoid potentially harmful drug interactions and avoid duplicative or unnecessary lab and radiology tests that can add excessive cost to patients and insurance providers. Importantly, it will allow doctors to collaborate so they can coordinate care for patients that have more than one condition and see multiple physicians.

Nowhere will this be more important than in the Medicare and Medicaid population.

Based on a statewide network that connects eleven Regional Health Information Organizations (RHIOs), the SHIN-NY will be operated as a public utility so that patients and providers can access their records no matter where they are in the state. In addition to improving patient care, the SHIN-NY has numerous other uses and benefits. It will be a critical tool in emergency management during a disaster such as Hurricane Sandy, allowing for better victim tracking and access to records. It will also improve New York’s public health surveillance and public health communication that can be vital during an outbreak.

Use of the SHIN-NY has already delivered tangible cost savings. In Rochester, a doctor’s use of the network in the ER resulted in 30% fewer admissions. This could translate to $52 million in savings across the state. Similarly, use of the network by a physician’s office resulted in 57% fewer readmissions within 30 days of a patient being discharged from a hospital. This could translate to $46 million in savings.

The SHIN-NY has also spurred economic growth and development of Health IT—one of the fastest growing tech sectors. The New York Digital Health Accelerator (NYDHA), a project supported by The Partnership Fund for New York City and the New York eHealth Collaborative, attracted venture capital to sponsor incubator start-up companies. These software developers are building apps to customize use of the SHIN-NY and make it more accessible and relevant to the public. This project, alone, is estimated to create 1500 new jobs in New York City over the next five years.

The SHIN-NY is rapidly becoming a model for other states in how deliver better healthcare.  But ultimately, the SHIN-NY depends on maximum participation of patients and providers. A majority of the New York State’s hospitals are already connected, but we need many more patients, physicians and healthcare providers to participate.  The more information in the network, the more valuable it becomes. Our goal is to achieve 75% of all providers within the next three years.  Thanks to the support of the New York State Department of Health and healthcare stakeholders across New York State, we are on well on our way to getting there.

David Whitlinger is the executive director of the New York eHealth Collaborative. He will discuss the SHIN-NY and the building of New York’s connected ecosystem at the November 14-15 Digital Health Conference in New York City.

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15 replies »

  1. Barry,

    You don’t need to know about relational databases to know that records from one doctor or hospital should be able to be read at another hospital or docs office. The equivalent system in the paper world would allow docs to write records in Chinese, Russian, Arabic, etc. that their collegues couldn’t read.

    This is why I find it so surprising that the Feds would require EMRs and certify them without making them talk to each other.

  2. “I know nothing about “relational databases, data dictionaries, schema”, and I suspect most readers of this blog don’t either”

    I don’t either which is why I never or hardly ever offer any comments about health IT issues except to note that interoperability would be highly desirable.

  3. Bobby,

    “Why do you even come here if you know nothing of the basics? Who are you?” This blob is called “The Health Care Blog”. I am interested in Health Care Reform and know a fair amount about Health Care.

    I am a physician in practice for 30 years. I am a former Department Chief of Radiology for a medium sized hospital. I was instrumental in developing Teleradiology for my group. I have been on the governing board of a large single specialty practice. These credentials indicate a level of understanding of a number of aspects of healthcare – not necessarily some of the IT issues.

    While I do not understand the jargon of IT, I think I understand the ideas behind an EMR at least as well as the average person. And once I was able to cut through your jargon I found that you and I were on the same page. Interesting how, even though we basically agree, you have managed to irritate me.

    Now I will ask you some questions:
    – Who are you?
    – Why do you come hear?
    – I assume you understand the IT aspects of the problem, but do you understand anything about the clinical/patient care side of the problem?

  4. Chill out, Bobby. Not sure what your story is, but this is NOT how you convince your audience or answer questions.This is the kind of attitude that gives IT a bad name.

    @ primary care doc

    @ legacy flyer

    You’re welcome here. Ask any questions you want.

  5. Legacy Flyer:

    As you can see, those of us who have to pay for and use these systems to generate the data that THCB and Health 2.0 “are all about” are clearly not welcome here and should just shut up.

    That’s kind of been the attitude of the entire HIT industry, hasn’t it?

  6. Most of THCB blog readers certainly DO know what those terms mean. Those terms are IT 101. THCB and Health 2.0 are all about the data.

    A primary barrier to the misnamed “interoperability” owes to the fact that everyone uses their own data dictionaries (the definitions of the variables that get captured by the EMR). Standardize that, and you’ve gone a LONG way to solving the interop/data exchange problem.

    Why do you even come here if you know nothing of the basics? Who are you?

  7. Bobby,

    I know nothing about “relational databases, data dictionaries, schema”, and I suspect most readers of this blog don’t either.

    Thank you for stooping to our level and stating your point in English.

  8. Get over it. What I posted and my subsequent is all pretty clear to anyone who knows anything about relational databases, data dictionaries, schema, and standards. I don’t know how to dumb it down any further.

    Ok, — YES — I’m saying that any EHR should be able to read the data from any other without modification or re-mapping. That any clearer?

  9. Clear as mud.

    You answered an either/or question with a “Yes”

    Typically, I do that when I want to irritate people. Was that your intent?

  10. Yes.

    Equivalently, I’m saying that I wrote that comment on my iMac plugged into a 120 VAC wall power plug manufactured to the NEMA 5-15 standard. I can do that anywhere in the country. Thew Mac is plugged into a standards CAT-5 cable going to my router.

    I don’t need umpty-thousand Meaningful Use Certified AC power standard architectures of wall plug and cable sizes and shapes.

    Data Dictionary. RDBMS 101.

    All we need is one.

  11. Bobby Gladd,

    So give me the “dummy’s version” of what you said.

    Are you saying that all EHRs should be able to read other EHRs (forgetting all the myriad technical details)?

    Or are you saying something else?

  12. No, No, No, No…!!!

    We have a thriving Standards Promulgation and Proliferation industry hard at work writing lengthy, obtuse “standards” documents (all dutifully Revision Controlled) that in the end really just yield the need for Crosswalk Standards Mapping!!! Ahhh… More Standards work!!

    As I observed on my REC blog:


    One. Then stand back and watch the Market Work Its Magic in terms of features, functionality, and usability. Let a Thousand RDBMS Schema and Workflow Logic Paths Bloom. Let a Thousand Certified Health IT Systems compete to survive. You need not specify by federal regulation any additional substantive “regulation” of the “means” for achieving the ends that we all agree are desirable and necessary. There are, after all, only three fundamental data types at issue: text (structured, e.g., ICD9, and unstructured, e,g., open-ended SOAP note narrative), numbers (integer and floating-point decimal), and images. All things above that are mere “representations” of the basic data (e.g., text lengths, datetime formats, logical, .tiffs, .jpegs etc). You can’t tell me that a world that can live with, e.g., 10,000 ICD-9 codes (going up soon by a factor of 5 or so with the migration to ICD-10) would melt into a puddle on the floor at the prospect of a standard data dictionary comprised of perhaps a similar number of metadata-standardized data elements spanning the gamut of administrative and clinical data definitions cutting across ambulatory and inpatient settings and the numerous medical specialties. We’re probably already a good bit of the way there given the certain overlap across systems, just not in any organized fashion.

    Think about it.

    Why don’t we do this? Well, no one wants to have to “re-map” their myriad proprietary RDBMS schema to link back to a single data hub dictionary standard. And, apparently the IT industry doesn’t come equipped with any lessons-learned rear view mirrors.

    That’s pretty understandable, I have to admit. In the parlance, it goes to opaque data silos, “vendor lock,” etc. But, such is fundamentally anathema to efficient and accurate data interchange (the “interoperability” misnomer).

    Yet, the alternative to a data dictionary standard is our old-news, frustratingly entrenched, Clunkitude-on-Steroids Nibble-Endlessly-Around-the-Edges Outside-In workaround — albeit one that keeps armies of Health IT geeks employed starting and putting out fires.

    Money better spent on actual clinical care.

    I’m still awaiting substantive pushback (though, my friend Chuck Webster took a quick [and weak] run at it. Basically, “inimical to innovation.”)

    There are conceptually really only two alternatives: [1] n-dimensional point-to-point data mapping, from EHR 1 to EHRs 2-n, or [2] a central data mapping/routing “hub,” into which EHRs 1-n send their data for translation for the receiving EHR.

  13. This is a good idea, but is essentially a patch on a bad system.

    All EMRs should be formatted so they can be read by other EMRs. To not have done this was a mind boggling stupid mistake by the Feds. And I suspect that campaign contributions were behind it.

    And it has been done with other medical data. Many years ago, the ACR demanded and got DICOM adopted. This requires all imaging equipment (CT, MRI, etc) to output its data in a common format. This means that a CT done on a GE machine puts out the same data format as one on a Siemens machine, etc. There is no need for data to be translated from one proprietary format to another.

    You are now putting a patch on this fundamentally flawed system – which is a worthwhile objective, but not as good as if it had been done right from the start.

    – What about patients that get some care across state lines in New Jersey or Connecticut?
    – What about a patient that moves to NY from California or moves from NY?

    Are they S.O.L.? (sh*t out of luck)