ABSTRACT
The New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants' experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites.
Subject(s)
Computer Communication Networks/organization & administration , Electronic Health Records/organization & administration , Outcome Assessment, Health Care/organization & administration , Patient-Centered Care , Humans , Information Dissemination , New York CityABSTRACT
The aim of this study was to understand home healthcare nurses' current experiences in obtaining outside clinical information at the point of care and the type of clinical information they most desire in their patients' health information exchange profile. A Web-based survey was deployed to home health workers in New York to learn about their experiences retrieving outside clinical data prior to having access to health information exchange, preferred data elements and sources in their patients' health information exchange profiles, and how availability of outside clinical data may affect emergency department referrals. Of the 2383 participants, 566 responded for a 23.8% overall response rate, and 469 of these respondents were RNs. Most RNs, 96.7%, agreed that easier and quicker access to outside information would benefit delivery of care, and 72.6% said the number of emergency department referrals would decrease. When asked about pre-health information exchange access to patient data, 96.3% said it was problematic. Inpatient discharge summaries were chosen most often by the RNs as a top five desired data element 81.5% of the time. Obtaining outside clinical information has been a challenge without health information exchange, but improved access to this information may lead to improved care. Further study is required to assess experiences with the use of health information exchange.
Subject(s)
Home Care Services/organization & administration , Information Management , NursesABSTRACT
Notifying ambulatory providers when their patients visit the hospital is a simple concept but potentially a powerful tool for improving care coordination. A health information exchange (HIE) can provide automatic notifications to its members by building services on top of their existing infrastructure. NYCLIX, Inc., a functioning HIE in New York City, has developed a system that detects hospital admissions, discharges and emergency department visits and notifies their providers. The system has been in use since November 2010. Out of 63,305 patients enrolled 6,913 (11%) had one or more events in the study period and on average there were 238 events per day. While event notifications have a clinical value, their use also involves non-clinical care coordination; new workflows should be designed to incorporate a broader care team in their use. This paper describes the user requirements for the notification system, system design, current status, lessons learned and future directions.
