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HITEC:Evaluating the Economic Effects of Health Information Exchange
Programs across New York State
Rainu Kaushal, MD, MPHAssociate Professor, Weill Medical College
Director of Pediatric Quality and Safety at KCCH/NYPHExecutive Director, HITEC
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Background
• Clinical decisions are data driven
• Health information technology (HIT) with health information exchange (HIE) has been embraced as one strategy to improve health care quality and reduce costs by improving access to data
• Regional clinical data exchanges are occurring, with unknown effects
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HEAL NY(Healthcare Efficiency and Affordability Law
for New Yorkers Capital Grants Program)
• $200 million investment• Implementation grants of $50,000 - $10,000,000
per grant (for capital investments)• Supporting multi-stakeholder HIE initiatives• Grantees are required to provide matching
funds and dedicate some funds for evaluation• Evaluation efforts are likely to vary in quality
and be non-standardized
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Why Evaluate?
• Demonstrate value of HEAL initiative– Demonstrate uptake and usage
• Encourage future HIT and HIE adoption– Demonstrate economic benefits– Demonstrate consumer and provider satisfaction– Demonstrate quality and safety benefits
• Iteratively refine HIT and HIE– Understand what is working well– Understand what can be improved
• Disseminate lessons learned and successes broadly
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HITEC
• Not for profit, multi-institutional academic collaboration – Based at Weill Medical College – With collaboration from Columbia University, SUNY-
Albany, University of Rochester and others
• Aims to ensure robust evaluations of HEAL NY and other HIE initiatives in NY State– Provides expertise in evaluation methodology, health
information technology, health economics, survey methodology and biostatistics
– Conducts analyses across active HIE initiatives
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CMWF Grant: Financial Methods
• Specific aim: Determine the ROI for providers of HIT/HIE implementation
• Methodology: Will include costs, benefits, and usage measures
• Design: Pre-post studies with concurrent controls
• Participants: 7 HEAL NY grantees– Diverse in terms of clinical setting, geography, and
type of HIT/HIE intervention– Community based interventions– Evaluation team has no control over type or timing
of HIT/HIE implementation
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Progress to Date
1. Developed a financial framework at the level of HIT/HIE functionalities
a. 104 functionalities
b. 5 settings
c. Each rated on likelihood of successful implementation and use, magnitude of financial benefit, ability to measure benefit
2. Validated by an expert panel
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Progress to Date (cont)
3. Each participating grantee determined which HIT/HIE functionalities they were implementing and prioritized their studies of interest
4. Mapped against HITEC framework
5. Now engaged in planning 7 studies
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Challenges
1. Varied HIT implementations for varied purposes2. Varied perspectives on what is important to
evaluate3. Variable timing of implementations4. Community based studies, network effects5. Confounders6. Rapid time-frame for studies7. Data source challenges
a. Availabilityb. Uniformityc. Metric definitiond. Importance of numerators and denominators
8. Financial constraints for data collection