Written by: Anuj Desai is Director of Business Development for the New York eHealth Collaborative (NYeC).

It Takes an Ecosystem

New Payment Models Require New Innovations

The healthcare system is undergoing a fundamental shift. Physicians who once used paper charts to manage patient records are now demanding new technologies. The federal government has provided over $50 billion to the marketplace, and adoption of EHRs is estimated at close to 60% across all segments. This number is increasing not linearly, but exponentially.

In addition, new models of care, such as Accountable Care Organizations (ACO’s), are shifting payment from “fee for service” healthcare delivery to managed, team-based care models. In New York, Governor Cuomo created a Medicaid Redesign Team aimed at reducing costs and driving more coordinated care.

The state is currently in the process of implementing a “Health Home” model. Out of 5 million Medicaid members, over 975,000 have two or more chronic conditions and will be enrolled in the Health Home program. A Health Home represents a cluster of healthcare providers who are collectively accountable for the care of a given group of patients. A “care manager” oversees an individual’s treatment, providing access to all of the services that patients need to stay healthy, out of the emergency room and out of the hospital. Health Home services are provided through a network of organizations—providers, health plans, and community-based organizations. And financial incentives are aligned such that providers receive payment if they coordinate care and drive better outcomes. NY is serious about this coordinated care model and has designated 61 Health Homes statewide, with plans on expanding even further in the next few years.

Given the strong shift in incentives and payment models, providers in New York and across the country are being forced to review their workflow, seeking new tools to better coordinate care. Typically, providers ask their EHR vendor to provide these tools. While an EHR system is great at helping a physician manage their patients within a practice, hospital, or system, providers now need to share data across systems to support entirely new models of care.

Providers are demanding tools, particularly in the areas of: care coordination, alerts, analytics, and patient engagement.

• Care Coordination: Collaborative care solutions that reflect the continuum of information regarding a patient, and support for team based care
• Alerts: Tools that provide a secure messaging environment for accurate communication and information exchange between transferring and receiving providers
• Analytics: Analytic capabilities that take into account both quality and financial measures to adequately identify risk
• Patient Engagement: Personal health management solutions that facilitate better healthcare decisions and help improve care management communications between the provider and/or family members.

 New York has made a significant investment in the adoption of Health IT

The State Department of Health has invested over $840 Million towards the adoption of Health IT in the state since 2006. This funding has led to significant adoption of EHRs in the state and the formation of 11 Regional Health Information Organizations (RHIOs), which, with appropriate patient consent, have the capacity to share medical information between healthcare providers in their region. The overall network of these HIEs is called the Statewide Health Information Network of New York (SHIN-NY). The SHIN-NY, overseen by the New York eHealth Collaborative (NYeC) and the NY DOH, requires a commitment from multiple hospitals, physicians, long-term and homecare providers, etc., to share data and enable interoperability for information exchange. The SHIN-NY contains clinical data from EHRs, labs, radiology reports, claims, and more. It is both a policy framework and the technical architecture to provide a platform for collaboration. And a core requirement of the Health Home program is that providers must connect to the SHIN-NY to coordinate care.

Creating channels for providers to access new tools for more efficiently managing patient care.

Currently, the only way for a physician to access clinical data in the SHIN-NY is through an EHR. EHR vendors don’t have all the capabilities required to manage the workflow required for the new care models. There has to be a better solution. From a NYeC perspective, we could attempt to build or buy solutions that meet the needs of our customers, but then how do we stay at the cusp of innovation? And a quick scan of the market shows that no single company has all the requirements that providers need.

SHIN-NY as the Platform

The health IT startup scene in New York is exploding, but there are challenges these companies must overcome to be successful. Hospitals and other providers are notoriously risk averse, so it is difficult for them to work with budding startup companies, even when their products are innovative. Hospitals are also notorious for being difficult customers, and navigating their procurement cycles can be nearly impossible for a small company. Once a customer is signed, integrating with the many different EHR vendor products used by hospitals can be daunting, given the significant interface costs and resources required. Finally, getting access to patient health information requires trust, so that only those who should have access actually get access. A secure authentication framework is essential to maintaining privacy and trust, and a small company does not have the resources to do it all.

There may be a solution: NYeC has developed the SHIN-NY API (Application Programming Interface) to create a standardized platform for leveraging the clinical data that is part of the statewide network. The API allows developers to build new technology on top of the SHIN-NY. Innovators and health IT companies can access the clinical information required to develop products that meet healthcare providers’ needs, with the appropriate policies and security in place. Tech companies only get access to the SHIN-NY API data if they have a provider customer who is a member of the SHIN-NY, and has executed the appropriate data use agreements.

As we look to other industries, we see many examples of innovative platforms which leverage data sources to drive innovation beyond the current walls. For example, Google exposed APIs to access data through Google maps, thus spurring innovation of many different apps that rely on map functionality. The National Oceanic and Atmospheric Administration (NOAA) also opened data to create a number of innovative apps which consumers rely on for their daily weather.

Building an Ecosystem
But there are still challenges. Many of the companies in Health IT need mentorship, funding, and guidance in order to succeed.

In 2012, NYeC, along with the Partnership for New York City Fund, launched the New York Digital Health Accelerator. The program funds 8 early- and growth-stage companies which are developing cutting-edge technology products for healthcare providers, in the four focus areas mentioned above. These companies are the first to get access to the SHIN-NY API. The program lasts 9 months and will conclude in May. We have provided up to $300,000 in funding per company from a syndicate of leading venture capital and strategic investors, along with direct mentorship and feedback from senior-level executives at a broad network of New York State provider organizations. Twenty six highly influential provider organizations are mentoring the companies and developing pilots of their technology.

With an initial investment of $4.2 million, the Accelerator is projected to create approximately 1,500 jobs over five years. It is also expected that the companies will attract upwards of $150-200 million in investment post program from the venture capital community. The NYDHA will stimulate a new marketplace, creating the next generation of healthcare tools, while positioning New York as a hub for the health IT entrepreneurial sector.

The Accelerator received over 250 applications from companies in 27 states and 10 countries. We realize that access to providers and the SHIN-NY API was a draw for many companies and that our unique combination of mentorship, funding and SHIN-NY data access has created an outstanding value proposition to the eHealth startup market. And we intend to scale up from 8 companies to many, many more.

2013: Opening Access to the SHIN-NY API and Beyond

As we begin the New Year, NYeC is developing a number of programs to engage with the startup community and to accelerate the development of new tools for our providers and patients.

The SHIN-NY API Developer Portal and Production access will go live at the end of Q1 2013. This portal will provide an API library and access to test data for any company wishing to engage with the SHIN-NY. Once a company has a provider that is a member of the SHIN-NY and has signed the required data use agreements, it will go through a certification program to ensure it is compliant with policies, and then will be given appropriate access to production.

NYeC will also launch a series of SHIN-NY Developer Forums to further engage tech startups, and educate the community about healthcare standards, the needs of providers, and updates on the SHIN-NY API. In addition, we are considering a number of strategic partnerships with other API platform providers. Our vision for 2013 is to have an entire ecosystem of apps developing against the SHIN-NY platform!

Finally, we are particularly excited about our partnership with the Health Data Consortium, and our selection as an HDC Affiliate. We look forward to working with the HDC team to explore new opportunities to engage with the developer community to drive innovative tools for our providers!

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