New York City Council Committee | NYC Health + Hospitals

New York City Council Committee

New York City Council Committee Hearing On Technology: Electronic Health Records

Bert Robles
Senior Vice President
Corporate Chief Information Officer
New York City Health and Hospitals Corporation

Good Afternoon Chairpersons Arroyo and Cabrera and members of the Health and Technology Committees. I am Bert Robles, Senior Vice President and Corporate Chief Information Officer for the New York City Health and Hospitals Corporation (HHC). I am joined today by Louis J. Capponi, MD, HHC’s Chief Medical Informatics Officer. Thank you for the opportunity to discuss HHC’s use of electronic medical record systems.

Over the past decade, HHC has been an industry leader in the implementation of Health Information Technology (HIT) and the usage of electronic medical record (EMR) systems. Many years ago, we recognized that HIT could contribute significantly to achieving care that is safer, more effective, efficient and patient-centered in both inpatient and outpatient/primary care settings. One of the foundations upon which we have built and expanded HIT programs is through a comprehensive electronic medical record.

HHC was one of the first hospital systems in New York State and the country to implement an EMR when we began this effort in the early 1990’s. We have invested more than $100 million over the past decade into our system that is used at all of our hospitals, long term care facilities and community based health centers. HHC’s EMR is in use by approximately 10,000 clinicians.

Since the implementation of our EMR, we have continued to build upon our strong foundation to add sophisticated functionality to enhance patient safety, support evidenced-based medicine, and ultimately improve patient outcomes. Over the past several years, we utilized state-of-the-art IT tools, to create an electronic chronic disease registry, an electronic medication administration tool, a depression screening tool and an asthma action plan. All of these were integrated into our EMR. The asthma action plan, for example, embeds evidenced-based treatment protocols which have enabled HHC’s clinical teams to more effectively manage their asthmatic patients. The use of HIT and other strategies, we believe, have contributed to reductions in HHC emergency department and hospital admissions for asthma.

The initial focus of our electronic chronic disease registry was on our diabetic population. The Diabetes Patient Registry is an electronic disease-tracking program that greatly improves doctors’ ability to comprehensively monitor and more effectively manage diabetes among the 58,000 enrolled diabetic patients. We pioneered the use of electronic registry for patients with diabetes and have seen a significant increase in the number of patients who have achieved healthy levels of blood sugar, blood pressure and cholesterol — the three leading indicators of good diabetes care.

Similarly, we established a Cardiovascular Risk Registry. This registry is an electronic disease tracking program that significantly improves a clinical team’s ability to monitor and manage cardiovascular disease among patients. The registry has identified more than 52,000 patients with high blood pressure and 33,000 patients with high cholesterol whose treatment is being closely monitored and better managed.

More recently we have continued to add enhancements to our electronic health records that support patient safety and other high priority clinical care initiatives. These included a system-wide implementation of a software-based approach to reducing the risk of intubated patients contracting ventilator-associated pneumonia. The ICU Ventilator Bundle Order Set (VBOS) is an enhancement to existing order-management software that hard-wires a series of safety interventions into the ordering process. With VBOS, providers are prompted to follow best practices that minimize the patient’s risk of secondary infection and the time spent on a mechanical ventilator.

We also launched a new Palliative Care Data-Entry and Reporting System, or PalTrack. This secure web-based system lets Palliative Care providers at all 11 HHC hospitals capture and manage a range of data relating to the breadth and timeliness of Palliative Care, including source and frequency of referrals, Palliative Care interventions and outcomes, and pertinent patient demographic information.

Several key projects have also recently come to fruition, including completion of a system-wide electronic platform that will improve blood utilization and the management of blood products used for transfusions. The new system replaces 11 legacy databases, and offers significantly greater ability for quality checks, and will allow for a standardized process that supports safety as well as data collection.

Additionally, an HHC-wide Deep Vein Thrombosis (DVT) Taskforce continued its efforts to improve safety around anticoagulation, designing decision-support tools that now guide clinicians toward safer medication dosing and monitoring. One such tool, now in use across the Corporation, alerts users when prerequisite blood tests have not been completed.

New York State has recognized the importance of health information exchange to improving the quality of healthcare delivery through its HEAL NY Health Information Technology grant funding program. HHC is participating in several HEAL NY funded projects which, among other objectives, includes simplifying the transfer of a patients medical history between doctors and hospitals. Regional Health Information Organizations, or RHIO’s, provide the technology and governance vehicle to transfer information between care systems to enable a patient’s information to follow them when they visit different providers throughout the city. HHC is currently connecting all of our facilities through one RHIO, the Interborough RHIO. The Interborough RHIO will provide a secure gateway for HHC to send and receive information between different caregivers.

HHC was recently the recipient of a $10 Million dollar HEAL NY Grant to extend the benefits of electronic medical records to patients with serious mental health conditions. This effort will not only enhance medical records used to care for this population, it will also improve our connection with community-based organizations who are so important to maintaining the well being for these patients.

Similar to efforts by New York State, the Federal Government has dedicated resources to encourage the widespread adoption of EMR’s. HHC is currently in the process of a major database upgrade to our electronic medical record to ensure our eligibility for financial incentives of more than $121 million under the American Recovery and Reinvestment Act of 2009 (ARRA). In order to qualify for these funds, certain requirements have to be met in order to meet the “meaningful use” standards that were set forth in ARRA. Among the critical meaningful use criteria are exchange of discharge and care summaries, e-prescribing, required clinical decision supports and certified software is necessary in order to meet the requirements of “meaningful use.” Our electronic record-keeping systems at several hospitals have already been converted to meet these standards. When the conversion of HHC’s other systems is completed this coming spring, the necessary groundwork will be laid for installation of a fully certified version of medical record software. Final installation of the certified software in all HHC facilities is anticipated by the summer of 2011.

At the same time that we are working toward meeting the meaningful use criteria, we are also planning for significant expansion of EMR. In addition to behavioral health, we are also pursuing new strategies for EMR functionality to support our large and busy emergency departments and our long term care facilities. These updates will be easier to use and allow us to more readily access a patient’s clinical data from anywhere within our system while offering much more robust functionality. This new EMR system will not just permit more intuitive and efficient documentation, but also guide and support more comprehensive and consistent evidence-based care.

As with any electronic system, ensuring that our systems are secure and redundant is essential. We have taken steps to consolidate and protect the data we gather. All major data center operations throughout the Corporation have been consolidated into two Corporate Data Centers. This gives us the opportunity to develop, implement and standardize policies, processes and procedures to operate an enterprise-wide IT environment. And, in this time of scarce resources, this initiative will generate operational savings through consolidation of services, maintenance contracts and equipment.

As you can see, HHC’s investments in developing robust information systems that electronically retain and process critical patient medical data continue to position us as national leaders among all hospitals. Our efforts have received national acclaim. Two of HHC’s Regional Networks have earned the coveted Nicholas E. Davies Award from the Healthcare Information and Management Systems Society for excellence in using electronic health records to improve healthcare delivery. In addition, HHC President Alan Aviles received the national CEO IT Achievement Award from the Healthcare Information and Management Systems Society and Modern Healthcare Magazine for leadership in the use of information technology to advance healthcare excellence.

We are proud of our efforts and the how this has contributed to improved health outcomes of our patients. HHC’s hospitals and community based health centers play a significant role in providing primary and inpatient care in New York City. HHC serves approximately 1.3 million patients each year who make 5 million outpatient visits at HHC facilities. With this sizable population and volume of primary care services, HHC realizes tremendous returns by leveraging our EMR, coupled with innovations in HIT, to improve the health and lives of many New Yorkers.

This concludes my written testimony. I now look forward to answering any questions you may have. Thank you.


Contact: Ian Michaels (HHC) (212) 788-3339

About HHC

The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlus, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.

WE ALWAYS PUT PATIENTS FIRST