Taconic Health Information Network and Community (THINC) (New York)

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Summary:

The Taconic IPA, a 3,000 physician independent practice association located in Fishkill, NY involved in an information technology project to improve the quality, safety, and efficiency of healthcare in our region. In the past, the organization worked with area hospitals and laboratories to create a community wide electronic data exchange. At the beginning of the project, Taconic IPA physicians electronically managed the data through a clinical messaging system as part of their daily workflow, which is the first step in adoption of an electronic health record (EHR). The Taconic IPA added a health care portal to the existing community wide electronic data exchange which allowed for use of the current electronic messaging system along with migration to a full EHR. We believed that a full EHR with clinical decision support and patient registries was required to signficantly improve the quality, safety, and efficiency of health care. Most uniform EHR systems have been developed and deployed in Integrated Delivery Systems or large university hospitals under a staff model setting. Independently practicing physicians and competing community hospitals do not engage in efforts to deploy interoperable systems with standards and common vocabularies necessary to address quality improvement on a population-based and individual physician basis. The IPA was one of the first to attempt deployment of a standard EHR with a community wide electronic data exchange among a large group of independently practicing physicians as has been done in staff model settings. Although studies have demonstrated cost savings and, to a limited extent, quality improvement in staff model implementations, large controlled trials do not exist in the private practice setting. Our project evaluated: physician office efficiency improvement and cost reduction, payer return on investment, safety improvement, and quality improvement. The groups evaluated included a control group, the group using the electronic messaging system, and a group using a full EHR.

Taconic Health Information Network & Community (THINC) - 2008

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    RFA: HS04-011: Transforming Health Care Quality through Information Technology (THQIT)
  • Grant Number: 
    UC1 HS 015316
  • Project Period: 
    09/04 – 03/08, Including No-Cost Extension
  • AHRQ Funding Amount: 
    $1,500,000
  • PDF Version: 
    (PDF, 45.69 KB)


Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Summary: The Taconic Independent Practice Association (TIPA), formed in 1989, is a not-for-profit health care corporation and at the inception of the grant, had a network representing over 3,000 physicians in nine counties of southeastern New York State. TIPA physicians were located in over 600 offices ranging from solo practitioners in rural areas to large multi-specialty, multi-location practitioners in urban areas with an average of three practitioners per office. In 2001, TIPA completed the initial plan for the deployment of the Hudson Valley Health Information Exchange. The initial stakeholders were MVP Healthcare (MVP), Vassar Brothers Medical Center, Kingston Hospital, MDS Laboratories, and 50 TIPA physicians. The project was to leverage a 3-year effort to bring health information technology (IT) to the Hudson Valley of New York. Fifty providers from a large physician organization made up of independent practitioners, a regional health plan, three hospitals, and a reference laboratory were key stakeholders in a regional health information exchange (HIE). This grant project anticipated adding a longitudinal viewing capability to the then-existing community-wide data exchange (CWDE) portal. A uniform implementation of ambulatory electronic medical records (EMRs) was completed. Also, the project engaged multiple payers in addition to MVP for incentive payments for technology adoption. Finally, a formal research project was performed to evaluate the project.

Specific Aims

  • 10 participating hospitals in the CWDE. (Ongoing *)
  • 500 physicians using EMR. (Achieved)
  • 500 physicians using clinical messaging application. (Achieved)
  • Two participating laboratories in the CWDE. (Achieved)
  • Five payers participating in pay-for-performance initiative. (Achieved with THINC Regional Health Information Organization [RHIO])

2008 Activities: Findings regarding use of EMR, particularly the laboratory result-viewing functionality, were published. At the end of the grant period, results of the study of electronic prescribing systems were being analyzed and prepared for publication.

Impact and Findings: Interfaces that had been built over the three years prior to this grant were able to be used in introducing a new HIE system; this reduced the typical implementation time from 12 to 3 months. Once an HIE is built, good strategic planning will allow leveraging of existing infrastructure with savings of time and money when adding new functionality. End-user involvement is critical for the success of deploying new technology in the community and is necessary in the decisionmaking process of choosing new functionality. The current rate of adoption is 36 percent, with 37 percent in group practices with less than six physicians. These figures represent a doubling of EMR penetration during the time of this project, with small practices in the region catching up with the rest of the region. The higher rate of EMR adoption by small physician practices in this project is believed to be attributable to the low up-front cost structure and implementation approach. The enhanced and ongoing combined implementation and support method is possible due to the concentration of users and support staff within the community. Although these results are preliminary, they raise questions about the traditional national EMR vendor implementation approach, and whether that approach may be a factor in the low EMR adoption rate for small physician practices. Survey results suggest that electronic laboratory result viewing was independently associated with higher ambulatory care quality; future longitudinal studies are needed to confirm this association. Stand-alone electronic prescribing with clinical decision support significantly reduced the rate of errors and is an important tool for reducing ambulatory medication error rates.

Selected Outputs

Kern L, Barron Y, Blair AJ 3rd, et al. Electronic result viewing and quality of care in small group practices. J Gen Intern Med 2008;23(4):405-10.

Grantee’s Most Recent Self-Reported Status (as of March 2008): This grant has been completed. The major aims of project and supporting data collection are complete. At the end of the grant period, data from the e-prescribing system/prescription error study were still being analyzed and prepared for publication. The organization THINC RHIO, which had arisen during the course of the project to promote multi-payer collaboration, continues to function independently of this grant, and it has begun work on a new project encouraging the development of National Committee for Quality Assurance-accredited medical home practices in the area.

Milestones: Progress is completely on track.

Budget: On target.

*This aim was not completed prior to the scheduled conclusion of the grant (March 2008), yet, as other sources of funding have been secured, it is still targeted for completion.

Taconic Health Information Network and Community (THINC) - Final Report

Citation:
Blair AJ 3rd. Taconic Health Information Network and Community (THINC) - Final Report. (Prepared by Taconic, IPA under Grant No. UC1 HS015316). Rockville, MD: Agency for Healthcare Research and Quality, 2008. (PDF, 53.59 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Population: 
This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.

The Taconic Health Information Network and Community of the Hudson Valley

A. John Blair, III, M.D.Creating an electronic medical record (EMR) system for a 3,000-physician IPA comprising mostly small, widely dispersed practices is no easy task, as A. John Blair, III, M.D., well knows.

"It's like a 3-D chess game. There's a lot of elbow-to-elbow work to doing this, which is why there are not too many success stories out there," says Blair, a laparoscopic surgeon and president and CEO of Taconic IPA, Inc., Fishkill, NY.

Taconic is the exception.

In late 2001, the IPA established a plan to implement a health information exchange (HIE) model among insurers, hospitals, laboratories, and physicians. Today, about 600 of the 16-year-old IPA's physicians in two of the eight counties covered by Taconic participate in the data exchange, called Taconic Health Information Network and Community (THINC). THINC allows physicians to electronically manage health care data via a clinical messaging system - the first step to adopting an electronic medical record (EMR). Using a secure password, physicians log in to a main portal from either laptop computers or personal digital assistants to retrieve lab reports, x-rays, and other clinical data.

"Within five seconds, you can pull up the results from a lab test. If it's a critical result, a beeper sounds so you can act on the information immediately. It's efficient, and the lab report won't get lost on a fax machine, or get misplaced," Blair says. As the HIE model phases in, more physicians will be added, as will the ability to write e-prescriptions and access EMRs.

A three-year, $1.5 million AHRQ grant will allow Taconic to push the project to the next level. The grant focuses on two priorities. The first is to hire an independent clinical investigator to study the impact of HIE on health care quality. The second is to expand the program by helping more of the IPA's primary care physicians offset the costs of participating in the electronic network.

"This grant will allow us to do seminal work, and to answer key questions: Does this type of technology really work? What's the value of the whole electronic data exchange, and does it actually improve the quality of health care and reduce medical errors? No one has ever had the data to study community-based physicians, where 80 percent of Americans get their health care," says Blair.

The impact study will assess outcomes among three groups, each comprising approximately 100 physicians: a control "paper" group, an electronic prescribing group, and a group using fully integrated EMRs. "We will look carefully at medical errors, adverse drug events, quality issues, and cost in all three groups," Blair explains.

The infusion from the grant will also help Taconic IPA's physicians overcome the cost hurdle of joining the network by providing technical assistance during start-up and implementation. "The No. 1 problem for small physician practices is the start-up costs of EMRs. The other problems are having the expertise, trouble-shooting capabilities, and training such programs require in order to use them," says Blair.

Start-up costs for EMRs can run $30,000 per physician; Taconic IPA physicians pay approximately $500 per month to use the system. "Large groups can afford to pay $1 million or so to implement an electronic system. We are offering a solution to the vast hoard of small practitioners who just can't afford to do this on their own," Blair says.

The program also opens the door to allow primary care physicians to qualify for some of the pay-for-performance incentive programs offered by insurers and employers to providers who use electronic information technology. A physician could receive up to $400 per month from such incentives, according to Blair.

"The ultimate goal is to help fill the void for the small practitioners who can't do this on their own, to improve the quality of health care, and to reduce medical errors," says Blair. 

This project does not have any related emerging lesson.