As New York City’s public health agency, the Health Department aims to understand and promote the health of all New Yorkers.  The Primary Care Information Project (PCIP), a bureau of the Health Department, uses data to support primary care practices in providing the best possible care for patients. The Hub Population Health System (“the Hub”) is an automated tool that gives PCIP the practice-level insights it needs to serve NYC REACH member practices and track health statistics in New York City. PCIP developed this system with eClinicalWorks (eCW) to gather de-identified and aggregated information about groups of patients from eCW systems. The Hub does not collect patient identifiable information from electronic health record (EHR) systems. Below we share answers to NYC REACH member practices’ questions about this unique tool for improving New Yorkers’ health.

Is the Hub HIPAA-Compliant and  Secure?
Yes. The Hub transmits patient counts to PCIP using an encrypted channel, and information is secured behind safeguards including encryption and firewalls. PCIP operates within all Health Department data security, privacy, and confidentiality policies. The Hub does not obtain any patient-identifiable information. It only receives and transmits answers to PCIP’s questions in the form of patient counts. All patient-identifiable data remain with the practice. For example, PCIP might use the Hub to find out how many patients with a diagnosis of hypertension had an office visit this year, but PCIP does not use the Hub to retrieve those patients’ names, dates of service, or other personal identifiers.

How Does the Hub Work?
PCIP sends a question (or “query”) to the Hub. The Hub sends that question to practices connected to the Hub. The practices’ EHR systems automatically return the answers to the Hub, and the Hub transmits the answers to PCIP through a secure channel. All Hub queries are in the form: “How many patients meet these criteria?” and all responses are in the form of a patient count. PCIP analyzes and shares this information with providers in easy-to-read, actionable reports. Neither eCW nor the Hub store any information after the Hub transmits the answers to PCIP. The Hub is only a mechanism for gathering and transmitting information to PCIP. Follow the steps in the diagram below to learn the process for transmitting patient counts through the Hub.

How Does the Hub Help NYC  REACH Practices?  

Monthly reports  
PCIP gathers patient counts to create “dashboard reports” for practices, which highlight opportunities for clinical intervention and identify patient populations that could benefit from community programs. These reports contain comprehensive information on a practice’s patient population including smoking rates, blood pressure rates, A1C control rates, and more. These reports allow providers to identify areas for practice-level improvement and compare their performance to community averages.

Provider support and technical assistance
PCIP reviews this information with providers to address gaps in care and meet requirements for state and federal incentive programs, such as the Quality Payment Program and Meaningful Use. PCIP relies on this information to provide customized technical support for practices and recommend workflow changes to meet quality improvement goals.

Which Practices Connect to the  Hub?
The Hub can only connect to practices that use eCW and have an active NYC REACH Membership Agreement, through which practices authorize PCIP to gather patient counts through the Hub.

Practices can request to be disconnected from the Hub at any time. Practices that terminate their NYC REACH membership are automatically disconnected from the Hub.  More than 700 NYC REACH member practices are connected to the Hub and nearly all of those are small primary care practices. These practices represent more than 6,000 providers and 2 million patients.

Who Can See Patient Counts?
PCIP staff are the first to receive and review patient counts. PCIP shares patient counts with providers in  quality improvement dashboard reports.  PCIP does not  share patient counts that can be linked to a specific practice with anyone, unless the practice gives explicit consent. PCIP only shares patient counts with external groups if the practice gives explicit consent, and PCIP never shares patient counts for commercial purposes.

Does the Hub Affect How I Use My EHR?
The Hub does not interfere with any activity on an EHR. It operates completely in the background and requires no input from administrators or providers.

Are the Data Accurate?
Yes. PCIP conducts rigorous quality assurance and testing to validate all questions and answers transmitted through the Hub before use.

How Does the Hub Impact Public Health?
PCIP uses the Hub as a public health surveillance tool. PCIP studies patient counts to identify trends in conditions such as hypertension, influenza-like illness, depression, and Hepatitis C. These analyses help to determine how the Health Department employs resources to improve public health in New York City.

This article was featured in the Fall 2019 NYC REACH Newsletter