Provider Overview
Mount Sinai Health System (MSHS) is an integrated health care system encompassing the Icahn School of Medicine at Mount Sinai and eight hospital campuses in the New York metropolitan area.
The Health System includes more than 7,200 physicians, including general practitioners and specialists, and 13 free-standing joint-venture centers. Mount Sinai also features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island.
The Step Two Policy Project thanks Patti Cuartas, DMSc, PA-C, MBA, PMP, FACHE, ACHIP, Executive Director and Associate CMIO, Digital and Technology Partners (DTP) at Mount Sinai Health System for her partnership on this Spotlight.
Challenges to be Solved
MSHS identified the need to more efficiently and accurately collect patient consent for clinical health information exchange amid its efforts to achieve Delivery System Reform Incentive Payment (DSRIP) goals. Prior to the project we’ll describe below, rates of consent for clinical health information sharing were very low across MSHS. Practically, when consent is unavailable, it is difficult for providers to understand a patient’s full clinical picture, coordinate their care, and align treatment approaches with other providers.
Barriers
New York State is an “opt-in” consent state, so patients must affirm providers’ rights to share their health information.
The system-wide improvement for the process of collecting patient consent was a daunting interdisciplinary task. Any effective intervention would need to work with the existing Epic registration system, be integrated into the ecosystem of several health information exchanges (HIEs), and educate patients, providers, and registration staff.
Technically, the project would be challenging because patients often utilize multiple providers within the system, so the solution would need to potentially integrate patients’ consents across multiple active registrations throughout MSHS. Additionally, the intervention would need to accurately account for previously completed paper consents.
Solutions
Using $2.3 million of DSRIP funds, MSHS developed a roadmap to digitize consent using a consolidated, prospective “Enterprise Information Exchange” (EIE) consent form, offered to all patients upon registration at any MSHS acute or ambulatory facility. The form enabled exchange of data via the Mount Sinai HIE, Healthix HIE (the regional Qualified Entity serving New York, specifically New York City and Long Island), CareQuality platform (exchange between Epic and non-Epic providers nationwide), and CareEverywhere platform (exchange with other Epic clients).
To support implementation of the new technology, the project team sponsored educational animated videos and training for staff to better understand the process for collecting consent, as well as the implications for patient experience and care quality. Videos were also created to explain consent to patients.
Results
The project started in August 2018 and was completed in December 2019. Having this focused consent strategy resulted in the following gains:
Delivered comprehensive training and education program for staff and patients, leading to improved consent understanding and data sharing
Increased overall consent collection rate for all of MSHS
Improved provider access to patient data from external sites and supported data sharing with DSRIP community partners
Prepared the organization for the mandates against information blocking in the 21st Century Cures Act
Goal: Increase the collection of consents for all of MSHS with a target average of 80% or higher (with some exceptions based on certain sites’ patient characteristics that would preclude them from consent expectations).
Result: The implementation of the EIE form and a streamlined “enhanced” registration workflow increased the collection of consents across MSHS to 86.3% by November 2020. Patient consents now track across multiple registration sites and are done completely digitally.
Goal: Improve provider access to patient data from external sites and support data sharing with DSRIP community partners.
Result: The project enabled data sharing with four HIEs and supported Mount Sinai PPS community partners (e.g., federally qualified health centers) in the implementation of CareQuality.
Goal: Improve staff and patients’ understanding of data sharing and consent through training and education.
Result: The project trained over 1,600 front desk registration staff members by December 2019 on the importance of data sharing and patient consent, as those staff are the first line of education for patients about what they can expect of their personal health information. New MSHS registration staff are trained in patient consent when they join the system.
Future Plans
The system that was developed facilitated the efficient exchange of patient consent history, medical history, and referrals, quick access to shared patient records and real-time care transition data, and improved management of disease with the integration of social determinants of health tools. It proved to be the framework upon which improved patient care could be achieved.
The project provided useful lessons for the future on developing interdisciplinary clinical and technological solutions. Such projects should have clinical and operational owners as well as information technology (IT) owners. IT should be involved early on, participating in relevant meetings and in decision-making along the way, “leading from behind.”
Moving forward, MSHS aims to further improve consent rates and continue its process of seamlessly integrating clinical information systems, including behavioral health and other sensitive data to improve the quality of care and patient experience.
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