In July we reported that HealtheConnections (HeC), a Syracuse, N.Y.-based health information exchange, was awarded a contract to provide statewide encounter alerts on behalf of the Statewide Health Information Network for New York (SHIN-NY) and is partnering with vendor PointClickCare (PCC) to provide the service. Elizabeth Amato, the HIE’s president and CEO, recently spoke with Healthcare Innovation about the alert program and the HIE’s transition to a cloud-native FHIR-based platform.
Amato succeeded Rob Hack as the company’s president and CEO in January 2025 after most recently serving as chief operating officer there. Previously she worked for several years at the New York eHealth Collaborative (NYeC), including as vice president of programs and services management.
Joining the conversation was Brian Drozdowicz, chief revenue officer at PCC, which has partnerships with 16 health information exchanges and partners with 21 state agencies and hospital associations.
Healthcare Innovation: How did it come about that HealtheConnections was awarded the contract to provide statewide encounter alerts?
Amato: It was a competitive procurement. We are the largest footprint HIE in New York. We have really strong relationships and really high customer satisfaction. We know our our customers very well. Through partnering with PCC and bringing in their really specific and innovative tooling, I think it just made a lot of sense for the state to select us.
HCI: Had HealtheConnections been working on ADTs with PCC prior to that?
Amato: No, not directly. For a long time we had been offering a homegrown alerting solution within our legacy platform. We were actually looking to move to something much more modern anyway, because we’re making a lot of other changes here. So the timing was actually perfect.
HCI: Before this contract, have ADT alerts been shared just within each HIE’s own region, and not across regions in the state?
Amato: There are definitely ADT alerts within each of the six HIE regions in New York. Since about 2016 or so, there have been cross-region alerts in New York, but they were imperfect. There were a lot of handshakes that had to land in order for an alert to move from, say, New York City to Syracuse. So it sufficed. It was better than the absence of alerts moving across the state, but I think NYeC realized that it was pretty inefficient, and was hard to centrally track. All of this led to them realizing that there had to be a better way — not just in picking alert providers that would do this on behalf of the state, like HeC and PointClickCare, but they also changed some of the under-the-covers architecture at the statewide level to make it more reliable.
HCI: Will the statewide alerts add more value for care managers, managed care organizations or ACOs who previously haven’t been able to see details about when a patient went to the hospital somewhere else in the state?
Amato: Absolutely. I do think standardizing this so that it’s a statewide ADT pipe is going to remove some of those potential failure points that did pain some of the care managers, because they didn’t receive an alert until the patient shows up and says, “Oh yeah, I was in the hospital six weeks ago.” I think it’s going to remove some of those cracks that things can slip through.
Drozdowicz: The technology that we’re using here is really something that we’ve proven nationwide. We operate the largest real-time notification network in the country today, with a huge percentage of acute facilities on that, so certainly it has been proven at scale. What we’ve seen is that reliability matters a whole heck of a lot. Uptime and standardization matter a whole lot, as does being able to consume the information in a standard format. We’ve also seen that a lot of the health plans that we work with have sort of defaulted to us as being their primary provider of alerts. If we’ve got the network within a geographical area, they’ll prefer to work with us because of the reliability, the standardization, and the fact that it’s been running at scale and very predictably for quite some time.
HCI: Does PointClickCare have experience with providing statewide alerts in other states?
Drozdowicz: There are more than a dozen states where we are working directly with an HIE provider, similar to HealtheConnections. Of course, every state has unique requirements. We have found that working with an HIE within the state with this type of arrangement yields the best results for providers, payers and patients within the state. I think the secret sauce to make this work best for everyone within New York is having a local HIE partner that truly understands the different dynamics within the markets. New York is a super unique place, right? And Elizabeth and her team will really be able to provide that local flavor and make sure that we’re meeting the needs of individuals within the state.
HCI: The statewide alert system is scheduled to go live sometime in the fall. What are some things that are happening now behind the scenes to make that happen? Is there piloting happening?
Amato: Actually, this is pilot week for us. With PointClickCare, we’re bringing on close to 10 pilots. Some are brand new to the HealtheConnections family. Some are existing participants that we’re now moving over to this new solution. Then through the month of September, we’re going to continue with migrating our existing customer base, and start to get out there and promote this across all regions of New York — especially to organizations that are really dependent on alerts and need to know what’s happening with their patients.
HCI: I wanted to switch topics and ask about some other interoperability developments there. We’ve written a little bit about NYeC’s uniform statewide common participation agreement. Can you explain a few of the ways that will improve the SHIN-NY’s ability to make records available across the state or break down silos?
Amato: I think it is really about streamlining the operations of the statewide health information network. It’s still a federated network with six different HIEs, and in some cases, whether it was governance-wise or contract-wise, that sometimes created friction, because while we had a common set of flow-down agreements or flow-down terms, there were still things that were implemented differently across the state. So the state made the decision to move to a statewide common participation agreement. And I think that they had a goal of increasing efficiency, unifying the data, and moving to a more statewide feel. I think it’s just about making the entire network a little more nimble and adaptable, and also allowing us to leverage some of these statewide services, like our new alerting service.
HCI: So is this offering of a statewide service a model and we’re likely to see more?
Amato: I don’t want to speak for the folks at NYeC, but I think there’s a realization that all six Qualified Entities don’t need to do all the things all at the same time and that maybe a centers-of-excellence approach could work.
HCI: A few years ago, I wrote about a presentation from somebody at NYeC about their work to shift to a FHIR foundation to enable SHIN-NY participants to access discrete pieces of patient information through APIs. Are they continuing that work to shift to a FHIR-based platform, and does that require you to change your tech stack?
Amato: Well, we’re actually doing that on our own. In the next month or two, we are moving to a completely cloud-native FHIR-based HIE platform that’s really going to open up a lot of doors for our participants to get some meaningful insights out of their own data, as well as the community data that we have access to.
HCI: Can you say which vendor you’re working with on that platform?
Amato: It’s actually something that is using commercially available cloud technologies that our team with a development partner are building from the ground up. We’re not going to one of the traditional off-the-shelf HIE platforms, which we think is going to allow us a lot of flexibility and the ability to control our own destiny into the future.
HCI: Do you still hear from the folks at NYeC about using FHIR to share data?
Amato: Yes, we do. There’s a lot of work in New York around the 1115 Medicaid waiver. Much of that is using FHIR data. But I think it’s in some pockets more than others.
HCI: Speaking of the 1115 waiver, I read that you partnered with Unite Us and three social care networks across the Hudson Valley and central New York to address health-related social needs. This was about exchanging health-related social need data between the social care networks and the SHIN-NY data lake. Can you give an update on that project?
Amato: We’re playing a couple of critical roles there. One is that we’re serving as the pipes to get the information out of their Unite Us platform up to the statewide data lake and back into their platform. We’re also working with the communities that those three SCNs operate in — the Hudson Valley, Central New York and the Southern Tier of New York — and working directly with hospitals, physician practices, and Federally Qualified Health Centers that may also be screening their patients for health-related social needs, and bringing that in, even though it’s sort of on the periphery of the official waiver boundaries. The patients are then connected to community-based resources to address any health-related social needs they have.
HCI: Among the services your HIE offers is image exchange, which allows providers to view images through a universal viewer or download them into their own system. Do most HIEs offer something like that? Or is that fairly unusual? And could you talk about how that gets the most usage in the system?
Amato: I can’t really speak to other states and HIEs. I think it’s a little bit mixed here in New York. Maybe 50 percent of the HIEs offer an image exchange solution. Our participants who use it absolutely love it. HIEs have always served up radiology reports. You could see that your patient had a chest X-ray, but that was it. Through image exchange, you can actually see the chest X-ray. And if you’re another radiology practice or a hospital, you can actually pull that image into your own PACS, and that eliminates the need for patients to go and get a CD of their images. Radiologists can actually collaborate in real time, which has been really interesting, particularly when there’s a concern that a patient might be having a stroke, especially in a rural setting. So it’s really exciting stuff. It is expensive to operate. I’ll share that with you. So not all HIEs do it, but we’ve found that it adds a lot of real value to our customers.
HCI: Another use case mentioned on your website is behavioral health. How do behavioral health providers participate in the HIE, and are there still issues around sharing behavioral health data or substance use disorder data in the state?
Amato: Not so much in New York. We have a very complicated consent model. But when it comes to Part 2 data, SUD data, behavioral health data, that complicated consent models actually helped us, because when a patient has granted consent, it includes their behavioral health data. So we really haven’t had the challenges that other states have had in engaging and bringing behavioral health providers into the fold, because they were able to actually see the data that they needed on their patients. We still treat it as sensitive data. We still have to hold that data back when we need to, but it’s been a real differentiator for New York, because we’ve been able to remove that barrier.
Drozdowicz: We’ve done a bunch of work around behavioral health and emergency department avoidance. It is a different topic, but we’ve launched a program in the state of Massachusetts that’s in every emergency department. It has a portal that helps to assess patients upon admittance to the ED and identifying if there’s a prior behavioral health diagnosis and then facilitating real-time referral out to inpatient psych facilities to help drive down cost and improve that patient experience.
HCI: Finally, I also wanted to ask both of you how you’re thinking about TEFCA right now.
Amato: We’re staying very close to it. TEFCA is playing a very important role nationwide. As I mentioned a few minutes ago, our consent policy here in New York makes that difficult for New York HIEs to either become QHINs or participate just because of the consent model here, but the state’s working very hard to reform certain pieces so that that doesn’t become a barrier for New York. We know that we need to stay relevant and stay connected, but there’s just a little bit of a process that we’re having to go through to get here.
Drozdowicz: We’re super-close to it as well. We do have a QHIN partner. We work closely with Kno2. They’ve been a fantastic partner over the years. We’re continually evaluating the role that we should play in helping to advance interoperability. It will be super interesting to see what happens in the next 12 to 18 months, and we’re keeping our options open in terms of the best ways that we can be in the front seat of helping to enable safe, appropriate, secure data exchange. It’s good to see things advancing.
