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(BHIX), a Regional Health Information Organization (RHIO), was developed through a community-driven collaboration between providers and payers interested in improving patient care through the application of technology across health care settings. Nationally recognized as a leader in advancing health information exchange, BHIX fosters improvements in community health information connectivity. BHIX supports sharing of health care data among patients, doctors and other practitioners, hospitals, long term and home care services, community based organizations, government agencies and insurers. Since its incorporation in 2007, BHIX has been governed by an independent board of directors, accountable to the regional community. BHIX manages data from nearly 2 million patients, representing encounters at dozens of health care facilities and insurers, most of whom feed data to BHIX on a real-time basis. Since implementing the InterSystems HealthShare platform in 2009, BHIX has continued to build and develop a portfolio of products and services that provide cost-effective access to a broad range of clinical information and related functionality to enhance patient care and support emerging models of care utilizing statewide and national technical standards. Last year BHIX was engaged to support grant projects, led by Maimonides Medical Center, integrating new participant organizations to its roster and adding additional data elements to facilitate care collaboration for special needs populations. BHIX also launched a secure Clinical Message Center enabling communications among and between BHIX users and facilitating patient referrals. To monitor significant patient events and to improve care coordination, BHIX designed and deployed real-time automated event notifications which are routed to care managers and clinicians, alerting them via email or notification to hand-held devices. 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(BHIX), a Regional Health Information Organization (RHIO), was developed through a community-driven collaboration between providers and payers interested in improving patient care through the application of technology across health care settings. Nationally recognized as a leader in advancing health information exchange, BHIX fosters improvements in community health information connectivity. BHIX supports sharing of health care data among patients, doctors and other practitioners, hospitals, long term and home care services, community based organizations, government agencies and insurers. Since its incorporation in 2007, BHIX has been governed by an independent board of directors, accountable to the regional community. BHIX manages data from nearly 2 million patients, representing encounters at dozens of health care facilities and insurers, most of whom feed data to BHIX on a real-time basis.BHIX provides cost effective access to a broad range of clinical information and related functionality to enhance patient care and support emerging models of care. In 2010, BHIX was engaged to support grant projects, led by Maimonides Medical Center, integrating new participant organizations to its roster to facilitate care collaboration for special needs populations. During this period, BHIX launched a secure Clinical Message Center enabling communications among and between BHIX users to facilitate patient referrals. To monitor significant patient events and to improve care coordination, BHIX designed and deployed real-time automated event notifications which are routed to care managers and clinicians, alerting them via email or notification to hand-held devices. These tools continue to enable clinicians to work effectively and collaboratively, providing value-added services to BHIX customers. Additionally, BHIX developed a new user interface or Landing Page, which supports a variety of users involved in many aspects of patient care management. To expand its user-base, BHIX automated its training and provisioning process, thereby creating an efficient, scalable method for training an increasing numbers of users of the BHIX.BHIX has worked to support many user types including providers using interoperable electronic health records. Using national, interoperable standards, BHIX is the first RHIO to support a seamless, bi-directional data flow directly from within the physician's electronic medical record. This enables the physician to query for community-wide health information without leaving his/her application. With the advent of the New York State Medicaid Health Home model of care, BHIX also added a growing number of community and behavioral health organizations, providing a technical framework for supporting Health Home operations and building connections to new care management applications.To date, nearly 2000 clinicians have been provisioned as BHIX users, including incoming hospital residents as part of their training and orientation as well as care managers responsible for coordinating care for high-risk patients who are enrolled in Health Homes. A significant milestone in 2012 was the announcement that BHIX would be the first New York City RHIO to sign-on to support the New York eHealth Collaborative (NYeC) in its efforts to integrate the downstate region, and ultimately the entire state, into a unified network for healthcare records. Furthermore, BHIXs robust infrastructure will be used as a key reference implementation for NYeC initiatives as it moves toward the development of the State Health Information Network for NY (SHIN-NY). Through the BHIX governance structure, input from clinicians, privacy officers and executive leadership continue to inform the evolving look, feel and functionality of the BHIX System. In addition to the increasing number and variety of data elements displayed in the Patient Record, BHIX has added vital signs, radiology and respiratory reports, care coordination documents (CCDs) and discharge summaries to round out health information available to providers. Additionally, BHIX has developed a Filtered Summary Report; a tabular view of BHIX community-wide health data that can be customized to support communications among clinicians through the BHIX Clinical Message Center. BHIX has also launched the BHIX Connect Indicator an at a glance dashboard integrated within a clinicians EHRs; it shares both user and patient context and provides a seamless workflow for clinicians.Clinicians have asserted that data available through BHIX and real-time event notifications have assisted them in the delivery of patient care, especially for those patients that present in emergency rooms and may not be able to articulate vital information. To support an increasing number of users, BHIX deployed an automated Help Desk application available 24/7 to provide user support.BHIX continues to focus its efforts on outreach, education, customer service and community engagement, collecting hundreds of thousands of patient consents which represent over seventeen foreign languages. Last year BHIX launched an updated website, www.bhix.org, and a monthly newsletter to further its reach and targeting both clinical and patient communities as well as the media. 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