Trenton Health Team is a data-driven organization as we constantly strive to focus our programs on the areas of highest need for our community. From our earliest efforts, adopting Advanced Access Scheduling and establishing the Community-wide Clinical Care Coordination Team (C4T) to examine and track the highest utilizers of the city’s emergency departments, we have worked to analyze and combine data sets that point us to solutions. This process of sharing and collaboratively reviewing Trenton-specific data was also at the heart of our community health needs assessment process, giving us a unique and highly actionable report – one that has served not only THT, but many of our partner organizations as well.
A signature accomplishment has been our launch of the Trenton Health Information Exchange (HIE) in January of 2014. Created and operated in partnership with CareEvolution, an industry-leading Michigan-based health information technology company, it provides health practitioners access to integrated and holistic patient records in real-time to support treatment decisions and strategies.
The HIE also plays a vital role in advancing efforts to improve our community’s health, allowing the creation of integrated reports and protocols that are designed to identify issues, trends, and particular health needs or disease conditions where interventions are warranted.
An example of cutting edge work in using data to improve outcomes has been THT’s development of a Clinical Decision Support (CDS) System, funded through the NJ Department of Health, to address diabetes and hypertension across outpatient providers within the Trenton community. With the success of our work in Trenton, the State has asked THT to support Newark in deploying a CDS System there as well.
Another important facet of THT’s work, funded by The Nicholson Foundation, has been the provision of care coordination for high-utilizing patients, many of whom have complex comorbidities. Using the HIE for identifying and monitoring a cohort of clients has shown us the power of shared data for care planning. THT is currently working to link behavioral and social sector data, including homelessness data, with the HIE to further advance an integrated approach to health across the community.
The HIE has grown quickly as providers and data partners learn the value of this real-time informational resource. Today more than 600 clinical users can access millions of records for more than 250,000 patients. The reporting functions of the HIE are being continuously enhanced to include analytics at both the macro (population) and micro (individual, disease category, age group, or other subset) levels.
The Trenton HIE is one of six HIEs in New Jersey, and our connection with the Camden HIE represents the first full integration of two of NJ’s Health Information Exchange systems.
To learn more about the Trenton HIE, click here.