iNYP Empowers a New Wave of Digital Doctors
With ubiquitous access to information, the doctors and nurses of NewYork-Presbyterian Hospital (NYP) are among a new breed of digital care providers thanks to a partnership between Columbia University’s Department of Biomedical Informatics (DBMI) and the Information Systems department at NYP.
Faculty and developers have combined their informatics expertise and service-oriented mindset to create iNYP, a next-generation clinical information system that provides fast, efficient access to data aggregated from multiple sources. iNYP contains information from over three million NYP patients dating to the 1980s, and is available on multiple web browsers, mobile phones, and tablets.
iNYP allows doctors and nurses to view patients’ medical charts longitudinally, making it easy to review information such as lab tests and radiology reports as well as admission notes, discharge summaries, and operative data. The information in iNYP comes from a multitude of systems designed by several distinct vendors.
“Instead of these data living in different silos, iNYP allows doctors to bring things together and display information in a unified way,” said Dr. David Vawdrey, who leads the technical and research team for iNYP.
The iNYP system has its roots in the earliest systems created at DBMI. In the 1980s, DBMI researchers developed CIS (Clinical Information System), which aggregated data from disparate systems into one central repository. CIS allowed doctors to access x-rays, lab tests, and more, all in one place—eliminating the need for clinicians to separately access different computer terminals across hospital departments.
By the mid-1990s, CIS’s infrastructure was becoming outdated, prompting developers to rebuild the system as a web application. In 1998, DBMI introduced WebCIS, one of the first systems of its kind. It quickly became one of the “stars” of the medical center, says Dr. Vawdrey, receiving praise because it was fast, efficient, and “built with clinicians in mind.”
iNYP continues this legacy by leveraging today’s most innovative web technology and involving clinicians in the design of the application. Unlike WebCIS, iNYP is available across all NewYork-Presbyterian campuses, providing composite information displays and visualizations on a range of devices.
“For example, your doctor can quickly call up a graph of your cholesterol level over the last 10 years on her iPad,” says Dr. Vawdrey. She can also easily access the results of recent a recent x-ray performed at a separate NYP facility, and review another physician’s notes from your last clinic visit.
Close collaboration with the NYP Data Analytics and Electronic Health Record (EHR) teams has expanded the capabilities of iNYP and helped to double the volume of users over the past two years. Currently there are almost 9,000 distinct users who access the application each month.
“Developing iNYP has been a labor of love,” says Weiwei Xu, a Technical Specialist at NYP and one of the principal developers of the application. “There is no better feeling than this—creating a product that ultimately improves patient care by integrating creative ideas with innovative technology solutions.”
Informaticians at DBMI and collaborators throughout NYP are expanding the iNYP platform to include eye-catching dashboards and advanced clinical decision support. One of the most exciting new applications is the HARVEST project created by DBMI’s Dr. Noémie Elhadad. This project summarizes a patient’s medical history through innovative natural language processing and data visualization techniques. Because of the close relationship between DBMI and NYP, students and faculty have access to a “living laboratory” for conducting cutting edge informatics research.
“iNYP typifies the unique partnership between the hospital and DBMI,” says Aurelia Boyer, Senior Vice President & Chief Information Officer at NewYork-Presbyterian. “In addition to providing a comprehensive view of clinical data, iNYP enables us to rapidly develop and disseminate innovative health information technology to the thousands of doctors and nurses working in our hospitals and clinics.”
While the iNYP platform is unique to NewYork-Presbyterian, the informatics principles it embodies are transferable to other academic medical centers. Today, most hospitals (including NYP) purchase commercial EHR systems. Being tied to any one vendor can limit an organization’s flexibility in the rapidly changing EHR marketplace. iNYP is vendor-independent and available as a plugin to several commercial EHR systems. Dr. Vawdrey credits the leadership of NewYork-Presbyterian for embracing a strategic vision that allows for clinical informatics innovation. “Collaborating with NYP gives informaticians at DBMI an incredible opportunity to design, develop, and implement next-generation informatics ideas in a real clinical environment—potentially affecting the way that thousands of clinicians do their jobs every day. We have a real opportunity to make healthcare delivery better, safer, and more cost-effective.”
Most importantly, the feedback from doctors and nurses about iNYP has been extremely positive. “iNYP is a crucial part of my daily clinical workflow, allowing me to easily locate critical information, facilitating decision-making in the inpatient and outpatient setting,” said Dr. Jamie Hirsch, a nephrology fellow at Columbia University Medical Center. “The ease of locating information and the logical layout and display improve my efficiency and allow me to share data with patients, enabling shared decision-making. iNYP’s usability means that I am easily able to obtain information on my patients or quickly learn about the medical history and problems of new patients.” He says new additions to the platform will enhance blood pressure management, preventive care, and vaccination administration.
Dr. Mark Schlangel, anesthesiology resident and chair of the Columbia Housestaff Quality Council, considers iNYP as his “go-to” clinical tool. “The ease of navigation, clear display, and the simple keyword search tool make iNYP my primary source for patient information,” he says, “With the advent of iNYP, my pre-operative workflow efficiency has increased tremendously.”
“If iNYP allows doctors to spend less time on the computer and more time with patients, then we know we are succeeding,” says Dr. Vawdrey. “Happy doctors are a good thing around here.”