Regional Health Information Exchange: Getting There

Ed Barthell – Wisconsin Health Information Exchange

Hugh Zettel, GE Healthcare

Questions

• What are RHIOs?

• Why RHIOs?

• What are clinical drivers for RHIOs in WI?

• What must happen to permit exchange?

• What should we be preparing to do?

Medical Trading Areas

US Administration’s Cornerstones for Care

• Connecting the System: Every medical provider has some system for health records. Increasingly, those systems are electronic. Standards need to be identified so all health information systems can quickly and securely communicate and exchange data.

• Measure and Publish Quality: Every case, every procedure, has an outcome. Some are better than others. To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care.

• Measure and Publish Price: Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each “episode of care.”

• Create Positive Incentives: All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-price health care. [http://dhhs.gov/transparency/ ]

WI 5 Year Pathway

• Create eHealth technology platform– Increase HIT adoption and use– Foster regional Health Information Exchange– Establish statewide services

• Value-based healthcare purchasing

• Enhance prevention and disease management

WI Assets & Readiness

• At least 17 operational projects exchanging personal health information electronically, with 11 more planned

• Almost 70% of practice sites have at least partially electronic records

BUT

• No common data standards

• No common patient index

LEAPING INTO THE

FUTURE

THE WISCONSIN HEALTH

INFORMATION EXCHANGE

April 27, 2004

Executive Order 13335

Commitment to the promotion of health information technology to improve efficiency, reduce medical errors, improve quality of care, and provide better information for patients and physicians.

Widespread adoption of interoperable electronic health records (EHRs) within 10 years so that health information will follow patients throughout their care in a seamless and secure manner.

Establishment of Office of National Coordinator for Health Information Technology (ONC)

Two Critical Challenges

1. Interoperability and portability of healthcare information

2. Encouraging electronic health record adoption

HHS - ONC Contracts

• Standards harmonization – HITSP– Interoperability specs this fall

• Compliance certification – CCHIT– EHRs and infrastructure components

• National architecture – NHIN (four)– Prototypes for interoperability

• Security and privacy – RTI International– Wisconsin participating

Interoperability showcase - HIMSS07 in New Orleans.

60 organizations demonstrating interoperability in a clinical workflow.

Based on Integrating the Healthcare Enterprise (IHE) implementation guides.

www.himss.org

CommonPIX Server

XDS Registry

CrossCommunity

Bridge

DocumentConsumer

Meta-Community using existing IHE Profiles

XDS Registry

XDS Repository

Patient IdentitySource

Patient IdentitySource

Patient IdentitySource

(1) (1)(1)

(3)

(2)

XDS Registry

(4)

(4)

(4)

(5)

XDS RepositoryXDS Repository

(6) (6)

(6)

Meta-Community

Community A

Community B

Community C

eHealth Care Quality and Patient Safety Board 2007

eHealth BoardChair: Kevin Hayden

Patient Care Advisory Group

Chair: Ed Barthell

Consumer Interests and Privacy

Advisory GroupChair: Cathy

Hansen

Public Health Advisory Group

Chair: Bevan Baker

Statewide Health Information

Exchange Advisory Group

Chair: Hugh Zettel

Operations

Executive CommitteeChairs of the Board and advisory group

E Health Report to governor November 2006

Governor submits budgetFirst Quarter 2007

Legislature approves budget First half 2007

AN OPPORTUNITY TO LEAD

High profile

Local problems

Local talent

Technical infrastructure

Willing partners

Wisconsin HealthInformation

Exchange

WHIE Business Plan

The value proposition:

The benefits obtained from the exchange of clinical information across institutional boundaries exceed the costs of implementing the exchange.

Organizational InfrastructureLegal agreementsProject Priorities - Pilots

PHASE ONE

PHASE TWO

PHASE THREE

PHASE FOUR

Organization Early OperationsPriority ProjectsEvaluation and ROI Definition

Organization Mature OperationsExpand Services and Participants$ PPM Model with ROI to Payors

Possible Secondary Data UsesExpanded Decision Support and Quality Tools

Govt funding, Grants

Dues

Payor funding or transaction fees

Potential funding from secondary data sales

Result and Document

Delivery System

Registration and Claims Repository

Clinical User Authentication and Auditing

Patient Record Location and Aggregation

Medication Allergy Immunization

Repository

Patient User Authentication and Auditing

Patient Pre - Registration

System

Patient Access to Medication

System

Clinician

Public Health

Patient

Actors

Sys Admin

Systems

Clinical Results Source System

s

Registration Systems

Claims System

s

PBM, Pharmacy Systems

Decision

Support System

s

Payor Care Mgt

WHIE ED Linking Project

HL7 Registration Message

WHIE ED Linking System Azyxxi

HIS HIS HIS HIS

Claims data

Clinical End UsersPublic Health Surveillance

Wisconsin Health Information ExchangeWisconsin Health Information Exchange

Stanikowski / Frank / N / 24yo / M / 12-03-81 / 312 Maple St / Milwaukee

AVAILABLE INFORMATION FOR:

Clear All Print Exit

Disclaimer language will be inserted here

SOUTHEAST WISCONSIN EMERGENCY DATA COORDINATION PROJ ECT

DIAGNOSES LOCATION CITY DATE

Diabetes Mellitus Mt. Sinai Hospital Emerg Dept Milwaukee 5-03-01Hypertension MLK Clinic Milwaukee 6-12-02Renal Insufficiency Columbia St. Mary’s FP Clinic Milwaukee 4-05-03

MEDICATIONS SCHEDULE PRESCRIBED BY DATE DATA SOURCE

Glyburide 10 mg po qd Dr. Anderson 5-03-01 Patient report HCTZ 50 mg po qd Dr. Smith 6-12-02 RxHub Pharmacy report

ALLERGIES REACTION NOTED BY DATE

NSAIDs Hives Dr. Anderson 5-03-01

CASE WORKER ASSIGNED

Ms Carolyn Jones Office Phone 414-290-5555 Pager 414-555-9090 After Hrs 414-444-7777

SPECIAL NEEDS / COMMENTS

Patient is not able to read English. Care coordinated by aunt – Ms. Jane Parker Phone 414-222-6666

Authorized Referral Physicians

PRIMARY PROVIDER ASSIGNED

Dr. Sam Adams Office Phone 414-290-5555 Pager 414-555-9090 After Hrs 414-444-777713111 N. Main Stree Miwaukee 53211

Immunization Information Results Reporting

Wisconsin Health Information Exchange

QUESTIONS ??