Minnesota e-Health Initiative: Update Progress and Opportunities

1. Minnesota e-Health Initiative:Update Progress and Opportunities Marty LaVenture, PhD, MPH Director, Center for Health Informatics Minnesota Department of Health Minnesota HIMSS Annual Meeting May 17, 2006

2. 2 Topic for Discussion What is the Minnesota e-Health Initiative? Progress and Current Action Emerging Themes Summit and Legislative update Opportunities for Input and Staying Connected

3. 3 Minnesota e-Health Initiative? Private-Public collaboration Guided by an Advisory Committee Comprehensive Vision Consumer and Community focus Inclusive scope: healthcare, long term care, public health and other settings The Committee was established in response to 2004/5 Legislation and is an advisory committee to the commissioner of Health. From the beginning the committee is intended to be: Strategic in its view Private�public collaboration and statewide in its scope and focus. Private public partnership exemplified in the co-chairs: Mary Brainerd � CEO of Health Partners, and Mary Wellik, Director of Olmsted County Public Health. The dedicated focus of this committee is intended to accelerate the use of health information technology (HIT) in all areas of the state. HIT including E HR, and more Purpose is 4 concepts: GOAL: Improve health care quality Action: Accelerate diffusion of knowledge & decision support; make complete record available GOAL: Increase patient safety Action: Avoid medical errors, especially at transitions of care GOAL: Reduce health care costs Action: Save �billions� each year; eliminate redundant studies , but also improving efficiencies GOAL: Improve public health Action: Increase communicable Disease surveillance capacity and preparedness and response The Committee was established in response to 2004/5 Legislation and is an advisory committee to the commissioner of Health. From the beginning the committee is intended to be: Strategic in its view Private�public collaboration and statewide in its scope and focus. Private public partnership exemplified in the co-chairs: Mary Brainerd � CEO of Health Partners, and Mary Wellik, Director of Olmsted County Public Health. The dedicated focus of this committee is intended to accelerate the use of health information technology (HIT) in all areas of the state. HIT including E HR, and more Purpose is 4 concepts: GOAL: Improve health care quality Action: Accelerate diffusion of knowledge & decision support; make complete record available GOAL: Increase patient safety Action: Avoid medical errors, especially at transitions of care GOAL: Reduce health care costs Action: Save �billions� each year; eliminate redundant studies , but also improving efficiencies GOAL: Improve public health Action: Increase communicable Disease surveillance capacity and preparedness and response

4. 4 Minnesota e-Health Initiative Vision& Multi-Dimensional Model �� accelerate the adoption and use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs and enable individuals and communities to make the best possible health decisions.� Following the review of information about needs and gaps� The Minnesota e-Health Initiative Steering Committee adopted a broad and bold vision and mission as reflected on this slide. It was published in a report to the legislature in January 2005. Please also note the multidimensional model of overlapping circles inside the outline of the state of Minnesota. The model also adopted by the committee, acknowledge that most health health information falls into 4 domains as reflected in the graphic (adapted from a national model) of the overlapping circle (domains) in this figure. The intersection domains are: Clinical � representing clinical / Medical related information Consumer � representing Personal health information Research and policy � representing information essential for research and policy decisions Public Health - / Population Health representing information to help assure healthy communities. Following the review of information about needs and gaps� The Minnesota e-Health Initiative Steering Committee adopted a broad and bold vision and mission as reflected on this slide. It was published in a report to the legislature in January 2005. Please also note the multidimensional model of overlapping circles inside the outline of the state of Minnesota. The model also adopted by the committee, acknowledge that most health health information falls into 4 domains as reflected in the graphic (adapted from a national model) of the overlapping circle (domains) in this figure. The intersection domains are: Clinical � representing clinical / Medical related information Consumer � representing Personal health information Research and policy � representing information essential for research and policy decisions Public Health - / Population Health representing information to help assure healthy communities.

5. 5 2006-2007 Minnesota e-Health Initiative Advisory Committee The MN statewide steering committee is represented by key stakeholders groups This committee consists of 26 senior level executives, leaders and experts representing: hospitals, small and large appointed by the MN HA health plans � appointed by council of health plans Physicians � appointed by MN Medical Assoc. nurses, - by the MNA other healthcare providers, academic institutions, state government purchasers, local and state public health agencies, citizens, and others with expert knowledge of health information technology and electronic health record systems As represented by this slide. The MN statewide steering committee is represented by key stakeholders groups This committee consists of 26 senior level executives, leaders and experts representing: hospitals, small and large appointed by the MN HA health plans � appointed by council of health plans Physicians � appointed by MN Medical Assoc. nurses, - by the MNA other healthcare providers, academic institutions, state government purchasers, local and state public health agencies, citizens, and others with expert knowledge of health information technology and electronic health record systems As represented by this slide.

6. 6 Progress � Proposed Action 2004-2007 MN e-Health Advisory Committee Progress to Date: September 2004 � June 2005 1. A Report to Legislature containing: A Discussion of Challenges and Gaps A Vision Statement A Roadmap for Strategic Actions Crosscutting Recommendations 2. A Collaborative Response to RFI for a National Health Information Network (NHIN) 3. Workgroup Reports �Principles for MN Health Information Exchange 4. Identified Opportunities and priorities for exchange Proposed Action: See slideProgress to Date: September 2004 � June 2005 1. A Report to Legislature containing: A Discussion of Challenges and Gaps A Vision Statement A Roadmap for Strategic Actions Crosscutting Recommendations 2. A Collaborative Response to RFI for a National Health Information Network (NHIN) 3. Workgroup Reports �Principles for MN Health Information Exchange 4. Identified Opportunities and priorities for exchange Proposed Action: See slide

7. Minnesota e-Health InitiativeRoadmap for Strategic Action Where do we begin to navigate a course for change? This slide is a composite of a thousand hours of the e-Health steering committee�s work. (Note: You have a printout of the full slide in your portfolio.) It starts with the vision, that is built upon the four national goals. Next are some specific recommendations for actions that can be accomplished in the short term. There are 6 cross-cutting recommendations that impact all the 4 goals: 1. Analyze Value of Investment and develop principles for financing. 2. Establish governance structure for sharing data. 3. Establish a statewide process for adopting and promoting national standards for data and interoperability. 4. Implement ongoing communications/education programs. 5. Establish policies and practices to ensure protection of confidentiality and security. 6. Endorse MDH�s continued leadership role in guiding e-Health development. The first three of these recommendations have been undertaken by working subcommittees on Finance, Governance, and Technical Standards/Architecture. Where do we begin to navigate a course for change? This slide is a composite of a thousand hours of the e-Health steering committee�s work. (Note: You have a printout of the full slide in your portfolio.) It starts with the vision, that is built upon the four national goals. Next are some specific recommendations for actions that can be accomplished in the short term. There are 6 cross-cutting recommendations that impact all the 4 goals: 1. Analyze Value of Investment and develop principles for financing. 2. Establish governance structure for sharing data. 3. Establish a statewide process for adopting and promoting national standards for data and interoperability. 4. Implement ongoing communications/education programs. 5. Establish policies and practices to ensure protection of confidentiality and security. 6. Endorse MDH�s continued leadership role in guiding e-Health development. The first three of these recommendations have been undertaken by working subcommittees on Finance, Governance, and Technical Standards/Architecture.

8. Electronic Health Record Adoption Progress Clinics: 2005 Survey: (300/651) 17% have fully Implemented EHR Hospitals: 2005 AHA survey 19% are fully Implemented DOQ-IT informatics project � Resources for Clinics MDH � Use of Rural Health Grants Collaboration on rules and implementation guides Continuing Need / Emerging Themes Informatics knowledge (tools) & support to small/rural/underserved clinics and hospitals, long term care, local public health departments Variation on implementation and use Education/Communication with policymakers, consumers

9. 9 Stratis Health Primary Care Clinic Survey (2005) Example Electronic Health Record Use in Minnesota�s Primary Care Clinics Stratis Health conducted a survey of adult primary care clinics to assess the current status of EHR implementation. Seventy-five percent of 603 total adult primary care clinics completed the survey from June 2005 to October 2005. The survey showed that 46% of respondents have implemented, or are in the process of implementing, an EHR (Figure 1). At the other end of the spectrum, 27% indicated �not implemented,� with no plans of EHR implementation within the next 24 months. Large clinic providers, which are most likely urban, are much more likely to have fully or partially implemented electronic health record systems than are smaller providers, which are most likely rural. The survey found that approximately 57% of Minnesota�s larger clinics have EHRs fully or partially implemented, compared to 25% for smaller clinics. � The survey respondents identified three government policy actions that would impact their decision to implement EHR: provide grant funds to assist in the purchase of an EHR; provide tax credits for investment in EHR; and provide low interest loans for the purchase of an EHR. � According to survey respondents, the top three barriers that have slowed/prevented implementation of an EHR in these clinics were: lack of capital resources to invest in an EHR; concern about loss of productivity during transition to EHR system; and concern about physician ability to input data into a computerized medical record. Electronic Health Record Use in Minnesota�s Primary Care Clinics Stratis Health conducted a survey of adult primary care clinics to assess the current status of EHR implementation. Seventy-five percent of 603 total adult primary care clinics completed the survey from June 2005 to October 2005. The survey showed that 46% of respondents have implemented, or are in the process of implementing, an EHR (Figure 1).

10. Minnesota Health Information Exchange Progress MN Health Care Connection (MHCC) Interim Board (Stratis Health as Incubator) Directory of 36 Projects. At least 6 HIE Projects underway; examples: CHIC � NE MN exchange AHRQ � Shared Abstract: Allina, Fairview, Health Partners & U of M MIIC � Immunization Exchange Medications � HIPPA collaborative Winona project Minnesota Privacy and Security Project Continuing Need / Emerging Themes Statewide coordination Initial funding and sustainable business model

11. 11 Purpose: Identify variations in organization-level business policies and practices around exchange. Identify and propose practical solutions, while preserving the privacy and security protections. Process: Work groups forming over the next month. Minnesota Privacy and Security Project: Starts June 2006

12. Personalize Care � Personal Health Record Progress Initial projects for consumer access (Children's, Fairview, HealthPartners, others) Continuing Need / Emerging Themes Minnesota definition for PHR and integration Projects for �My Medication History,� �My Registration Information� Adopt consumer principles Consumer education and information resources

13. 13 Example Advertisement

14. Population Health / Public Health Progress MN-PHIN: Population health knowledge, preparedness, response activity �InformationLinks� Project from the Robert Wood Johnson Foundation Initial assessment of informatics capacity Continuing Need / Emerging Themes Adopt common data exchange standards for disease reporting Interoperability across dozens of silo information systems used at state and local levels Roadmap for population health / prevention indicators; e.g. Indian Health Service model.

15. 15 Emerging Themes, Consumer Focused Action - By advancing the implementation and use of�: Empower Consumers �My Personal Health Record�, �My Medication and Immunization History�, �My Registration Information�- Replace the Clipboard � Inform and Connect Clinicians Electronic Health Record abstract in Emergency Departments Statewide use of e-Prescribing Chronic disease monitoring/management Statewide access to laboratory results Statewide immunization history & decision support � Protect Communities Reliable and timely provider detection and reporting of diseases to MDH, with the timely return of information on community risks and threats An integrated Minnesota Public Health Information Network (MN-PHIN) for state-local emergency detection and response.

16. 16 Consumer Benefit Examples I save time and worry because there is no need to fill out lengthy forms or explain my health history (and possibly forget something important) when I go to the doctor. My electronic health records will not be lost, even in the event of a disaster. No matter where I go to the doctor, my providers have health information about me.

17. 17 Consumer Benefit Examples (continued) I get test results quickly and can understand them. I can securely communicate electronically with my health care provider if I chose to. I have greater confidence that public health agencies and healthcare providers are prepared to help in the event of a health emergency.

18. 18 2006 Minnesota Proposal for Public Funding The Governor recommends $12,000,000 in FY 2007 to invest in the use of Interoperable Electronic Health Record Systems and related Health Information Technology for: Matching Grants to Communities for interoperable EHR Provide resources for technical support with the projects and statewide Status: Pending legislative action/resolution

19. 19 Key Challenges and Opportunities for MN HIMSS Continuing communications and education Supporting collaboration / coordination statewide Meeting rural & underserved needs Increasing informatics & IT capacity Integrating population/public health Public funding

20. 20 Opportunities for Input and Staying Connected MN e-Health Summit - Thursday June 29 Pre-Summit Workshop - Wed PM June 28 MN Privacy and Security Project Volunteer / Review work Volunteer Advisory Committee work groups Share your project(s) in the Minnesota e-Health directory

21. 21 www.health.state.mn.us/e-health Minnesota Department of Health Marty LaVenture Director, Center for Health Informatics 651 201-5950 martin.laventure@health.state.mn.us Barb Wills Director, Center for Data Initiatives 651 282-6373 barb.wills@health.state.mn.us Thank youThank you