Wisconsin’s eHealth Initiative and the ED Linking Project November 8, 2008 WI ACHE Webinar

1. Wisconsin’s eHealth Initiative and the ED Linking ProjectNovember 8, 2008 WI ACHE Webinar To Access Audio: 866-365-4406 Pass code: 2741820

2. Agenda Secretary Kevin Hayden – 10 minutes • Brief overview of Wisconsin eHealth Initiative • Implications for acute care providers • Health Information Exchange Dr. Edward Barthell - ED Linking - 10 minutes • Overview of Project/timeline • Physician’s response • Clinical improvements Bill Bazan – 10 minutes • Competitive Challenge • Business case for connectivity • Equal Partnership/Change in Culture Gary Nicolas – 10 minutes • IT considerations • Flexibility - Interoperability • 4 steps toward Adoption Q& A – 10 minutes

3. Kevin R. HaydenSecretary of Wisconsin’s Department of Health and Family Service

4. A Discussion on Wisconsin’s eHealth Initiative Department of Health and Family Services

5. Wisconsin's eHealth Initiative and the ED Linking Project Kevin R. Hayden, Secretary Department of Health and Family Services http://ehealthboard.dhfs.wisconsin.gov/

6. The eHealth Initiative Goal: Successful implementation of a statewide health information exchange (HIE) system that is interoperable with the Nationwide Health Information Network (NHIN).

7. eHealth Activities in DHFS: • Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health care; • Promote investment in HIE to improve the quality, safety and value of health care; • Assure patient privacy in the exchange of health information; • Link HIT and HIE to public health, prevention and disease management activities; • Collaborate with others; • Support the Governor's eHealth Care Quality and Patient Safety Board.

8. Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health • Statistics: • Overall, about 77% of ambulatory practice sites have electronic practice management systems (billing, scheduling, etc.) -- includes about 84% of practice sites in large systems and 57% of practice sites that are independent or part of small systems. • 16 % of ambulatory practice sites have totally electronic patient records systems – includes 17% of practice sites in large systems and 11% of practice sites that are independent or part of small systems. • 69% of ambulatory practice sites have some combination of paper and electronic patient records.

9. Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health cont. • Medicaid Transformation Grant • Wisconsin Health Information Exchange (WHIE) • ~ $3 million grant from DHFS through CMS Medicaid Transformation grant • Value – Driven Health Care Initiative - - align WI’s Medicaid program’s quality measurement strategies with WCHQ’s.

10. Promote investment in HIE to improve the quality safety and value of health care Request for Proposal Development Purpose: • To obtain consulting services and expertise for state-level HIE assessment, planning, and architectural (business & technical) design; • Promote the development of secure, trusted, technically compatible statewide HIE across public and private sectors.

11. Assure patient privacy in the exchange of health information Health Information Security and Privacy Collaboration (in progress): • Allow disclosure without consent of the following information in 51.30 treatment record to all treating providers with a need to know: name, address, date of birth, name of mental health providers, dates of service, diagnosis, medications, allergies, other relevant demographic information and NEW – biometric diagnostics like lab and non-psych testing and symptoms. • Eliminating barriers to documentation, re-disclosure and oral disclosure of information to those involved in care or treatment of patient e.g. family members.

12. Collaborate With Others • Wisconsin Health Information Organization • Wisconsin Collaborative for Health Care Quality • Wisconsin Hospital Association • Wisconsin Medical Society

13. Support the Governor's eHealth Care Quality and Patient Safety Board

14. Implications: • Resources • Governor Doyle’s Biennial Executive Budget  Resources: grants, tax credits  Governance: statutorily establish Council • Certification and development of standards for interoperability • Removing statutory and regulatory barriers

15. Implications cont.: • Alignment: • HIT platform with value-based purchasing strategies • Population health with disease/chronic care management • Sustainability

16. Acknowledgements: • Dr. Barthell of the Wisconsin Health Information Exchange • Bill Bazan of the Wisconsin Hospital association for their great dedication to this project • Tom Wetzel for convening this webcast

17. Dr. Edward BarthellExecutive Vice President for Infinity HealthCare Inc. and Chief Medical Officer of EMSystem

18. ED Linking Project Information Sharingbetween Emergency Departments and Community Health Centers June, 2007 18

19. 19 THE PROBLEM

20. 20 SOLUTION Implement a health information exchange system that will allow multiple hospitals, clinics, and healthcare institutions to rapidly access past medical history data about patients. • A FIRST STEP • Provide clinicians access to past medical history for patients that register for care at safety net facilities – emergency departments and community health centers.

21. 21 KEY REQUIREMENTS Make data available to clinicians in a manner that is virtually transparent to current workflow. Provide sufficient “hit ratio” and accuracy of record matching to make queries worthwhile. Ensure security and confidentiality of all medical records and compliance with HIPAA and applicable state regulations.

22. 22 GOVERNANCE What is (who are) WHIE? A collaborative group with a broad based board of advisors include representatives of health care providers, payors, patients, educational institutions, and other stakeholders DATA SHARING PARTNERS Aurora Health Care Children's Hospital of Wisconsin Columbia - St. Mary's Hospitals Froedtert and Community Health Wheaton Franciscan Healthcare DHFS Medicaid

23. 23 MAKING IT WORK Formal planning process Providers, HIT experts, Project management Implementation plan completed fall 2006 Building a collaborative network Meetings, Data sharing agreements Arranging for funding Healthcare provider investment Medicaid transformation grant Technical provider contributions Evaluation – Sustainability planning

24. 24 CURRENT PROCESS • Clinician must think to ask for previous records • Previous records often unavailable • Manual or electronic process to retrieve local records • Labor intensive process to retrieve records from other institutions • Lack of previous records leads to errors and redundancy

25. 25 NEW PROCESS • Automatic regional query initiated by registration message • Available data displayed on pick list for clinicians or support staff • Includes summary info from both local hospital and outside facilities • Review on line or print to attach to paper chart • Decrease errors and redundancy ED Linking System

26. 26 2007 2008 Q3 Q4 Q1 Q2 Q3 Q4 . . . Mobilize HL7 Interface(s) VPN Setup and Config Azyxxi Setup and Config Legal Agreements Review & Select Medicaid Data Fields ED Workflow Usability Evaluate Solution Establish Baseline

27. 27 THE PLATFORM

28. 28 EVALUATION Economic Modeling Workflow Impact

29. Bill BazanVice PresidentMetro Milwaukee, Wisconsin Hospital Association

30. EMERGENCY DEPARTMENT CARE COORDINATION COMMITTEE…AND THE IT LINKING PROJECT 30

31. KEY CONCEPTS: Secure health information exchange Enhance care management Provide needed medical information Continuity of care Med. Reconciliation/patient safety Connection to primary care home Financial impact of doing nothing 31

32. STEP 1: WHO SHOULD BE AT THE TABLE? 32

33. 33 ED PHYSICIANS INFORMATION SYSTEM PERSONEL FEDERALLY QUALIFIED HEALTH CENTERS HOSPITAL/SYSTEM ADMINISTRATORS ED NURSE MANAGERS SOCIAL WORKERS/CASE MANAGERS

34. MILWAUKEE HEALTH CARE PARTNERSHIP 34 • AURORA • CHILDREN’S • COLUMBIA - ST. MARY’S • FROEDTERT • WHEATON FRANCISCAN • 4 FQHC’S • Recently, KEVIN HAYDEN & ROB HENKEN

35. MHCP: IMPROVE HEALTH CARE FOR THE UNDERSERVED POPULATIONS IN MILWAUKEE COUNTY 36

36. GOALS: COVERAGE FOR ALL ACCESS TO PROVIDERS AND SERVICES ENHANCE CARE COORDINATION SYSTEM-WIDE PROMOTE HEALTH AND WELLNESS IMPROVE COST EFFECTIVENESS OF CARE FOR UNINSURED AND UNDERINSURED INDIVIDUALS

37. OPERATING DELIVERABLES FOR EDCCC Improve ED care coordination policies and procedures within and across the entire system of providers Community-wide triage and referral policies Decrease in non-emergent ED utilization Increase in assignment to primary care homes Implement IT LINKING PROJECT 37

38. IT LINKING PROJECT AND AZYXXI TECHNOLOGY PLATFORM TO INTEGRATE DATA FROM MULTIPLE DIVERSE HEALTH CARE IT SYSTEMS PRESENT MEDICAL INFORMATION TO ED CLINICIANS IN A USEFUL WAY 38

39. Gary NicolasVice President, Healthcare Portfolio, Technology Solutions Company

40. IT Considerations for EHR Gary V Nicolas

41. Build With A Blueprint • Standards Based • Not finalized, yet… • Start now, incorporate changes to standards based on adoption by the market place as they develop. • Flexibility • Realize there will be changes as adoption increases and standards are adapted • Scalability • Pick one or two players that are committed to growing • Interoperability • Build on Standards, Play by the Standards • Integration • Achieved through standards, get the theme? • Learn From Others • Partners Community Healthcare, Inc. (PCHI) • www.partners.org • NYC Health The Primary Care Information Project (PCIP) • www.nyc.gov/pcip

42. Four Stage Maturity Model Think Personal - Get Digital

43. Overview • Digitization – reduction of paper with unification and federation of all data across standards based platforms • Virtualization – providing tools and access for diagnosticians independent of location. Start digital, stay digital. • Collaboration – Efficiently connecting resources throughout the care delivery process and reducing variation so as to enhance service. Sharing the data will improve the quality of care • Personalization – enhancing the patient and family experience using electronic communities and support tools

44. Four Stage Model

45. Stage 1 - Digitization Trends and Illustrative Examples

46. Digitization Buying Trends…

47. The Evolution of the Visual EHR

48. Where Are We Headed With Visual Health Records? Source: Frost & Sullivan; HIMSS Analytics

49. …What About IT Architecture and Standards?

50. Interoperability Standards Become Mature Gartners’ Hype cycle for Healthcare Provider Technologies – 7/2006