Developing State and Regional-Level Health Information Exchange Breakout Session

1. Developing State and Regional-Level Health Information ExchangeBreakout Session Hugh Zettel, GE Healthcare Ed Barthell, NIMI Denise Webb, WI DHFS

2. Today’s Session • National HIE Landscape • National Activities and Impacts • State-Level HIE • Planning & Design Project • Regional HIE in Wisconsin • Emergency Department Linking Project • Group Discussion Questions • Next Steps

3. National HIE Landscape • National HIT Agenda Completing Year 4 • American Health Information Community (AHIC) – Establish Use-case Priorities • 2005 – Establish Workgroup focus areas • 2006 – 3 Use-cases • 2007 – 4 Use-cases • 2008 – 6 Use-cases • AHIC mechanisms drive processes on Standards, Certification, Exchange, Policy

4. National HIE Landscape • Health Information Technology Standards Panel • Harmonizes standards and establishes interoperability specifications to implement AHIC use cases • Interoperability specifications comprised of “Transaction Packages” or building blocks that can be re-used • 2006 – 3 Use-cases  52 “recognized” standards • 2007 – 4 Use-cases  60 “accepted” standards • 2008 – 6 Use-cases  102 “data exchange requests” • Interoperability specifications based on existing standards & Frameworks such as Integrating the Healthcare Enterprise (IHE)

5. National HIE Landscape • Nationwide Health Information Network • Phase 1 – Four contracts, three geographies/contract to show HIE • Phase 2 – Begin to incorporate AHIC use-cases and use of HITSP specifications in a trial implementation • Five Federal agencies • 15 health information exchanges (state, regional) • Testing in September 2008

6. National HIE Landscape • Marketplace Diffusion of HITSP Standards • Executive Order 13410 – use of standards for entities contracting with Federal Government • DoD, VA, Insurance carriers • Stark EHR donations • EHR Certification • 2008 CCHIT Ambulatory and Inpatient EHR Interoperability Requirements • CCHIT for Networks to begin later this year • Seven States link HITSP/ CCHIT to EHR Legislation

7. National HIE Landscape • HIE Evolution • eHI 4th Annual Survey reports 130 initiatives…Sustainability the major challenge • Efforts to address governance, security&privacy policies increasing – led by state HISPC efforts • “Below the radar” HIE efforts growing • Use of HITSP standards, Registry/Repository model for IDN build-outs, especially Stark EHR • Provider RFP’s include HITSP, CCHIT language

8. State-Level HIE: Planning and Design • Stakeholder Assessment and Environmental Scan • Inventory and assess statewide public and private technical assets and resources for use in state-level HIE • Select and prioritize business use cases for HIE • Propose feasible business and technical architecture options for state-level HIE in Wisconsin • Develop detailed business and technical plans for state-level Wisconsin HIE option selected and approved by eHealth Board • Inform and educate Wisconsin HIE stakeholders on current market and capabilities of commercially available HIE solutions and products

9. Regional HIE in Wisconsin • Emergency Department Linking Project • Overview & Current Status • Results and Lessons Learned • Opportunities

10. WHIE: History • Formation Fall 2005 – EHI funded • Business Plan delivered to EHI Dec 2006 • Governance, Functional Priorities, Financial Models • Funding raised for ED Linking early 2007 • Project start June 2007

12. WHIE: Southeast Wisconsin Statistics Population of WI – 5,609,705 (2006) Population 9 counties (2006) – 2,198,037 Population 65+ - 275,355 (12.4%) Projected ED visits annually 834,356 Projected ambulatory visits – 6,973,106 12

13. Friday, February 1, 2008 Health system consolidation has Milwaukee doctors losing power The Business Journal of Milwaukee - by Elizabeth Sanders Advanced Healthcare and Aurora Health Care agree to form broad new alliance to improve care July 31, 2007 http://www.ah.com/Article.asp?Doc=327 Dr. Lowell Keppel . . . “There’s a lot of potential to use technology to gain economies of scale and really help with the health care quality and cost issues.” Milwaukee Business Journal More health care consolidation in 2008 - SynergyHealth to announce partner soon Small BizTimes 1/25/08 Press Release - Medical Associates to Join ProHealth Care November 11, 2007 http://www.prohealthcare.org/OPage.asp?PageID=OTH000606

14. Friday, February 1, 2008 Health system consolidation has Milwaukee doctors losing power The Business Journal of Milwaukee - by Elizabeth Sanders Advanced Healthcare and Aurora Health Care agree to form broad new alliance to improve care July 31, 2007 http://www.ah.com/Article.asp?Doc=327 Milwaukee County – Four major health systems Nine County Area – Six major health systems Dr. Lowell Keppel . . . “There’s a lot of potential to use technology to gain economies of scale and really help with the health care quality and cost issues.” Milwaukee Business Journal More health care consolidation in 2008 - SynergyHealth to announce partner soon Small BizTimes 1/25/08 Press Release - Medical Associates to Join ProHealth Care November 11, 2007 http://www.prohealthcare.org/OPage.asp?PageID=OTH000606

15. WHIE: Focus Overall Goal – right data available at right time Specific New Behavior – retrieve and review regional data on every visit, update regional data as a result of the visit.

16. What is the Value Proposition that is supported by this new behavior? Clinician – helps me to deliver better care Patient – helps me to receive better care Payer – helps me to save money (maybe enough that I can share some with clinician and patient)

17. ED Linking Project • Conceived by committee led by WHA • Supported by hospital systems • - Milwaukee Health Care Partnership • Funded by State of WI DHFS • Technical services by Microsoft • Evaluation by MCW and UW-Madison

18. Integration through “interfaces” The Amalga database is built from the standard feeds of existing data sources (an “Azyxxi Interface”) Amalga Parsing Scripts are created for each Amalga Interface The implementation process helps define: Define how and where you’ll use Azyxxi to define desired Interfaces What specific questions will you answer? Who will be using it? What data sources are required? 1 A B C 2 A B C 3 A B C 1 A B C 2 A B C 3 A B C 1 A B C 2 A B C 3 A B C • Flexible, “cellular” data structure • Data is divided into multiple components, clearly identifiable within each transaction • Data can be re-organized into unlimited buckets to answer an unlimited number of queries • Search is fast because it does not require scrolling through thousands of transactions to source the data. “GET” DATA “STORE” DATA “SHOW ” DATA 1A 1B 1C 2A 2B 2C 3A 3B 3C Amalga Parsing Engine User-Customizable Queries for Data Retrieval

19. WHIE Blended Architecture Data Feeds Clin1 Clin2 Clin3 StMary Sinai StFran HospN MCaid PayrN A B C D E F Clin4 Clin5 Clinic Hosting Ctr Amalga message queue, parsing, metadata tagging, record matching Hosted Data Store G Amalga application server, authentication, response to queries, audit trail H I J StMary Sinai StFran HospN MCaid PayrN Clinics Data Views K L Public Health Maint Audit

20. Emergency Department Linking Project • Initial challenge • Get on the priority list • Management, legal, technical, clinical

21. ED Linking Project: • Initial Lessons Learned • Importance of Expectation Management • Challenge of Culture Change

22. http://www.annemergmed.com/article/S0196-0644(07)01178-X/abstracthttp://www.annemergmed.com/article/S0196-0644(07)01178-X/abstract Milwaukee Health Care Partnership • WHIE as enabling technology • Care Plans opportunity

23. WHIE Sustainability Plan - ED Linking Use Existing Payment System Encounter Based Scale Spread Benefits Across Value Chain

24. Next Steps • Medicaid Data • Public Health • Addition of next Phase data sharing sites • Addition of clinics data use and data sharing • Expansion to wider geography • Collaboration with others statewide

25. Make no little plans; they have no magic to stir men's blood and probably will themselves not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will not die. • Daniel Burnham, Architect Union Station

26. Group Discussion Questions • What should be the role(s) of a state-level HIE entity? What aspects of health information exchange are most important to focus on at a state-level? What will provide the most value and support to regional and local-level HIE efforts? • What form of legal entity should govern state-level HIE and what is the best strategy for forming this organization? What are the most important steps to take in establishing state-level HIE governance? What role should Wisconsin state government play in this state-level entity?

27. Group Discussion Questions • What existing statewide (public or private) assets or resources should be considered for state-level HIE and a statewide HIE infrastructure that would help connect the state-level HIE to regional/local HIEs in Wisconsin and to the Nationwide Health Information Network? • What are the most significant barriers or challenges to state-level HIE? How should we deal with these barriers or challenges?

28. Group Discussion Questions • Who should pay for the services provided by a state-level HIE organization and why? What are some strategies for convincing HIE stakeholders to participate financially in the start-up costs and long-term sustainability of a state-level HIE initiative? • How should we measure the value and impact of the services a state-level HIE would provide? • Other questions/discussion.

29. Next Steps • Share key points/themes with conference attendees • Launch state-level HIE planning and design project • Seek stakeholder input through “just-in-time” workgroups and meetings

30. For More Information Please Contact: Denise Webb WI DHFS Denise.Webb@wisconsin.gov WI eHealth Care Quality and Patient Safety Board http://ehealthboard.dhfs.wisconsin.gov/