Minnesota e-Health Initiative Regional and Cross-Border Considerations in eHealth

1. Minnesota e-Health InitiativeRegional and Cross-Border Considerations in eHealth Wisconsin eHealth Implementation Summit March 15th, 2007 – Madison Wisconsin Marty LaVenture, MPH, PhD, Director, Center for Health Informatics Minnesota Department of Health

2. Cross-Border Considerations Providing Strategic Leadership Protecting Communities, Public Health Ensuring Privacy and Security Enabling Exchange Leveraging Funding and Incentives MDH - Minnesota e-health initiative

3. Wisconsin/Minnesota Border Context • 27 Counties border • ~ 1.5 Million Citizens • 3 Large City Areas • ~ 4 emerging RHIO’s • ~165 Clinics • ~26 Hospitals • Plus LTC, Public Health, Home Care agencies and more MDH - Minnesota e-health initiative

4. Minnesota e-Heath: A Summary of Key Milestones 2003: Governor’s Health Cabinet established 2004: E-Health Records Work Group • Report to Legislature, January 2005, outlines vision and roadmap for strategic action 2005: MN e-Health Advisory Committee • 4 year commitment of statewide leadership 2006: Governor Proposed $12 Million in matching grants. Legislature Funded $1.5 Million for 2006. 2007 and Beyond:Continued work and progress MDH - Minnesota e-health initiative

5. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

6. Strategic Leadership: MN e-Health Advisory Committee Co-Chairs: Mary Brainerd, Mary Wellik • Members Representing • Hospitals * Health plans • Physicians * Primary Care • Nurses * Purchasers (Public and Private) • Long Term Care * Academic/Research • Pharmacies * Public health (Local and State) • Citizens * Labs • Quality improvement Organization • Other Experts (5) MDH - Minnesota e-health initiative

7. Strategic Leadership Strategic Leadership Includes… • Clear Vision and Scope • Road Map for Action • Help Focus and Set Priorities • Public Funding and Policy • Assess, Evaluate and Monitor Progress MDH - Minnesota e-health initiative

8. 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.” Source: Committee Report to the Legislature, January 2005 MDH - Minnesota e-health initiative

9. Minnesota e-Health Focus • Empower Consumers with the information they need to make informed health decisions • Inform and Connect Healthcare Workers so they have access to the information they need. • Protect Communities with accessible prevention resources, and rapid detection and response to community health threats. • Ensure Infrastructure needed to fulfill the e-Health vision MDH - Minnesota e-health initiative

10. Examples of Some 45+ Projects Emerging Statewide • Informatics Education • St. Scholastica • University of MN • Exchange Projects • MnHCC – Statewide coordination • CHIC/SISU – Northeast MN • Shared Abstract: (AHRQ grant) • MIIC – Immunization registry • Medications – e-prescribing through the HIPAA Collaborative • Winona community exchange project • Itasca County Health Network • Community Collaborative Grants (3) • Personal Health Records • Fairview • HealthPartners • Children’s Hosp • Willmar Project • Public Health • MN PHIN • Fast Forward • EHR Adoption/Use • DOQ-IT Project • Grants Program • Telehealth • University of MN

11. Stratis Health Primary Care Clinic Survey MDH - Minnesota e-health initiative

12. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

13. Minnesota e-Health and MN-PHIN Interoperability and Health Information Exchange MN Public Health Information Network (MN-PHIN) – improving State-Local effectiveness & efficiency MDH - Minnesota e-health initiative

14. Public Health Data to Inform Clinical PracticeExample: Influenza ELR Surveillance Provides Clinical Care Decision Support (Diagnosis and Treatment) Decision Support Public Health Clinical Care Surveillance ELR Adapted from: Larry Hanrahan PhD MS, Wisconsin division of Health

15. Why do we need MN-PHIN? • Limited ability to electronically exchange data with community partners (e.g., providers, hospitals, LTC, jails). • Inability to consolidate data for comprehensive view of community/ population health • Silo information systems; little interoperability • Inefficient/sub-optimal client services because of fragmented data MDH - Minnesota e-health initiative

16. The Frustrations and Dreams of Local Staff Day-long interviews with eleven agencies highlighted areas MN-PHIN needs to focus on to break down silos. MDH - Minnesota e-health initiative

17. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward Privacy & Security 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

18. Privacy Barriers to HIEs • Implementation of Minnesota’s Patient Consent Requirements • Patient consent required for nearly all disclosures of health records – including treatment • Patients need to give written consent • Consent generally expires within one year • Limited exceptions to consent • Medical emergency • Within “related health care entities • Consents that do not expire • Disclosures to providers being consulted • Disclosures to payers for payment MDH - Minnesota e-health initiative

19. Patient Consent - Variations and Barriers • Minnesota’s patient consent requirements cause a barrier to the electronic exchange of health information because: • Health care providers cannot agree on “when” and “how” patient is required to exchange patients’ health information • Minnesota’s requirements were designed for paper-based exchanges and are not conducive to a real-time, automated electronic exchange MDH - Minnesota e-health initiative

20. Legislative Solutions • 10 Statutory Modifications for Legislative Consideration • Clarify undefined terms and ambiguous concepts: • Define “Health Record” • Define “Medical Emergency” • Define “Related Health Care Entity” • Clarify “Current Treatment” • Apply consent requirements to new concepts: • Introduce and define “Record Locator Service” • Introduce and define “Identifying Information” • Apply consent requirements to a Record Locator Service MDH - Minnesota e-health initiative

21. Legislative Solutions (cont) • 10 Statutory Modifications for Legislative Consideration • Update mechanisms that facilitate the electronic exchange: • Create ability of a provider to rely on another provider’s representation of having obtained consent • Develop a legal framework for allocating liability between disclosing and requesting providers • Permit representation of consent to be transmitted electronically when requesting patient information • Recodify Minnesota’s patient consent statutes to make the requirements easier to understand for patients and health care providers MDH - Minnesota e-health initiative

22. Security: 4As: What Are They? • Authorizing individuals to access patient data • Authenticating individuals when accessing patient data • Setting Access controls to appropriately limit authorized individuals’ access to patient data • Coordinating Auditing activities across organizations to assure patient data has not been inappropriately accessed MDH - Minnesota e-health initiative

23. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward Privacy & Security Exchange: Mn Health Care Connection 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

24. Interoperability is More than Wires MDH - Minnesota e-health initiative

25. Minnesota Health Care Connection MDH - Minnesota e-health initiative

26. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward Privacy & Security Exchange: Mn Health Care Connection Funding & Incentives: 12 Grants 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

27. Minnesota E-Health Grant Program • 2006: $1.5 million in one time grants • Matching Grants to Communities for interoperable EHR • Focus is on rural providers and underserved areas of the state. • 2007 Governors $29.5M Proposed e-Health Grants Initiative MDH - Minnesota e-health initiative

28. Key Projects Initiated(Policy – Funding – Implementation) Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward Privacy & Security Exchange: Mn Health Care Connection Funding & Incentives: 12 Grants More…. 04 05 06 07 08 09 10 11 12 MDH - Minnesota e-health initiative Years

29. Opportunities for Collaborative Action • Metrics / Assessment • Catalogue our border issues • Action plans for common projects • Modernizing Disease outbreak systems MDH - Minnesota e-health initiative

30. Opportunities for Action (continued) • Collaborate model consent forms • Collaborate on consumer information material • Develop model practices for security • Develop action plans for common projects • Collaborate model for value proposition MDH - Minnesota e-health initiative

31. Thank You! Key Contacts for More Information: www.health.state.mn.us/ehealth • Minnesota Department of Health Marty LaVenture, PhD– Director of Health Informatics 651 201-5950 martin.laventure@health.state.mn.us Bill Brand– Deputy Director, Health Informatics 651-201-5508 bill.brand@health.state.mn.us MDH - Minnesota e-health initiative