EHealth Initiatives in Wisconsin Electronic Healthcare Bringing it Home

1. 1 eHealth Initiatives in Wisconsin � Electronic HealthcareBringing it Home Seth Foldy, MD, MPH, FAAFP Medical College of Wisconsin Susan Wood eHealth Chief of Staff Department of Health and Family Services HIPAA COW Conference September 29, 2006

2. 2 Issues for Discussion Governor Doyle�s Executive Order creating the eHealthcare Quality and Patient Safety Board Health Information Security and Privacy Collaboration Fit with National Health Information Technology Priorities Fit with Current Health Information Initiatives in our State Significance for Wisconsin

3. 3 Governor Doyle�s Executive Order Purpose - to improve the quality and safety of health care in Wisconsin It creates a permanent eHealth Care Quality and Patient Safety Board This Board will develop a plan for statewide use of electronic health records and exchange of information from these systems This initiative is a key component of the Governor�s Affordability Agenda � working to improve access and quality in our health care system and to address the economic impact of the current health care system

4. 4 A Public � Private Enterprise The eHealth Board has 13 private sector and 7 public sector members Chair is the Health Secretary in the Governor� s Cabinet The current role for government is to convene stakeholders, develop consensus on principles and standards, staff planning efforts, and represent the interests of public health and public sector purchasers A wide range of private sector stakeholders are working to develop the Action Plan

5. 5 Five Year Action Plan The eHealth Board created five work groups to develop components of the plan: Patient Care Information Exchange Consumer Interests Governance Finance The Action Plan will be submitted to the Governor in December 2006 with recommendations to: achieve statewide use of electronic health records and decision support systems at the point of patient care; and provide a means for timely and appropriate exchange of data across medical settings

6. 6

7. 7 Progress Report Four work groups made preliminary reports to the eHealth Board August 3, 2006 The Governance group began meeting in August Wonderful ideas and energy from work group participants Commitment to transparency and engaging stakeholders See all reports at the eHealth Board web site: http://ehealthboard.dhfs.wisconsin.gov/

8. 8 Health Information Security and Privacy Collaboration RTI awarded contracts awarded to 30+ states May 2006 Wisconsin�s proposal integrates work on the �Privacy Project� with the structure and processes being created for the eHealth Board Wisconsin is eligible to receive the maximum funding per state of $350,000. The funds will be used for staff costs in DHFS, for contractors to support these work activities and related meeting expenses Staffing: About 12 people working part time on this project, staffing the four work groups required by the contract

9. 9 Privacy ProjectExpectations Assess variations in organization-level business policies and state laws that affect health information exchange in the state Work closely with RTI, the National Governor�s Association and other states to exchange information and experiences regarding interoperable health information exchange barriers and best practices Identify and propose practical solutions that protect privacy and security of health information and permit interoperable health information exchange;

10. 10 Expectations (con�t.) Develop plans to implement solutions in the state and, if applicable, at the federal level. Each state is also expected to work with health care professionals, patients and others to address privacy and security issues and identify solutions for broad application; and to manage the project according to RTI requirements. The issues raised and solutions identified will set out a road map for Wisconsin in terms of eliminating barriers to health information exchange and provide a foundation for future work by the national agencies and facilitate health information exchange across the states

11. 11 eHealth and the Privacy Project �One of the strongest early lessons we�re learning from our research on electronic health information is that some of the main challenges for adoption are not technical issues. Rather they are issues of inclusion and trust. This work on privacy and security will leave an indelible mark on the ultimate formulation of a national health information network.� Dr. Carolyn M. Clancy, Director of the Agency for Healthcare Quality and Research, announcing the grant awards

12. 12 eHealth and Privacy Project As part of its charge the Board is expected to �identify options for serving consumer health information needs and insuring health information privacy and security in electronic health information exchange� as it develops the Wisconsin Action Plan for Health Care Quality and Patient Safety. The Wisconsin eHealth Board will serve as the Steering Committee for the HIPSC project - overseeing the activities of multiple working teams and linking their work with other key organizations � especially HIPAA COW.

13. 13

14. 14 Where are we now? National context The Wisconsin eHealth Action Plan process Future vision Discussion

15. 15 Motivation: Poor Access to Health Information 40% of outpatient prescriptions unnecessary 20% of lab & x-ray tests ordered because originals can not be found 18% medical errors from inadequate patient information. Patients get only 54.9% of recommended care 49% of notifiable diseases reported - B. Middleton PHIN 2005 Conference

16. 16 Motivation � The Unsustainable Cost of Health Care $1.8 Trillion / Yr 15% of GDP ~ 2X OECD Median (8.5%) 18.7% GDP in 2014 Medicare�s Projected Deficit $27 Trillion (7x SS) Unsustainable Growth � Doubles Every 10 Years - Health Spending Projections Office of the Actuary, CMS J Health Affairs 2005 -Health Spending in the US and the rest of the Industrialized World. J Health Affairs 2005

17. 17 Public Health Improvement Needs Linking clinical and community-based prevention is needed more than ever: Wisconsin�s national health ranking dropped to 13th (from 9th in 2004) reflecting obesity, ? child poverty. Since 1990 the prevalence of obesity soared by 105% - from 11.3% to 23.2% of the population Wisconsin�s infant mortality rate was substantially worse for minorities Our state ranked 23rd for cardiovascular deaths and 23rd for total mortality. Challenges of early outbreak detection, disaster management, efficiency of public health case management, and uptake of public services Source: America�s Health Rankings for 2005, United Health Foundation

18. 18 Annual costs of paper-shuffling in SE Wisconsin - $668 million, up to 900 lives

19. 19 Consumers Want Health IT

20. 20 Office of the National Coordinator for Health IT Established by Executive Order 13335 (April 27, 2004) Responsible for realizing the President�s vision of Health IT: Widespread adoption of interoperable EHR within 10 years Medical information follows the consumer Clinicians have complete, computerized patient information Quality initiatives measure performance and drive quality-based competition Public health and bioterrorism surveillance are seamlessly integrated into care Decade of Health Information Technology: Delivering Consumer-centric and Information-Rich Health Care

21. 21 US DHHS 10 Year Priorities

22. 22

23. 23 Aug. 8 2006 Stark Safe Harbor Stark Act exception rules to permit donations of electronic prescribing and EMR technology Such donations must include interoperability Issued by HHS CMS and OIG May be superceded by legislation

24. 24 Executive Order Aug. 22, 2006 Federal health care programs (excl. Medicaid) use interoperability standards in own systems Federal contractors ordered to use interoperability standards Transparency of agencies and contractors in quality measurements & reporting Transparency in prices Implement quality & efficiency improvement including pay for performance

25. 25 Meanwhile, back in Wisconsin�

26. 26

27. 27 What Are HIT versus HIE?

28. 28 HIE & HIT Perspectives

29. 29 HIE and HIT Perspectives (cont�d) 

30. 30 What Is A RHIO?Regional Health Information Organization Non-Profit - Public / Private Electronic Health Record Data Exchange Clinical Records Shared (Across Provider Systems) to Facilitate Care

31. 31 What is a Medical Trading Area?

32. 32 The Road Map Governor Doyle has asked the eHealth Board to identify: existing eHealth resources including funding to support the development of a statewide eHealth information infrastructure technology options options for serving consumer health information needs how best to insure privacy and security in electronic health information exchange how to facilitate statewide adoption of EHR standards to enable statewide and national exchange how best to create organizational and governance structures for a statewide eHealth information infrastructure

33. 33 Some draft ideas� Encourage regional exchanges supported by statewide Standards Incentives Policy Infrastructure Economies of scale

34. 34 Regional Exchanges Can Develop: Electronic result and document delivery Improved information access Reduced info mgmt. costs Improved collaboration Improved reporting of public health conditions Improved communication with and between clinical partners

35. 35 Patient-centric (cross-organization) Visit and diagnosis lists Med, immunization and allergy lists Test and result summaries Support Better care coordination Better disease management Reduced redundant costs Improved care quality and safety Early outbreak detection and disaster resource management Regional Exchanges Can Develop:

36. 36

37. 37 Sample Recommendations Vendor agnostic Use emerging national standards for interoperability Enable patient access and management of personal health information Incentivize, aid HIT implementation Reduce restrictions on data exchange between treating clinicians

38. 38 Sample Recommendations Enable public health-oriented decision support Patient-entered registration module Distribute costs and benefits among stakeholders Avoid �rip & replace� Maintain existing data ownership

39. 39 Inventory of HIT/HIE in Wisconsin The Governor�s Executive Order requires an annual assessment of the adoption of health information technology by Wisconsin healthcare providers Ambulatory survey MetaStar and Seth Foldy collaborating Survey of ambulatory practices, EDs, Outpatient Clinic EMR use To be repeated annually, comparable to national statistics Inpatient survey Rural Wisconsin Health Cooperative and Gunderson Lutheran and Seth Foldy collaborating Interview survey of hospital systems Work toward annual survey with WHA in future Health Information Exchange efforts inventory MetaStar and Seth Foldy collaborating

40. 40 WI Health Information Exchange (WHIE) Governance Early funding User management pilot Business plan Draft agreements Projects Emergency Department sharing Results delivery Medication list

41. 41 RHIO Development South Central WisconsinHealth Information Data Exchange

42. 42 Mapping Initiatives & Converging Agendas Work planned 2007-2011 coinciding with eHealth Action Plan 20+ initiatives Includes: Wisconsin Healthcare Quality Collaborative Public Health Information Network WEDSS electronic disease reporting Child health systems Wisconsin Health Information Organization Wisconsin Immunization Registry and RECIN PeriData Statewide Perinatal Database Safety Collaboratives Biosense Region 7 EMSystem Wisconsin Medical Society unified credentialing This will be part of the eHealth Report

43. 43 What�s next? The report from the eHealth Board will go to the Governor December 1, 2006 Once approved, implementation will begin eHealth Board will sponsor an Implementation Summit at the Fluno Center in March 2007 Privacy Project will continue through March 2007 to complete all of its work. How to track and influence developments Participate in the HISPC work groups Communicate your interests to the work group leaders Monitor developments and react to proposals via the eHealth board web site: http://ehealthboard.dhfs.wisconsin,gov

44. 44 Thank you! Seth Foldy sfoldy@sbcglobal.net Susan Wood woodss@dhfs.state.wi.us Collaborators: UW Population Health Institute, MetaStar Funders: Wi DHFS, US-DHHS/ONC, Robert Wood Johnson Foundation, CDC, HRSA