Wisconsin ehealth initiative
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Wisconsin eHealth Initiative. Presenters: Denise Webb, eHealth Program Mgr Tim Bartholow, MD, Prairie Clinic Partner October 17, 2008. Wisconsin eHealth Overview. Background Health Information Technology (HIT) Adoption Health Information Exchange (HIE) Health Information Privacy

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Wisconsin ehealth initiative

Wisconsin eHealth Initiative

Presenters:

Denise Webb, eHealth Program Mgr

Tim Bartholow, MD, Prairie Clinic Partner

October 17, 2008


Wisconsin ehealth overview
Wisconsin eHealth Overview

  • Background

  • Health Information Technology (HIT) Adoption

  • Health Information Exchange (HIE)

  • Health Information Privacy

  • Health Care Transparency and Public Reporting

Protecting and promoting the health and safety of the people of Wisconsin


Background executive order 129
Background: Executive Order 129

  • Issued by Governor Jim Doyle, Nov 2005

  • Created eHealth Care Quality and Patient Safety Board

  • Directed Board to:

    • Develop and implement a 5-year Action Plan

    • Annually assess HIT adoption rate by Wisconsin heath care providers

    • Annually report on Board’s plans, activities, accomplishments, and recommendations

Protecting and promoting the health and safety of the people of Wisconsin


Background ehealth goals
Background: eHealth Goals

  • Make health information available at point of care for all patients

  • Prevent medical errors

  • Avoid redundant, unnecessary medical procedures

  • Improve coordination of care

  • Promote wellness and prevention

  • Track and manage chronic disease

  • Early detection of infectious disease outbreaks

  • Further health care research

  • Engage and enable consumers to effectively participate in their health care decisions

  • Control health care costs

  • Measure and publically report on health care quality, safety, and efficiency

Protecting and promoting the health and safety of the people of Wisconsin


Background ehealth board 2006 workgroup structure
Background: eHealth Board 2006 Workgroup Structure

Protecting and promoting the health and safety of the people of Wisconsin


Background ehealth action plan
Background: eHealth Action Plan

  • Public-private collaboration for widespread adoption and use of HIT and HIE

  • Support for acquisition and use of EHR by small provider groups and safety-net providers

  • Creation of a business and technical architecture for HIE, including a state-level HIE organizational and governance structure

  • Updating provisions for security and privacy

  • Link HIT and HIE to population health improvement

Protecting and promoting the health and safety of the people of Wisconsin


Background key ehealth activities thru 2008
Background: Key eHealth Activities thru 2008

  • Developed and delivered the 5-year eHealth Action Plan to Governor Doyle

  • Completed two annual WI HIT surveys

  • Completed a health information security and privacy collaboration project, resulting in legislation to revise Wisconsin’s health information privacy laws

  • Developing regional and state-level HIE

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption and use
HIT Adoption and Use

  • Goal: Achieve 100% adoption and use of certified EMR systems and other HIT by Wisconsin health care providers

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption and use benefits
HIT Adoption and Use—Benefits

  • Quality

    • Reminds physicians about appropriate preventive care

    • Indentifies harmful drug interactions or possible allergic reactions to prescribed medications

    • Helps physicians manage patients with complex chronic conditions

    • Can readily provide relevant health literature/handouts from the EMR system to the patient

    • Enables patients to interact with their physicians through the Internet

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption and use benefits1
HIT Adoption and Use—Benefits

  • Efficiency

    • Eliminates use of medical transcription

    • Eliminates or substantially reduces need to physically pull medical charts for office visits

    • Provider prompts to prescribe generic medications instead of costly brand names

    • Reduces the duplication of diagnostic tests

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption and use1
HIT Adoption and Use

How are we doing in Wisconsin?

Protecting and promoting the health and safety of the people of Wisconsin


Wi physician practice statistics
WI Physician Practice Statistics

Physician Distribution by Group Size

N=13,071

Source: WMS, Oct 08

N=13,071

Source: WMS, Oct 08

Protecting and promoting the health and safety of the people of Wisconsin


Major Health Care Systems

Marshfield Clinic

Affinity

Aspirus

Aurora

Dean

Douglas

Bayfield

Michigan

Gundersen

Iron

Mayo

Ashland

Vilas

Washburn

Ministry

Sawyer

Oakleaf

Florence

Burnett

Oneida

Forest

Prevea

Price

Rusk

Barron

St. Luke's

Minnesota

Polk

Lincoln

Marinette

St. Mary's

Langlade

Chippewa

Theda

Taylor

Menominee

Dunn

Oconto

UW Health

St. Croix

Shawano

Marathon

Door

Wheaton

Claire

Eau

r

Pie

ce

Waupaca

Pepin

Marshfield Clinic

Buffalo

X

X

Clark

Kewaunee

Outagamie

Laboratory Only

Wood

Brown

Portage

Jackson

Trempealeau

Calumet

Winnebago

Waushara

Manitowoc

Adams

Marquette

Crosse

La

Monroe

Sheboygan

Green

Juneau

Lake

Fond

Lac

du

Vernon

Ozaukee

Columbia

Richland

Sauk

Washington

Dodge

Crawford

Dane

Milwaukee

Iowa

X

X

Iowa

Jefferson

Grant

Waukesha

Walworth

Racine

Kenosha

Green

Rock

Lafayette

Data compiled by Ziegler Capital Markets Group in conjunction

with Systems & Processes Dept, December 2007


Wi ambulatory hit survey 2006 2007
WI Ambulatory HIT Survey, 2006-2007

Protecting and promoting the health and safety of the people of Wisconsin


Wi ambulatory hit survey 2006 20071
WI Ambulatory HIT Survey, 2006-2007

N=6,170 (47% of WI physicians)

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption conclusions
HIT Adoption Conclusions

  • Adoption rates are higher in larger WI practice sites

  • Overall adoption rates still low, especially in smaller group practices

  • EMR users in WI generally have a positive impression of the impact the EMR has on many aspects of their practice

  • Predominant barrier to adoption--economics

Protecting and promoting the health and safety of the people of Wisconsin


Hit adoption and use strategies
HIT Adoption and Use Strategies

  • Tax credits

  • Grants

  • Loans

  • Donations/underwriting

  • Consortia/shared services

  • Technical assistance—e.g.,MetaStar’s Doctor’s Office Quality-Information Technology (DOQ-IT)

  • Incentive payments—e.g. CMS EMR Demonstration

Protecting and promoting the health and safety of the people of Wisconsin


Hit consumer perspective
HIT – Consumer Perspective

  • Need for more education and marketing on electronic medical records and their benefits

  • Generational gap—cyber natives vs. cyber immigrants

Protecting and promoting the health and safety of the people of Wisconsin


Health information exchange hie
Health Information Exchange (HIE)

  • State-Level HIE

  • Regional Level HIE- Emergency Department (ED) Linking Project

Protecting and promoting the health and safety of the people of Wisconsin


Achieving sustainable hie industry in wisconsin
Achieving Sustainable HIE Industry in Wisconsin

  • Technology and Adoption:

    • Widespread HIT adoption

    • An interoperable architecture

    • Exchange of real-time or near real-time information

  • Business Models:

    • Sustainable business models

  • Governance and Oversight:

    • A governance body for electronic HIE

    • A management structure

    • Accountability structures

Protecting and promoting the health and safety of the people of Wisconsin


State level hie planning and design
State-Level HIE Planning and Design

  • Task #1—Stakeholder Assessment and Environmental Scan

  • Task #2—Inventory and assess statewide public and private technical assets and resources for use in state-level HIE

  • Task #3—Select and prioritize business use cases for HIE

  • Task #4—Propose feasible business and technical architecture options for state-level Wisconsin HIE

  • Task #5—Develop detailed business and technical plans for the state-level Wisconsin HIE option selected and approved by eHealth Board

  • Task #6—Inform and educate Wisconsin HIE stakeholders on current market and capabilities of commercially available HIE solutions and products

Protecting and promoting the health and safety of the people of Wisconsin


Regional level hie ed linking
Regional-Level HIE – ED Linking

  • Wisconsin Health Information Exchange (WHIE)—southeast Regional Health Information Organization (RHIO) covering nine counties

    • One-stop, regional health-information search network

    • Providing access initially to Milwaukee County’s 10 hospital ED’s, one Milwaukee Federally Qualified Health Center (FQHC), and three public health departments

    • Medicaid and hospital systems are funding first phase of community exchange

    • Microsoft is contributing development and hosting services

    • Base product—Microsoft Amalga

Protecting and promoting the health and safety of the people of Wisconsin


Ed linking workflow
ED Linking Workflow

  • Available data displayed on pick list for clinicians or support staff

  • Automatic regional query initiated by registration message

  • Returns patient summary info from both local hospital and outside facilities and Medicaid

    • Admission, Discharge, Transfer (ADT) data

    • Clinically-relevant Medicaid claims data

  • Review online or print to attach to paper chart

Protecting and promoting the health and safety of the people of Wisconsin


Ed linking status
ED Linking Status

  • The health information exchange is receiving live ADT data from 12 greater Milwaukee metro area hospitals and their associated service points/clinics

  • Live in three hospital ED’s and public health with ADT data only

  • Go live with Medicaid Data – Nov 2008

  • Evaluation being conducted by UW-Madison and Medical College of Wisconsin

  • ED physicians and public health response is positive

Protecting and promoting the health and safety of the people of Wisconsin


Health information privacy
Health Information Privacy

  • Privacy Legislation (enacted April 1, 2008)

    • WI Stat. 146, General Health Information

    • WI Stat. 51.30, Sensitive Health Information (eff. 10/1/08)

  • Health Information Security and Privacy Collaboration (Phase III project)

  • Continued analysis of state’s privacy policy

Protecting and promoting the health and safety of the people of Wisconsin


Health care transparency and public reporting
Health Care Transparency and Public Reporting

  • Measuring and publishing information on health care quality, safety, and efficiency

    • Wisconsin Collaborative for Healthcare Quality (WCHQ)

    • Wisconsin Hospital Association (WHA)

    • Wisconsin Health Information Organization (WHIO)

Protecting and promoting the health and safety of the people of Wisconsin



Wchq members

Affinity Health System

Aspirus Wausau Hospital

Aurora Advanced Healthcare

Aurora Health Care

Aurora UW Medical Group

Bellin Health

Columbia St. Mary's

Dean Health System

Franciscan Skemp Healthcare - Mayo Health System

Froedtert & Community Health

Gundersen Lutheran

Hospital Sisters Health System

LakeShore Medical Clinic

Luther Midelfort-Mayo Health System

Marshfield Clinic

Medical Associates Health Centers

Medical College of Wisconsin

Mercy Health System

Meriter Hospital

Monroe Clinic

Prevea Health

ProHealth Care

St. Joseph's Hospital

St. Marys Hospital Medical Center

ThedaCare

University of Wisconsin Hospital and Clinics

University of Wisconsin Medical Foundation

West Bend Clinic - Froedtert & Community Health

Wheaton Franciscan Healthcare

WCHQ Members

Protecting and promoting the health and safety of the people of Wisconsin


Wchq measures

Breast Cancer Screening

Cervical Cancer Screening

Colorectal Cancer Screening

Diabetes: Blood Sugar (A1c) Testing

Diabetes: Blood Sugar (A1c) Control

Diabetes: LDL Cholesterol Testing

Diabetes: LDL Cholesterol Control

Diabetes: Kidney Function Monitored

Diabetes: Kidney Function Monitored

Diabetes: Blood Pressure Control

Uncomplicated Hypertension: Blood Pressure Control

Cardiovascular Conditions: LDL Cholesterol Testing

Cardiovascular Conditions: LDL Cholesterol Control

Adults with Pneumococcal Vaccinations

Tobacco Use Screening

Postpartum Care

WCHQ Measures

Protecting and promoting the health and safety of the people of Wisconsin


Wisconsin hospital association wha
Wisconsin Hospital Association (WHA)

Protecting and promoting the health and safety of the people of Wisconsin


WHA

  • Voluntary statewide public reporting program

  • Reporting by 122 (or 98%) of Wisconsin hospitals on health care quality and safety

Protecting and promoting the health and safety of the people of Wisconsin


Public reporting on wi hospitals
Public Reporting on WI Hospitals

Protecting and promoting the health and safety of the people of Wisconsin


Wisconsin health information organization whio
Wisconsin Health Information Organization (WHIO)

  • Voluntary partnership of health care stakeholders

  • Membership is intentionally diverse to reflect the varied perspectives of the Wisconsin healthcare marketplace

  • Non-profit § 501(c)(3) organization

  • Formed to create a trusted data source with which to generate provider performance reports and perform other health care analytics

Protecting and promoting the health and safety of the people of Wisconsin


Goals of whio
Goals of WHIO

  • To aggregate health care data from sources across the State of Wisconsin to create a single reliable data source that can be used by multiple stakeholders to examine variations in efficiency, quality, safety, and cost

  • To improve the quality, cost, safety, and efficiency of Wisconsin health care by sharing the results with providers, purchasers and consumers

  • To support provider quality improvement initiatives

  • To empower consumers to make value-based health care choices

Protecting and promoting the health and safety of the people of Wisconsin


WHIO

  • Where does WHIO fit?

  • Who benefits from WHIO ?

  • Who participates in WHIO?

Protecting and promoting the health and safety of the people of Wisconsin


Whio s members

Anthem Blue Cross Blue Shield of Wisconsin

Greater Milwaukee Business Foundation on Health

Humana

Employers Health Care Alliance Cooperative

United Healthcare of Wisconsin

WEA Trust

WPS Health Insurance

The Wisconsin Collaborative for Healthcare Quality

Wisconsin Medical Society

Wisconsin Department of Health Services

Wisconsin Department of Employee Trust Funds

Wisconsin Hospital Association

Group Health Cooperative –South Central Wisconsin

WHIO’s Members

Protecting and promoting the health and safety of the people of Wisconsin


Whio data mart details
WHIO Data Mart Details

  • Initial feeds from Anthem BCBS, United Healthcare, Humana, WEA Trust and Wisconsin Physicians Service

    • 1.9 million members (fully insured and self funded)

    • 3 additional data sources (including Medicaid) will be added in 2009

  • 27 months of member and claim data

    • January 2006 through March 2008

  • De-identified Payor, Purchaser/Employer and Member information

  • Identified Provider Practice Group but not individual provider

  • Data Mart delivery (planned 12/08)

Protecting and promoting the health and safety of the people of Wisconsin


Whio data mart details cont
WHIO Data Mart Details (cont.)

  • Charged or billed amounts included in data

  • Ingenix’s Impact Intelligence software provides access to the data in the data mart

    • Software accessible via internet portal

    • Over 500 pre-programmed measures/analytics included

    • Data extracts are supported and accessible through Excel, SAS or Access.

Protecting and promoting the health and safety of the people of Wisconsin


Wisconsin ehealth summary
Wisconsin eHealth Summary

HIT + HIE = BETTER, SAFER, EFFICIENT CARE

Protecting and promoting the health and safety of the people of Wisconsin


Questions
QUESTIONS

Protecting and promoting the health and safety of the people of Wisconsin


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