Regional Health Information Exchange: Getting There

1. Regional Health Information Exchange: Getting There Ed Barthell – Wisconsin Health Information Exchange Hugh Zettel, GE Healthcare

2. Questions • What are RHIOs? • Why RHIOs? • What are clinical drivers for RHIOs in WI? • What must happen to permit exchange? • What should we be preparing to do?

3. Medical Trading Areas

4. US Administration’s Cornerstones for Care • Connecting the System: Every medical provider has some system for health records. Increasingly, those systems are electronic. Standards need to be identified so all health information systems can quickly and securely communicate and exchange data. • Measure and Publish Quality: Every case, every procedure, has an outcome. Some are better than others. To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care. • Measure and Publish Price: Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each “episode of care.” • Create Positive Incentives: All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-price health care. [http://dhhs.gov/transparency/ ]

5. WI 5 Year Pathway • Create eHealth technology platform • Increase HIT adoption and use • Foster regional Health Information Exchange • Establish statewide services • Value-based healthcare purchasing • Enhance prevention and disease management

6. WI Assets & Readiness • At least 17 operational projects exchanging personal health information electronically, with 11 more planned • Almost 70% of practice sites have at least partially electronic records BUT • No common data standards • No common patient index

7. LEAPING INTO THE FUTURE THE WISCONSIN HEALTH INFORMATION EXCHANGE

8. April 27, 2004 Executive Order 13335 Commitment to the promotion of health information technology to improve efficiency, reduce medical errors, improve quality of care, and provide better information for patients and physicians. Widespread adoption of interoperable electronic health records (EHRs) within 10 years so that health information will follow patients throughout their care in a seamless and secure manner. Establishment of Office of National Coordinator for Health Information Technology (ONC)

9. Two Critical Challenges • Interoperability and portability of healthcare information • Encouraging electronic health record adoption

10. HHS - ONC Contracts • Standards harmonization – HITSP • Interoperability specs this fall • Compliance certification – CCHIT • EHRs and infrastructure components • National architecture – NHIN (four) • Prototypes for interoperability • Security and privacy – RTI International • Wisconsin participating

11. Interoperability showcase - HIMSS07 in New Orleans. 60 organizations demonstrating interoperability in a clinical workflow. Based on Integrating the Healthcare Enterprise (IHE) implementation guides. www.himss.org

12. Meta-Community using existing IHE Profiles Meta-Community Common PIX Server Community B (1) (1) Patient Identity Source (1) (3) XDS Registry Community A Cross Community Bridge Patient Identity Source (4) XDS Repository (4) (4) XDS Registry Community C Patient Identity Source (2) (6) (5) XDS Registry XDS Repository Document Consumer XDS Repository (6) (6)

14. eHealth Care Quality and Patient Safety Board 2007

15. E Health Report to governor November 2006 Governor submits budget First Quarter 2007 Legislature approves budget First half 2007

17. Wisconsin Health Information Exchange AN OPPORTUNITY TO LEAD High profile Local problems Local talent Technical infrastructure Willing partners

18. WHIE Business Plan The value proposition: The benefits obtained from the exchange of clinical information across institutional boundaries exceed the costs of implementing the exchange.

19. Organizational Infrastructure Legal agreements Project Priorities - Pilots PHASE ONE Govt funding, Grants Dues Organization Early Operations Priority Projects Evaluation and ROI Definition PHASE TWO Payor funding or transaction fees Organization Mature Operations Expand Services and Participants $ PPM Model with ROI to Payors PHASE THREE Potential funding from secondary data sales Possible Secondary Data Uses Expanded Decision Support and Quality Tools PHASE FOUR

20. Actors Systems Clinical User Authentication and Auditing Clinical Results Source Systems Sys Admin Result and Document Delivery System Patient Record Location and Aggregation Clinician Registration Systems Registration and Claims Repository Claims Systems Public Health Medication Allergy Immunization Repository PBM, Pharmacy Systems Patient User Authentication and Auditing Payor Care Mgt Patient Pre - Registration System Decision Support Systems Patient Patient Access to Medication System

21. WHIE ED LinkingProject HIS HIS HIS HIS HL7 Registration Message Claims data WHIE ED Linking System Azyxxi Public Health Surveillance Clinical End Users

25. Wisconsin Health Information Exchange

26. QUESTIONS ??