regional health information exchange: getting there ed barthell – wisconsin health information...
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Regional Health Information Exchange: Getting There
Ed Barthell – Wisconsin Health Information Exchange
Hugh Zettel, GE Healthcare
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?
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/ ]
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
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
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)
Two Critical Challenges
1. Interoperability and portability of healthcare information
2. Encouraging electronic health record adoption
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
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
CommonPIX Server
XDS Registry
CrossCommunity
Bridge
DocumentConsumer
Meta-Community using existing IHE Profiles
XDS Registry
XDS Repository
Patient IdentitySource
Patient IdentitySource
Patient IdentitySource
(1) (1)(1)
(3)
(2)
XDS Registry
(4)
(4)
(4)
(5)
XDS RepositoryXDS Repository
(6) (6)
(6)
Meta-Community
Community A
Community B
Community C
eHealth Care Quality and Patient Safety Board 2007
eHealth BoardChair: Kevin Hayden
Patient Care Advisory Group
Chair: Ed Barthell
Consumer Interests and Privacy
Advisory GroupChair: Cathy
Hansen
Public Health Advisory Group
Chair: Bevan Baker
Statewide Health Information
Exchange Advisory Group
Chair: Hugh Zettel
Operations
Executive CommitteeChairs of the Board and advisory group
E Health Report to governor November 2006
Governor submits budgetFirst Quarter 2007
Legislature approves budget First half 2007
AN OPPORTUNITY TO LEAD
High profile
Local problems
Local talent
Technical infrastructure
Willing partners
Wisconsin HealthInformation
Exchange
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.
Organizational InfrastructureLegal agreementsProject Priorities - Pilots
PHASE ONE
PHASE TWO
PHASE THREE
PHASE FOUR
Organization Early OperationsPriority ProjectsEvaluation and ROI Definition
Organization Mature OperationsExpand Services and Participants$ PPM Model with ROI to Payors
Possible Secondary Data UsesExpanded Decision Support and Quality Tools
Govt funding, Grants
Dues
Payor funding or transaction fees
Potential funding from secondary data sales
Result and Document
Delivery System
Registration and Claims Repository
Clinical User Authentication and Auditing
Patient Record Location and Aggregation
Medication Allergy Immunization
Repository
Patient User Authentication and Auditing
Patient Pre - Registration
System
Patient Access to Medication
System
Clinician
Public Health
Patient
Actors
Sys Admin
Systems
Clinical Results Source System
s
Registration Systems
Claims System
s
PBM, Pharmacy Systems
Decision
Support System
s
Payor Care Mgt
WHIE ED Linking Project
HL7 Registration Message
WHIE ED Linking System Azyxxi
HIS HIS HIS HIS
Claims data
Clinical End UsersPublic Health Surveillance
Wisconsin Health Information ExchangeWisconsin Health Information Exchange
Stanikowski / Frank / N / 24yo / M / 12-03-81 / 312 Maple St / Milwaukee
AVAILABLE INFORMATION FOR:
Clear All Print Exit
Disclaimer language will be inserted here
SOUTHEAST WISCONSIN EMERGENCY DATA COORDINATION PROJ ECT
DIAGNOSES LOCATION CITY DATE
Diabetes Mellitus Mt. Sinai Hospital Emerg Dept Milwaukee 5-03-01Hypertension MLK Clinic Milwaukee 6-12-02Renal Insufficiency Columbia St. Mary’s FP Clinic Milwaukee 4-05-03
MEDICATIONS SCHEDULE PRESCRIBED BY DATE DATA SOURCE
Glyburide 10 mg po qd Dr. Anderson 5-03-01 Patient report HCTZ 50 mg po qd Dr. Smith 6-12-02 RxHub Pharmacy report
ALLERGIES REACTION NOTED BY DATE
NSAIDs Hives Dr. Anderson 5-03-01
CASE WORKER ASSIGNED
Ms Carolyn Jones Office Phone 414-290-5555 Pager 414-555-9090 After Hrs 414-444-7777
SPECIAL NEEDS / COMMENTS
Patient is not able to read English. Care coordinated by aunt – Ms. Jane Parker Phone 414-222-6666
Authorized Referral Physicians
PRIMARY PROVIDER ASSIGNED
Dr. Sam Adams Office Phone 414-290-5555 Pager 414-555-9090 After Hrs 414-444-777713111 N. Main Stree Miwaukee 53211
Immunization Information Results Reporting