Wisconsin’s eHealth Initiative and the ED Linking Project November 8, 2008 WI ACHE Webinar

Wisconsin’s eHealth Initiative and the ED Linking Project

November 8, 2008 WI ACHE Webinar

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866-365-4406

Pass code: 2741820

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AgendaSecretary Kevin Hayden – 10 minutes

o Brief overview of Wisconsin eHealth Initiativeo Implications for acute care providerso Health Information Exchange

Dr. Edward Barthell - ED Linking - 10 minutes

o Overview of Project/timelineo Physician’s responseo Clinical improvements

Bill Bazan – 10 minutes

o Competitive Challengeo Business case for connectivityo Equal Partnership/Change in Culture

Gary Nicolas – 10 minutes

o IT considerationso Flexibility - Interoperabilityo 4 steps toward Adoption

Q& A – 10 minutes

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Kevin R. HaydenSecretary of Wisconsin’s Department of Health and

Family Service

4A Discussion on Wisconsin’s

eHealth Initiative

Department of Health and Family Services

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Wisconsin's eHealth Initiative and the ED Linking Project

Kevin R. Hayden, Secretary

Department of Health and Family Services

http://ehealthboard.dhfs.wisconsin.gov/

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The eHealth Initiative Goal:

Successful implementation of a statewide health information exchange (HIE) system that is interoperable with the Nationwide Health Information Network (NHIN).

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eHealth Activities in DHFS: • Promote investment in adoption of electronic

medical records in health care settings to improve the quality, safety and value of health care;

• Promote investment in HIE to improve the quality, safety and value of health care;

• Assure patient privacy in the exchange of health information;

• Link HIT and HIE to public health, prevention and disease management activities;

• Collaborate with others; • Support the Governor's eHealth Care Quality

and Patient Safety Board.

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Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health

• Statistics: – Overall, about 77% of ambulatory practice sites have

electronic practice management systems (billing, scheduling, etc.) -- includes about 84% of practice sites in large systems and 57% of practice sites that are independent or part of small systems.

– 16 % of ambulatory practice sites have totally electronic patient records systems – includes 17% of practice sites in large systems and 11% of practice sites that are independent or part of small systems.

– 69% of ambulatory practice sites have some combination of paper and electronic patient records.

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Promote investment in adoption of electronic medical records in health care settings to improve the quality, safety and value of health cont.

• Medicaid Transformation Grant – Wisconsin Health Information Exchange

(WHIE) – ~ $3 million grant from DHFS through CMS

Medicaid Transformation grant• Value – Driven Health Care Initiative - - align

WI’s Medicaid program’s quality measurement strategies with WCHQ’s.

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Promote investment in HIE to improve the

quality safety and value of health care

Request for Proposal Development

Purpose: • To obtain consulting services and expertise for

state-level HIE assessment, planning, and architectural (business & technical) design;

• Promote the development of secure, trusted, technically compatible statewide HIE across public and private sectors.

11Assure patient privacy in the exchange of health information

• Allow disclosure without consent of the following information in 51.30 treatment record to all treating providers with a need to know: name, address, date of birth, name of mental health providers, dates of service, diagnosis, medications, allergies, other relevant demographic information and NEW – biometric diagnostics like lab and non-psych testing and symptoms.

• Eliminating barriers to documentation, re-disclosure and oral disclosure of information to those involved in care or treatment of patient e.g. family members.

Health Information Security and Health Information Security and Privacy Collaboration (in progress):Privacy Collaboration (in progress):

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Collaborate With Others

• Wisconsin Health Information Organization

• Wisconsin Collaborative for Health Care Quality

• Wisconsin Hospital Association

• Wisconsin Medical Society

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Support the Governor's eHealth Care Quality and Patient Safety

Board

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Implications: • Resources

– Governor Doyle’s Biennial Executive Budget

Resources: grants, tax credits

Governance: statutorily establish Council

• Certification and development of standards for interoperability

• Removing statutory and regulatory barriers

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Implications cont.:

• Alignment: – HIT platform with value-based

purchasing strategies – Population health with

disease/chronic care management

• Sustainability

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Acknowledgements:

• Dr. Barthell of the Wisconsin Health Information Exchange

• Bill Bazan of the Wisconsin Hospital association for their great dedication to this project

• Tom Wetzel for convening this webcast

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Dr. Edward BarthellExecutive Vice President for Infinity HealthCare Inc. and

Chief Medical Officer of EMSystem

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ED Linking ProjectInformation Sharing between

Emergency Departments and Community Health Centers

June, 2007Wisconsin Health Information ExchangeEMERGENCY DEPARTMENT LINKING

Manage AccessSystem Admin

ED Clinicians

Public Health Official

Participating Hospitals

Regional GAMP DB

EDS Medicaid

HMOs Medicaid Patient Info

Monitor/Audit Logs

Maintain PatientIndex (Matches)

Process PatientInformation

Publish PatientIndex

Locate PatientInformation

View PatientInformation

Enter PatientEncounter Narrative

View AggregatedPatient Information

Manage Help Desk

Public Health Case Manager

Query AggregatedPatient Information

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THE PROBLEM

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SOLUTION

Implement a health information exchange system that will allow multiple hospitals, clinics, and healthcare institutions to rapidly access past medical history data about patients.

A FIRST STEP

Provide clinicians access to past medical history for patients that register for care at safety net facilities – emergency departments and community health centers.

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KEY REQUIREMENTS

Make data available to clinicians in a manner that is virtually transparent to current workflow.

Provide sufficient “hit ratio” and accuracy of record matching to make queries worthwhile.

Ensure security and confidentiality of all medical records and compliance with HIPAA and applicable state regulations.

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GOVERNANCE

What is (who are) WHIE? A collaborative group with a broad based board of advisors include representatives of health care providers, payors, patients, educational institutions, and other stakeholders

DATA SHARING PARTNERS

Aurora Health Care Children's Hospital of WisconsinColumbia - St. Mary's HospitalsFroedtert and Community HealthWheaton Franciscan HealthcareDHFS Medicaid

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MAKING IT WORK

Formal planning processProviders, HIT experts, Project managementImplementation plan completed fall 2006

Building a collaborative networkMeetings, Data sharing agreements

Arranging for fundingHealthcare provider investmentMedicaid transformation grantTechnical provider contributions

Evaluation – Sustainability planning

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CURRENT PROCESS

Patient Triage

Register

Treat Patient

Order Patient Chart

Clinician must think to ask for previous records

Previous records often unavailable

Manual or electronic process to retrieve local records

Labor intensive process to retrieve records from other institutions

Lack of previous records leads to errors and redundancy

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NEW PROCESS

Patient Triage

Register

Treat Patient

Order Patient Chart

Automatic regional query initiated by registration message

Available data displayed on pick list for clinicians or support staff

Includes summary info from both local hospital and outside facilities

Review on line or print to attach to paper chart

Decrease errors and redundancy

ED Linking System

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Q4 Q1Q3 Q2

2007

Q3

2008

Q4

Mobilize

Evaluate Solution

. . .

Establish Baseline

Legal Agreements

Review & Select Medicaid Data Fields

ED Workflow

Usability

HL7 Interface(s)

VPN Setup and Config

Azyxxi Setup and Config

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THE PLATFORM

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EVALUATION

Economic Modeling Workflow Impact

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Bill BazanVice President

Metro Milwaukee, Wisconsin Hospital Association

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EMERGENCY DEPARTMENT CARE

COORDINATION COMMITTEE…AND THE

IT LINKING PROJECT

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KEY CONCEPTS:Secure health information exchangeEnhance care managementProvide needed medical informationContinuity of care Med. Reconciliation/patient safetyConnection to primary care homeFinancial impact of doing nothing

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STEP 1:

WHO SHOULD BE AT THE

TABLE?

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ED PHYSICIANSINFORMATION SYSTEM PERSONELFEDERALLY QUALIFIED HEALTH CENTERSHOSPITAL/SYSTEM ADMINISTRATORSED NURSE MANAGERSSOCIAL WORKERS/CASE MANAGERS

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MILWAUKEE HEALTH CARE PARTNERSHIP

AURORA

CHILDREN’S

COLUMBIA - ST. MARY’S

FROEDTERT

WHEATON FRANCISCAN

4 FQHC’S

Recently, KEVIN HAYDEN & ROB HENKEN

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MHCP:

IMPROVE HEALTH CARE FOR THE UNDERSERVED POPULATIONS IN MILWAUKEE COUNTY

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GOALS: COVERAGE FOR ALL ACCESS TO PROVIDERS AND SERVICES ENHANCE CARE COORDINATION SYSTEM-

WIDE PROMOTE HEALTH AND WELLNESS IMPROVE COST EFFECTIVENESS OF CARE

FOR UNINSURED AND UNDERINSURED INDIVIDUALS

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OPERATING DELIVERABLES FOR EDCCC

Improve ED care coordination policies and procedures within and across the entire system of providers

Community-wide triage and referral policies Decrease in non-emergent ED utilization Increase in assignment to primary care homes Implement IT LINKING PROJECT

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IT LINKING PROJECT AND AZYXXI

TECHNOLOGY PLATFORM TO INTEGRATE DATA FROM MULTIPLE DIVERSE HEALTH CARE IT SYSTEMS

PRESENT MEDICAL INFORMATION TO ED CLINICIANS IN A USEFUL WAY

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Gary NicolasVice President, Healthcare Portfolio,

Technology Solutions Company

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IT Considerations for EHRGary V Nicolas

41Build With A Blueprint•Standards Based

•Not finalized, yet…•Start now, incorporate changes to standards based on adoption by the market place as they develop.

•Flexibility•Realize there will be changes as adoption increases and standards are adapted

•Scalability•Pick one or two players that are committed to growing

•Interoperability•Build on Standards, Play by the Standards

•Integration•Achieved through standards, get the theme?

•Learn From Others•Partners Community Healthcare, Inc. (PCHI)

www.partners.org•NYC Health The Primary Care Information Project (PCIP)

www.nyc.gov/pcip

http://www.partners.org/

http://www.nyc.gov/pcip

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Four Stage Maturity ModelThink Personal - Get Digital

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Overviewo Digitization – reduction of paper with unification and federation of all data

across standards based platforms

o Virtualization – providing tools and access for diagnosticians independent of location. Start digital, stay digital.

o Collaboration – Efficiently connecting resources throughout the care delivery process and reducing variation so as to enhance service. Sharing the data will improve the quality of care

o Personalization – enhancing the patient and family experience using electronic communities and support tools

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Four Stage Model Stage 1 Stage 2 Stage 3 Stage 4

ValueOrientation

Digitization Virtualization Collaboration Personalization

People Systems / Service Lines

Networks / Physicians

Communities / CareTeams

Global / Patients and Families Populations

ProcessRequisition-less, Paper Lean and

Filmless

Efficiency andCycle Time

Improvement

Reduced Variation, Increased

Predictability (eTAT)

Demand Forecasting, Dynamic Resource

Allocation

TechnologyEHR, Visual EMR,

CAD PACS, Speech Recognition

Visual EHR, Grids, Unified

Messaging, Archive Unification

Exchanges, Collaborative

Filtering, Internet Suspend and

Resume

Cloud Computing, Social “Open” Health Records, Interactive

Search and Diagnosis

Information and Measurement

Schemas / Operational Business

Intelligence / Dashboards

Taxonomies / Predictive

Modeling / Gauges

Ontological / Adaptive

Optimization / Visual Operations

Semantic Web / Perpetual

Optimization / Autonomic Systems

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Stage 1 - DigitizationTrends and Illustrative Examples

46Digitization Buying Trends… Stage 1

Digitization

Systems / Service Lines

Requisition-less,

Paper Lean and Filmless

EHR, Visual EMR, CAD

PACS, Speech Recognition

Schemas / Operational

Business Intelligence / Dashboards

47The Evolution of the Visual EHRStage 1

Digitization


Requisition-less,






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Source: Frost & Sullivan; HIMSS Analytics

Stage 1

Digitization


Requisition-less,






Where Are We Headed With Visual Health Records?

49…What About IT Architecture and Standards?

Stage 1

Digitization


Requisition-less,






50Interoperability Standards Become Mature

Gartners’ Hype cycle for Healthcare Provider Technologies – 7/2006

Stage 1

Digitization


Requisition-less,






51Drivers for adopting IT Standards in

eHealth

• Clear separation of concerns :– Healthcare specific needs -> healthcare standards – IT common needs -> IT standards

• Leverage experiences from other industries– Security : finance , e-commerce– Workflow : ERP business

• SDO resources are scarce – SDO development effort is large (1-5 FTE/ profile)– Focus scarce resources to healthcare specific standards

• Customer demand– Healthcare authorities demand for open (ISO) standards

*Source IHE Interoperability Workshop Author Charles Parisot (GE Healthcare)

Stage 1

Digitization


Requisition-less,






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Service Bus Blueprint Transactions)Integration Based on HCIT Standards

For more information on IHE standards see www.ihe.net

Stage 1

Digitization


Requisition-less,






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Stage 2 - VirtualizationTrends and Illustrative Examples

54Source Data Is AvailableStage 2

Virtualization



Improvement


Messaging, Archive

Unification

Taxonomies / Predictive Modeling /

Gauges

55Industry Is Demanding VirtualizationStage 2

Virtualization



Improvement


Messaging, Archive

Unification


Gauges

56Expectation Management? Example of

Radiology Report TATExam Complete to Report Final

Observation: Based upon a review of actual Turn Around Time (TAT) data for one month we observe that reports are taking from a few minutes up to 24 hours to complete. The majority of reports are taking 20 – 40 minutes to complete. Are your patients seeing this?

Stage 2

Virtualization



Improvement


Messaging, Archive

Unification


Gauges

57Virtual Radiology (Example)Stage 2

Virtualization



Improvement


Messaging, Archive

Unification


Gauges

58Example: Batch and Flow Processes in Radiology

Stage 2

Virtualization



Improvement


Messaging, Archive

Unification


Gauges

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Stage 3 - CollaborationTrends and Illustrative Examples

60Research Access To A GridStage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume


Optimization / Visual

Operations

ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf

61Patient Authorized Access to Image Grid

ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf

Stage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume



Operations

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What comes after Collaborative records?M

illio

ns o

f Pro

cedu

res/

Year

Source: Frost & Sullivan; HIMSS Analytics

Stage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume



Operations

63Visual Search for Health 2.0

http://diamond.cs.cmu.edu/papers/mi2007.pdf

Stage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume



Operations

64Visual Search for Health 2.0Stage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume



Operations

65Visual Search for Health 2.0

http://download.intel.com/technology/techresearch/research_day/2006/rai_diamond.pdf

Stage 3

Collaboration

Communities / Care

Teams




Filtering, Internet

Suspend and Resume



Operations

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Stage 4 - PersonalizationTrends and Illustrative Examples

67Consumer Driven Patient CareStage 4

Personalization

Global / Patients

and Families Populations

Demand Forecasting,

Dynamic Resource Allocation

Cloud Computing,

Social “Open” Health

Records, Interactive Search and Diagnosis

Semantic Web /

Perpetual Optimization /

Autonomic Systems

68Not Helpful….Stage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

69That’s a little better…Stage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

70This is Interesting…Stage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

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Ahh, That’s Better!Stage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

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Information Outside:

• Belongs to Community

• Visible

• Public

Knowledge Inside:

• Invisible

• Private

SSN Total View of the Patient

Medical SearchBlogs and Communities

Teaching Files

Digital ImagesElectronic Health Records

Under the WaterlineStage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

73Health 2.0 Patient PowerStage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

74Connections for Families and FriendsStage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

http://www.moreaboutmaddie.com/index.cfm

75The Rise of the e-PatientStage 4

Personalization

Global / Patients


Demand Forecasting,


Cloud Computing,



Semantic Web /


Autonomic Systems

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• Standards based design and integration to support– Visual EHR with Bi-directional integration with AEHRs– Integration of Cardiology, Pathology, Oncology, Pathology, others– Portable documents using IHE PID specification and CCR/CCD– Standardize naming conventions and rationalize data elements– Unification of archives (take the ‘A’ out of PACS)– Workflow virtualization

• Paper lean– Requisition-less Workflow– Paperless workflow for Physicians, Nurses, technologists…– Use digital pens, electronic clipboards, portals and kiosks

• Measurement and Optimization of Patient Experience– Turn Around Time (TAT) and Results Reporting to patients– Flow efficiency and wait time – from the Patient’s perspective

Summary Example: From Digital to Virtual

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Q & A

78Contact InformationDr. Edward BarthellInfinity Healthcare1035 Glen Oaks LaneMequon, WI [email protected]

Bill BazanVP, Metro Milwaukee, WHA 3200 W. Highland Ave.Milwaukee, 53208 414-431-0105 [email protected]

Donald L. DavisLean Value Stream Manager, Installation ServicesGE Healthcare 2607 N Grandview BlvdSN-472, Pole b6Waukesha, WI 53188 262 544 [email protected]

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Contact Information Cont’dKevin R. Hayden

Secretary

Wisconsin Department of Health & Family Services

1 West Wilson Street, Room 650

P.O. Box 7850

Madison, WI 53707-7857

608/266-9622

Gary V Nicolas

Vice President, Healthcare

Technology Solutions Company

55 East Monroe Street

Chicago IL 60603

219.531.5747

[email protected]

Documents

Wisconsin’s eHealth Initiative and the ED Linking Project November 8, 2008 WI ACHE Webinar