1. Wisconsins eHealth Initiative and the ED Linking Project November 8, 2008 WI ACHE Webinar To Access Audio: 866-365-4406 Pass code: 2741820

2. 2 Agenda Secretary Kevin Hayden – 10 minutes oBrief overview of Wisconsin eHealth Initiative oImplications for acute care providers oHealth Information Exchange Dr. Edward Barthell - ED Linking - 10 minutes oOverview of Project/timeline oPhysicians response oClinical improvements Bill Bazan – 10 minutes oCompetitive Challenge oBusiness case for connectivity oEqual Partnership/Change in Culture Gary Nicolas – 10 minutes oIT considerations oFlexibility - Interoperability o4 steps toward Adoption Q& A – 10 minutes

3. 3 Kevin R. Hayden Secretary of Wisconsins Department of Health and Family Service

4. 4 A Discussion on Wisconsins eHealth Initiative Department of Health and Family Services

5. 5 Wisconsin's eHealth Initiative and the ED Linking Project Kevin R. Hayden, Secretary Department of Health and Family Services http://ehealthboard.dhfs.wisconsin.gov/

6. 6 The eHealth Initiative Goal: Successful implementation of a statewide health information exchange (HIE) system that is interoperable with the Nationwide Health Information Network (NHIN).

7. 7 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.

8. 8 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.

9. 9 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 WIs Medicaid programs quality measurement strategies with WCHQs.

10. 10 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.

11. 11 Assure 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 Privacy Collaboration (in progress):

12. 12 Collaborate With Others Wisconsin Health Information Organization Wisconsin Collaborative for Health Care Quality Wisconsin Hospital Association Wisconsin Medical Society

13. 13 Support the Governor's eHealth Care Quality and Patient Safety Board

14. 14 Implications: Resources –Governor Doyles Biennial Executive Budget Resources: grants, tax credits Governance: statutorily establish Council Certification and development of standards for interoperability Removing statutory and regulatory barriers

15. 15 Implications cont.: Alignment: –HIT platform with value-based purchasing strategies –Population health with disease/chronic care management Sustainability

16. 16 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

17. 17 Dr. Edward Barthell Executive Vice President for Infinity HealthCare Inc. and Chief Medical Officer of EMSystem

18. 18 ED Linking Project Information Sharing between Emergency Departments and Community Health Centers June, 2007 18

19. 19 THE PROBLEM 19

20. 20 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. 20

21. 21 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. 21

22. 22 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 Wisconsin Columbia - St. Mary's Hospitals Froedtert and Community Health Wheaton Franciscan Healthcare DHFS Medicaid 22

23. 23 MAKING IT WORK Formal planning process Providers, HIT experts, Project management Implementation plan completed fall 2006 Building a collaborative network Meetings, Data sharing agreements Arranging for funding Healthcare provider investment Medicaid transformation grant Technical provider contributions Evaluation – Sustainability planning 23

24. 24 CURRENT PROCESS 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 24

25. 25 NEW PROCESS 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 25

26. 26 Q4Q4Q1Q1Q3Q3Q2Q2 2007 Q3Q3 2008 Q4Q4 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 26

27. 27 THE PLATFORM 27

28. 28 EVALUATION Economic Modeling Workflow Impact 28

29. 29 Bill Bazan Vice President Metro Milwaukee, Wisconsin Hospital Association

30. 30 EMERGENCY DEPARTMENT CARE COORDINATION COMMITTEE…AND THE IT LINKING PROJECT 30

31. 31 KEY CONCEPTS: Secure health information exchange Enhance care management Provide needed medical information Continuity of care Med. Reconciliation/patient safety Connection to primary care home Financial impact of doing nothing 31

32. 32 STEP 1: WHO SHOULD BE AT THE TABLE? 32

33. 33 ED PHYSICIANS INFORMATION SYSTEM PERSONEL FEDERALLY QUALIFIED HEALTH CENTERS HOSPITAL/SYSTEM ADMINISTRATORS ED NURSE MANAGERS SOCIAL WORKERS/CASE MANAGERS 33

34. 34 MILWAUKEE HEALTH CARE PARTNERSHIP AURORA CHILDRENS COLUMBIA - ST. MARYS FROEDTERT WHEATON FRANCISCAN 4 FQHCS Recently, KEVIN HAYDEN & ROB HENKEN 34

35. 35 MHCP: IMPROVE HEALTH CARE FOR THE UNDERSERVED POPULATIONS IN MILWAUKEE COUNTY 36

36. 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

37. 37 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 37

38. 38 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 38

39. 39 Gary Nicolas Vice President, Healthcare Portfolio, Technology Solutions Company

40. 40 IT Considerations for EHR Gary V Nicolas

41. 41 Build 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

42. 42 Four Stage Maturity Model Think Personal - Get Digital

43. 43 Overview o 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

44. 44 Four Stage Model Stage 1Stage 2Stage 3Stage 4 Value Orientation DigitizationVirtualizationCollaborationPersonalization People Systems / Service Lines Networks / Physicians Communities / Care Teams Global / Patients and Families Populations Process Requisition-less, Paper Lean and Filmless Efficiency and Cycle Time Improvement Reduced Variation, Increased Predictability (eTAT) Demand Forecasting, Dynamic Resource Allocation Technology EHR, 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

45. 45 Stage 1 - Digitization Trends and Illustrative Examples

46. 46 Digitization 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

47. 47 The Evolution of the Visual EHR Stage 1 Digitization Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards

48. 48 Source: Frost & Sullivan; HIMSS Analytics Stage 1 Digitization Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards Where Are We Headed With Visual Health Records?

49. 49 …What About IT Architecture and Standards? Stage 1 Digitization Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards

50. 50 Interoperability Standards Become Mature Gartners Hype cycle for Healthcare Provider Technologies – 7/2006 Stage 1 Digitization Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards

51. 51 Drivers 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 Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards

52. 52 Service Bus Blueprint Transactions) Integration Based on HCIT Standards For more information on IHE standards see www.ihe.net Stage 1 Digitization Systems / Service Lines Requisition-less, Paper Lean and Filmless EHR, Visual EMR, CAD PACS, Speech Recognition Schemas / Operational Business Intelligence / Dashboards

53. 53 Stage 2 - Virtualization Trends and Illustrative Examples

54. 54 Source Data Is Available Stage 2 Virtualizatio n Networks / Physicians Efficiency and Cycle Time Improvement Visual EHR, Grids, Unified Messaging, Archive Unification Taxonomies / Predictive Modeling / Gauges

55. 55 Industry Is Demanding Virtualization Stage 2 Virtualizatio n Networks / Physicians Efficiency and Cycle Time Improvement Visual EHR, Grids, Unified Messaging, Archive Unification Taxonomies / Predictive Modeling / Gauges

56. 56 Expectation Management? Example of Radiology Report TAT Exam 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 Virtualizatio n Networks / Physicians Efficiency and Cycle Time Improvement Visual EHR, Grids, Unified Messaging, Archive Unification Taxonomies / Predictive Modeling / Gauges

57. 57 Virtual Radiology (Example) Stage 2 Virtualizatio n Networks / Physicians Efficiency and Cycle Time Improvement Visual EHR, Grids, Unified Messaging, Archive Unification Taxonomies / Predictive Modeling / Gauges

58. 58 Example: Batch and Flow Processes in Radiology Stage 2 Virtualizatio n Networks / Physicians Efficiency and Cycle Time Improvement Visual EHR, Grids, Unified Messaging, Archive Unification Taxonomies / Predictive Modeling / Gauges

59. 59 Stage 3 - Collaboration Trends and Illustrative Examples

60. 60 Research Access To A Grid Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf

61. 61 Patient Authorized Access to Image Grid ftp://ftp.globus.org/pub/incubator/medicus/Globus_MEDICUS.pdf Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations

62. 62 What comes after Collaborative records? Millions of Procedures/Year Source: Frost & Sullivan; HIMSS Analytics Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations

63. 63 Visual Search for Health 2.0 http://diamond.cs.cmu.edu/papers/mi2007.pdf Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations

64. 64 Visual Search for Health 2.0 Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations

65. 65 Visual Search for Health 2.0 http://download.intel.com/technology/techresearch/research_day/2006/rai_diamond.pdf Stage 3 Collaboratio n Communities / Care Teams Reduced Variation, Increased Predictability (eTAT) Exchanges, Collaborative Filtering, Internet Suspend and Resume Ontological / Adaptive Optimization / Visual Operations

66. 66 Stage 4 - Personalization Trends and Illustrative Examples

67. 67 Consumer Driven Patient Care Stage 4 Personalizati on 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

68. 68 Not Helpful…. Stage 4 Personalizati on 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

69. 69 Thats a little better… Stage 4 Personalizati on 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

70. 70 This is Interesting… Stage 4 Personalizati on 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

71. 71 Ahh, Thats Better! Stage 4 Personalizati on 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

72. 72 Under the Waterline Stage 4 Personalizati on 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

73. 73 Health 2.0 Patient Power Stage 4 Personalizati on 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

74. 74 Connections for Families and Friends Stage 4 Personalizati on 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 http://www.moreaboutmaddie.com/index.cfm

75. 75 The Rise of the e-Patient Stage 4 Personalizati on 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

76. 76 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 Patients perspective Summary Example: From Digital to Virtual

77. 77 Q & A

78. 78 Contact Information Dr. Edward Barthell Infinity Healthcare 1035 Glen Oaks Lane Mequon, WI 53092 414-290-6700 ebarthell@infinityhealthcare.com Bill Bazan VP, Metro Milwaukee, WHA 3200 W. Highland Ave. Milwaukee, 53208 414-431-0105 bbazan@mailbag.com Donald L. Davis Lean Value Stream Manager, Installation Services GE Healthcare 2607 N Grandview Blvd SN-472, Pole b6 Waukesha, WI 53188 262 544 3267 donald.davis@med.ge.com

79. 79 Contact Information Contd Kevin 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 gary.nicolas@techsol.com