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?

Medical Trading Areas

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. [ ]

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

L EAPING I NTO T HE F UTURE T HE W ISCONSIN H EALTH I NFORMATION E XCHANGE

April 27, 2004 Executive Order 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.

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

eHealth Care Quality and Patient Safety Board 2007 eHealth Board Chair: Kevin Hayden Patient Care Advisory Group Chair: Ed Barthell Consumer Interests and Privacy Advisory Group Chair: Cathy Hansen Public Health Advisory Group Chair: Bevan Baker Statewide Health Information Exchange Advisory Group Chair: Hugh Zettel Operations Executive Committee Chairs of the Board and advisory group

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

A N O PPORTUNITY T O L EAD High profile Local problems Local talent Technical infrastructure Willing partners Wisconsin Health Information 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 Infrastructure Legal agreements Project Priorities - Pilots PHASE ONE PHASE TWO PHASE THREE PHASE FOUR Organization Early Operations Priority Projects Evaluation and ROI Definition Organization Mature Operations Expand Services and Participants $ PPM Model with ROI to Payors Possible Secondary Data Uses Expanded 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 Systems Registration Systems Claims Systems PBM, Pharmacy Systems Decision Support Systems Payor Care Mgt

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

Wisconsin Health Information Exchange

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