Minnesota e-Health Initiative Progress and Plans 2005 – 2006 An Update Topics for Discussion Update on Progress Role of Stratis Health for advancing Goal #2 recommendations for MN-HIE Presenters Marty LaVenture, Director, Center for Health Informatics, MDH Greg Linden, CIO Stratis Health

2 Motivation: Preparedness, Response and Electronic Health Records HHS Secretary Leavitt …. "There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records... than Katrina." …. (HHS - 9/13/2005). Hurricane Katrina –Many paper health and health care records lost permanently –Many digital records available in days

3 Motivation: Storm of Problems Error rates are too high –20 deaths due to errors in MN Hospitals in 2004 Quality is inconsistent –~50% of adults dont get offered recommended care Costs are escalating –11% average yearly cost growth over past 5 years. Research results are not rapidly used –~ 17 years until new innovations are widely used. Capacity for early detection & response to threats and disasters is minimal –Katrina response –Limited Public Health Capacity

4 Motivation: Un-Linked Systems Are Resource Expensive we typically have to enter the same child's name again and again in 6 or more data systems and then try and keep the address and related information up to date. It can be a nightmare and it is expensive. - Local Public Health Department Director

5 Motivation: Information Technology Can Help Solve Real Problems Today 40% of outpatient prescriptions unnecessary 20% of lab & x-ray tests ordered because originals can not be found 18% medical errors from inadequate patient information. Patients get only 54.9% of recommended care 49% of notifiable diseases reported - Dr. Blackford Middleton, PHIN 2005 Meeting

6 Motivation: Minnesota Gaps* * Preliminary data – Based on limited surveys Type of Facility/ ProviderNumberEstimated use of HIT Gap/ Comment Clinics / Primary Care~ 700Est. 5%-15%Small & rural clinics Long Term care-Nursing Homes ~ 402~ 2% - 4%Clinical support, Inter- connectivity Emergency Departments~ 129~ 10% - 12%Core data access, Connect across systems Local Public Health Departments ~ 91VariesLimited access to community data No Interoperability

7 Opportunity: National Framework for Strategic Action* 2004 Goals 1.Inform Clinical Practice 2.Interconnect Clinicians 3.Personalize Care 4.Improve Population Health 2005 Action American Health Information Community (AHIC) 4 - RFPs: Pilots NHIN Harmonize Health IT Standards Assess Privacy & Security Develop Certification Process for Health IT

8 What is the Minnesota e-Health Initiative? Private-Public collaboration Guided by an advisory committee Born of need and legislation: 2004/05 Dedicated to accelerate the use of Health Information Technology (HIT) in all areas of the state… For the purpose of: –Improving health and health care quality –Increasing patient safety –Reducing health care costs –Improving public health

9 MN e-Health Steering Committee Progress – Proposed Actions Progress To date Delivered report to Legislature (vision, roadmap, recommendations) Developed principles for MN Health information exchange (MH- HIE) (Goal 2: Interconnect) Collaborated on response to NHIN- RFI Identified priorities for MN-HIE Held statewide summit Next Action Steps MN Health Information Exchange Seek further input/commitment Establish Board Business planning for exchange: e.g. Laboratory, Pharmacy, Disease Surveillance Advisory Committee Assure broad HIT assessment Advance the roadmap: Goal 1: Goal 3: and Goal 4:

10 Vision for Minnesota e-Health … accelerate the adoption and use of Health Information Technology to improve healthcare quality, increase patient safety, reduce healthcare costs and enable individuals and communities to make the best possible health decisions. Source: Committee Report to the Legislature, January 2005

Minnesota e-health Initiative Roadmap for Strategic Action Source: Committee Report to the Legislature, January 2005 Statewide Build on National work In progressWorkgroups

12 Strengths of Minnesota Approach Statewide approach Private-Public initiative Broad participation and strong collaboration Build on existing initiatives Comprehensive vision- e.g. includes many settings and disciplines Global vision, incremental – sustainable implementations

Minnesota e-Health Initiative A private-public collaboration to accelerate use of Health Information Technology in order to improve health care quality, Increase patient safety, reducing health care costs, and improve public health Rev Goal # 2 Interconnect Clinicians Goal # 4 Improve Population /Public Health Goal # 1 Inform Clinical Practice Goal # 3 Personal Health Record Statewide Advisory Committee Example Statewide Activities by Goal Stratis Health: MN Health Information Exchange (MN-HIE) – Establish Board, Business case HIPAA Collaborative: Medication history exchange CHIC – NE MN planning for exchange AHRQ – Shared Abstract: Allina, Fairview, Health Partners, U of M Access for individuals and care givers MDH: Rural Health Grants Stratis Health:/QIO: DOQ-IT program Assessment (Stratis Health, MDH/U of M) MDH/LPHA: MN-PHIN – Governance, Population Indicators RWJF Funding Application

Minnesota e-Health Initiative MN Health Information Exchange Update from Stratis Health 10/21/05 Topics for Discussion MN-HIE Update from Stratis Health Greg Linden, CIO Stratis Health

15 Recommendation: Form a Minnesota Health Information Exchange MN-HIE will interconnect clinicians and be the connection point for: National Health Information Network (NHIN) Community-Based Initiatives

16 Recommendation: Form a Minnesota Health Information Exchange The MN-HIE governance structure will be developed utilizing a phased-in approach. Phase II MN-HIE Implementation Phase III MN-HIE Development & Maintenance Phase I MN-HIE Initialization

17 Minnesota Health Information Exchange Role of Stratis Health Build on Year 1 recommendations Gather stakeholder input for transition phase Update HIT Assessment framework Recommend Board of Directors Establish legal structure for MN-HIE Develop business plan for three identified business areas Develop framework for funding

18 Stakeholder Input to date We (MDH and Stratis Health) have started to meet with key stakeholder groups (e.g. Buyers, Health Plans, Hospitals) General consensus: Keep communicating Move forward! More meetings to come!

19 HIT Assessment Objectives Inventory the major assessments and related data collection tools for measuring the status of HIT adoption in Minnesota –Identify gaps in current adoption of HIT –Identify gaps in assessments of HIT –Present the findings to the MN e-Health Advisory Committee Establish an ongoing assessment framework

20 HIT Assessment Domains Hospitals Clinics Long Term Care Facilities Emergency depts Local Pub Health depts Pharmacies Clinical Laboratories Home Care and Home Health Agencies Health systems Health Plans Tele-medicine Sites Persons/Consumers Physicians Registered Nurses Stand-Alone Radiology Practices State agencies represented by the Health Care Cabinet MN Dept of Health MN Dept of Human Services

21 Ongoing Assessment Collaboration Working with MDH and the U of MN Health Informatics division to develop a comprehensive informatics framework for ongoing assessment on Minnesota It will include assessment needs for all 4 Minnesota strategic goals, across all the domains

22 MN-HIE Interim Board Recommendation: The MN e-Health Steering Committee recommended (June 23, 2005) establishing an Interim Board for the MN-HIE Key principle for the MN-HIE Board: –MN-HIE will be operated with a multi- stakeholder Board of Directors

23 Interim Board Composition –Community Hospital –Consumer –Health Plan –Hospital System –Insurance Company –Pharmacy –Physician –Public Health –Purchaser –Quality Improvement Organization –State Government Recommendation: The workgroup recommends that the Interim Board represents interests in the following areas:

24 Phased Approach Recommendation: Once MN-HIE is established, composition of the Board will evolve over time as the organization moves through three phases of development Phase I: Initialization –Establish a governance structure that will be used to define, plan, and design the MN-HIE

25 Interim Board Next Steps Identify candidates to represent the interests identified by the Governance Workgroup An update on this process will be presented to the Advisory Committee as part of the November update The objective is to finalize selection of the Interim Board and convene its first meeting in 1Q06

26 Next Steps and Challenges Priority for the work plan Advance strategic topics for the 4 Goals Encourage state wide coordination Assure underserved needs are met Address population health issues Include readiness for preparedness and response Effective communications and education

27 Key Contacts for More Information: Stratis Health (Minn. Exchange Planning) Greg Linden - VP/Chief Information Officer (952) Minnesota Department of Health Marty LaVenture, PhD – Director of Health Informatics Barb Wills – Thank You! - Questions