Developing State and Regional-Level Health Information ExchangeBreakout Session

Hugh Zettel, GE Healthcare

Ed Barthell, NIMI

Denise Webb, WI DHFS

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Today’s Session National HIE Landscape

National Activities and Impacts State-Level HIE

Planning & Design Project Regional HIE in Wisconsin

Emergency Department Linking Project Group Discussion Questions Next Steps

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National HIE Landscape National HIT Agenda Completing Year 4

American Health Information Community (AHIC) – Establish Use-case Priorities 2005 – Establish Workgroup focus areas 2006 – 3 Use-cases 2007 – 4 Use-cases 2008 – 6 Use-cases

AHIC mechanisms drive processes on Standards, Certification, Exchange, Policy

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National HIE Landscape Health Information Technology Standards Panel

Harmonizes standards and establishes interoperability specifications to implement AHIC use cases

Interoperability specifications comprised of “Transaction Packages” or building blocks that can be re-used 2006 – 3 Use-cases 52 “recognized” standards 2007 – 4 Use-cases 60 “accepted” standards 2008 – 6 Use-cases 102 “data exchange requests”

Interoperability specifications based on existing standards & Frameworks such as Integrating the Healthcare Enterprise (IHE)

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National HIE Landscape Nationwide Health Information Network

Phase 1 – Four contracts, three geographies/contract to show HIE

Phase 2 – Begin to incorporate AHIC use-cases and use of HITSP specifications in a trial implementation Five Federal agencies 15 health information exchanges (state, regional) Testing in September 2008

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National HIE Landscape Marketplace Diffusion of HITSP Standards

Executive Order 13410 – use of standards for entities contracting with Federal Government DoD, VA, Insurance carriers Stark EHR donations

EHR Certification 2008 CCHIT Ambulatory and Inpatient EHR

Interoperability Requirements CCHIT for Networks to begin later this year

Seven States link HITSP/ CCHIT to EHR Legislation

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National HIE Landscape HIE Evolution

eHI 4th Annual Survey reports 130 initiatives…Sustainability the major challenge

Efforts to address governance, security&privacy policies increasing – led by state HISPC efforts

“Below the radar” HIE efforts growing Use of HITSP standards, Registry/Repository model

for IDN build-outs, especially Stark EHR Provider RFP’s include HITSP, CCHIT language

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State-Level HIE: Planning and Design Stakeholder Assessment and Environmental Scan Inventory and assess statewide public and private

technical assets and resources for use in state-level HIE

Select and prioritize business use cases for HIE Propose feasible business and technical architecture

options for state-level HIE in Wisconsin Develop detailed business and technical plans for

state-level Wisconsin HIE option selected and approved by eHealth Board

Inform and educate Wisconsin HIE stakeholders on current market and capabilities of commercially available HIE solutions and products

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Emergency Department Linking Project

Overview & Current StatusResults and Lessons LearnedOpportunities

Regional HIE in Wisconsin

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WHIE: HistoryFormation Fall 2005 – EHI fundedBusiness Plan delivered to EHI Dec 2006

Governance, Functional Priorities, Financial Models

Funding raised for ED Linking early 2007Project start June 2007

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Population of WI – 5,609,705 (2006) Population 9 counties (2006) –

2,198,037 Population 65+ - 275,355 (12.4%) Projected ED visits annually 834,356 Projected ambulatory visits –

6,973,106

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WHIE: Southeast Wisconsin Statistics

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More health care consolidation in 2008

- SynergyHealth to announce partner

soon Small BizTimes 1/25/08

Friday, February 1, 2008

Health system consolidation has Milwaukee doctors

losing power

The Business Journal of Milwaukee - by Elizabeth

Sanders Dr. Lowell Keppel . . . “There’s a lot of potential to use technology to gain economies of scale and really help with the health care quality and cost issues.” Milwaukee Business Journal

Advanced Healthcare and Aurora Health Care agree to form broad new alliance to improve careJuly 31, 2007 http://www.ah.com/Article.asp?Doc=327

Press Release - Medical Associates to Join ProHealth CareNovember 11, 2007 http://www.prohealthcare.org/OPage.asp?PageID=OTH000606

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More health care consolidation in 2008

- SynergyHealth to announce partner

soon Small BizTimes 1/25/08

Friday, February 1, 2008

Health system consolidation has Milwaukee doctors

losing power

The Business Journal of Milwaukee - by Elizabeth

Sanders Dr. Lowell Keppel . . . “There’s a lot of potential to use technology to gain economies of scale and really help with the health care quality and cost issues.” Milwaukee Business Journal

Advanced Healthcare and Aurora Health Care agree to form broad new alliance to improve careJuly 31, 2007 http://www.ah.com/Article.asp?Doc=327

Press Release - Medical Associates to Join ProHealth CareNovember 11, 2007 http://www.prohealthcare.org/OPage.asp?PageID=OTH000606

Milwaukee County – Four major health systems

Nine County Area – Six major health systems

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WHIE: Focus

Overall Goal – right data available at right time

Specific New Behavior – retrieve and review regional data on every visit, update regional data as a result of the visit.

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What is the Value Proposition that is supported by this new behavior?

Clinician – helps me to deliver better carePatient – helps me to receive better carePayer – helps me to save money

(maybe enough that I can share some with clinician and patient)

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ED Linking Project Conceived by committee led by WHA Supported by hospital systems

- Milwaukee Health Care Partnership

Funded by State of WI DHFS Technical services by Microsoft Evaluation by MCW and UW-Madison

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Integration through “interfaces” •The Amalga database is built from the standard feeds of existing data sources (an “Azyxxi Interface”)•Amalga Parsing Scripts are created for each Amalga Interface•The implementation process helps define:

• Define how and where you’ll use Azyxxi to define desired Interfaces

• What specific questions will you answer?• Who will be using it?• What data sources are required?

1 A B C2 A B C3 A B C

1 A B C2 A B C3 A B C

1 A B C2 A B C3 A B C

1 A B C2 A B C3 A B C

1 A B C2 A B C3 A B C

1 A B C2 A B C3 A B C

Amalga Parsing Engine

1A1A 1B1B 1C1C

2A2A 2B2B 2C2C

3A3A 3B3B 3C3C

“STORE” DATA “SHOW ” DATA“GET” DATA

User-Customizable Queries for Data Retrieval

Flexible, “cellular” data structure•Data is divided into multiple components, clearly identifiable within each transaction

•Data can be re-organized into unlimited buckets to answer an unlimited number of queries

•Search is fast because it does not require scrolling through thousands of transactions to source the data.

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StMary

A

Data Feeds

Data Views

Sinai StFran

E

HospN

B

MCaid

C

Clin1 Clin2

Clin4 Clin5

Clin3

Clinic Hosting Ctr

F

Hosted Data Store G

Clinics

StMary Sinai StFran HospN MCaid

H J

Public Health

I

Amalga message queue, parsing, metadata tagging, record matching

LMaint Audit

D

K

PayrN

PayrN

Amalga application server, authentication, response to queries, audit trail

WHIE Blended Architecture

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Emergency Department Linking ProjectInitial challenge Get on the priority list Management, legal, technical, clinical

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ED Linking Project: Initial Lessons Learned

Importance of Expectation Management Challenge of Culture Change

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Milwaukee Health Care Partnership

WHIE as enabling technology Care Plans opportunity

http://www.annemergmed.com/article/S0196-0644(07)01178-X/abstract

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WHIE Sustainability Plan - ED Linking

Use Existing Payment SystemEncounter Based ScaleSpread Benefits Across Value Chain

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Medicaid Data Public Health Addition of next Phase data sharing sites Addition of clinics data use and data sharing Expansion to wider geography Collaboration with others statewide

Next Steps

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Make no little plans; they have no magic to stir men's blood and probably will themselves not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will not die.

Daniel Burnham, Architect Union Station

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Group Discussion Questions1. What should be the role(s) of a state-level HIE

entity? What aspects of health information exchange are most important to focus on at a state-level? What will provide the most value and support to regional and local-level HIE efforts?

2. What form of legal entity should govern state-level HIE and what is the best strategy for forming this organization? What are the most important steps to take in establishing state-level HIE governance? What role should Wisconsin state government play in this state-level entity?

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Group Discussion Questions3. What existing statewide (public or private) assets

or resources should be considered for state-level HIE and a statewide HIE infrastructure that would help connect the state-level HIE to regional/local HIEs in Wisconsin and to the Nationwide Health Information Network?

4. What are the most significant barriers or challenges to state-level HIE? How should we deal with these barriers or challenges?

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Group Discussion Questions5. Who should pay for the services provided by a

state-level HIE organization and why? What are some strategies for convincing HIE stakeholders to participate financially in the start-up costs and long-term sustainability of a state-level HIE initiative?

6. How should we measure the value and impact of the services a state-level HIE would provide?

7. Other questions/discussion.

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Next Steps Share key points/themes with conference

attendees Launch state-level HIE planning and design

project Seek stakeholder input through “just-in-time”

workgroups and meetings

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For More Information Please Contact:

Denise Webb WI DHFS Denise.Webb@wisconsin.gov

WI eHealth Care Quality and Patient Safety Boardhttp://ehealthboard.dhfs.wisconsin.gov/