Developing State and RegionalLevel Health Information Exchange Breakout Session

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Developing State and Regional-Level Health
Information ExchangeBreakout Session

• Hugh Zettel, GE Healthcare
• Ed Barthell, NIMI
• Denise Webb, WI DHFS

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Todays 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
  initiativesSustainability the major challenge
• Efforts to address governance, securityprivacy
  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 RFPs 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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Regional HIE in Wisconsin
Emergency Department Linking Project Overview
Current Status Results and Lessons
Learned Opportunities
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WHIE History Formation Fall 2005 EHI
funded Business Plan delivered to EHI Dec
2006 Governance, Functional Priorities, Financial
Models Funding raised for ED Linking early
2007 Project start June 2007
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WHIE Southeast Wisconsin Statistics

• 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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Friday, February 1, 2008 Health system
consolidation has Milwaukee doctors losing
power The Business Journal of Milwaukee - by
Elizabeth Sanders
Advanced Healthcare and Aurora Health Care agree
to form broad new alliance to improve care July
31, 2007 http//www.ah.com/Article.asp?Doc327
Dr. Lowell Keppel . . . Theres 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
More health care consolidation in 2008 -
SynergyHealth to announce partner soon Small
BizTimes 1/25/08
Press Release - Medical Associates to Join
ProHealth Care November 11, 2007
http//www.prohealthcare.org/OPage.asp?PageIDOTH0
00606
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Friday, February 1, 2008 Health system
consolidation has Milwaukee doctors losing
power The Business Journal of Milwaukee - by
Elizabeth Sanders
Advanced Healthcare and Aurora Health Care agree
to form broad new alliance to improve care July
31, 2007 http//www.ah.com/Article.asp?Doc327
Milwaukee County Four major health
systems Nine County Area Six major
health systems
Dr. Lowell Keppel . . . Theres 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
More health care consolidation in 2008 -
SynergyHealth to announce partner soon Small
BizTimes 1/25/08
Press Release - Medical Associates to Join
ProHealth Care November 11, 2007
http//www.prohealthcare.org/OPage.asp?PageIDOTH0
00606
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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 care
• Patient helps me to receive better care
• Payer 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 youll use Azyxxi to define
  desired Interfaces
• What specific questions will you answer?
• Who will be using it?
• What data sources are required?

• 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.

STORE DATA
SHOW DATA
GET DATA
1A
1B
1C
2A
2B
2C
3A
3B
3C
Amalga Parsing Engine
User-Customizable Queries for Data Retrieval
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WHIE Blended Architecture
Data Feeds
Clin1
Clin2
Clin3
StMary
Sinai
StFran
HospN
MCaid
PayrN
A
E
B
C
F
D
Clin4
Clin5
Clinic Hosting Ctr
Amalga message queue, parsing, metadata tagging,
record matching
Hosted Data Store
G
Amalga application server, authentication,
response to queries, audit trail
H
J
I
StMary
Sinai
StFran
HospN
MCaid
PayrN
Clinics
Data Views
L
K
Public Health
Maint Audit
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Emergency Department Linking Project Initial
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)0
1178-X/abstract
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WHIE Sustainability Plan - ED Linking
Use Existing Payment System Encounter Based
Scale Spread Benefits Across Value Chain
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Next Steps

• 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

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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 Questions

• 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?
• 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 Questions

• 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?
• 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 Questions

• 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?
• How should we measure the value and impact of the
  services a state-level HIE would provide?
• 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_at_wisconsin.gov
• WI eHealth Care Quality and Patient Safety Board
• http//ehealthboard.dhfs.wisconsin.gov/