Transcript eHealth Governance Proposal September 18, 2006

Wiscosnin’s eHealth Initiative
September 21, 2007
Wisconsin eHealth
Action Plan
Value-based
Purchasing
eHealth
Technology
Platform
Prevention
and Disease
Management
eHealth Care Quality and
Patient Safety Board
Department of Health and
Family Services
Transforming Health Care in the US: medical
perspective
IOM - 6 Characteristics of Quality Care:
 Patient-Centered
 Safe
 Equitable
 Timely
 Effective
 Efficient

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Transforming Health Care in the US: Why
Health Information Technology? Need easily
accessible data/information in order to:
Improve Quality
 Reduce Errors (Improve Safety)
 Reduce Cost
 Increase Administrative Efficiencies
 Reduce Paperwork
 Expand access to affordable health care

Robert M. Kolodner, MD
National Coordinator
ONCHIT
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Transforming Health Care in the US: Why
Interoperable HIT?

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In addition to improved individual patient care,
it will also bring many public health benefits
including:
Early detection of infectious disease outbreaks
around the country;
Improved tracking of chronic disease
management; and
Evaluation of health care based on value
enabled by the collection of de-identified price
and quality information that can be compared.
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Transforming Health Care in the US: the market-driven
perspective – Value-Driven Health Care Initiative of the
Bush Administration

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Consumers deserve to know the quality and cost of their
health care. Health care transparency provides
consumers with the information necessary, and the
incentive, to choose health care providers based on
value.
Providing reliable cost and quality information empowers
consumer choice. Consumer choice creates incentives at
all levels, and motivates the entire system to provide
better care for less money. Improvements will come as
providers can see how their practice compares to others.
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Four Cornerstones of Value-driven Health
Care:
Interoperable Health Information
Technology
 Measure and Publish Quality Information
 Measure and Publish Price Information
 Promote Quality and Efficiency of Care
(pay for performance)

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National HIT Agenda:
…foster widely available services that
facilitate the accurate, appropriate,
timely, and secure exchange of health
information
 …information that follows the consumer
and supports clinical decision-making

John Loonsk
Office of the National Coordinator for HIT
DHHS
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State Activities:
Health Information Security and Privacy
Collaboration (HISPC)
 State Level HIE

Jodi Daniel ONCHIT/DHHS
Thomasian and Nolan NGA Center for Best Practices
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WI’s eHealth Action Plan
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Where is Wisconsin going with eHealth?
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The WI Health Care Environment
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eHealth Care Quality and Patient Safety Board
Wisconsin Collaborative for Healthcare Quality
(WCHQ)
Wisconsin Health Information Organization (WHIO)
Wisconsin Hospital Association (WHA)
Provider HIT adoption
 DOQ-IT
 Rural Health Cooperative
Wisconsin Health Information Exchange (WHIE)
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eHealth Care Quality and Patient Safety Board 2007
eHealth Board
Chair: Kevin Hayden
Executive Committee
Chairs of the Board and advisory group
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
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eHealth Board Members
Chair: Kevin Hayden, Secretary, Department of Health and Family Services
Betsy Abramson, Elder Law Attorney and Consultant
Christopher Alban, MD, Clinical Informaticist, Epic Systems Corporation
Bevan Baker, Commissioner of Health, City of Milwaukee Health Department
Edward Barthell, MD, Executive Vice President, CIO, Infinity Healthcare
Gary Bezucha, Administrator, Boscobel Area Health Care
Patricia Flatley Brennan, Professor of Nursing and Industrial Engineering
Catherine Hansen, Director, Health Information Services, St. Croix Regional Medical
Center
Ravi Kalla, CEO and President, Symphony Corporation
Don Layden, Executive Vice President, Corporate Development, Metavante Corporation
Dan Schoof, Deputy Secretary, Department of Administration
Lois Murphy, IT Specialist, Veterans Administration
Candice Owley, RN, President, Wisconsin Federation of Nurses and Health Professionals
Debra Rislow, CIO and Director of Information Systems, Gundersen Lutheran
Peg Smelser, Chief Operating Officer, Wisconsin Education Association Trust
Lon Sprecher, Sr. VP and COO, Deant Health Insurance
Eric Stanchfield, Secretary, Employee Trust Funds
John Toussaint, MD, President and CEO, ThedaCare
Justin Starren, MD, PhD, Marshfield Clinic Research Foundation
Hugh Zettel, Director, Government and Industry Relations, GE Healthcare
Technologies
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Wisconsin eHealth Initiative
Public-private collaboration for
widespread adoption of HIT/HIE
 Wisconsin’s eHealth Action Plan
includes:
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Create a technical infrastructure
Establish a governance structure for health
information exchange
Develop options for addressing privacy and
security issues
Support the acquisition of EHR systems by
small provider groups and safety-net
providers
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eHealth Technology Platform—Current Focus

HIT adoption
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Encourage adoption and investment in
electronic health record systems
Regularly monitor adoption progress
Health information exchange
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Foster creation of regional health
information exchanges
Simultaneously focus on state-level health
information exchange services
Focus early on providing patient information
timely and at point of care
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eHealth Action Plan—Current Activities
Transition from planning to
implementation
 eHealth Board advisory groups
 Implementing Medicaid Transformation
Grant project
 Addressing privacy concerns
 Governor’s 2007-09 Biennial Budget and
Health Provisions
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Wisconsin Privacy Project: Phase 1
(July 2006 - March 2007)
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33 states and Puerto Rico funded through DHHS Office of
the National Coordinator via Research Triangle Institute
(RTI) to:
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Assess variations in organization-level business policies and state
laws that affect health information exchange
Propose practical solutions that protect privacy and security of
health information and permit interoperable exchange
Develop plans to implement solutions
State-level data combined by the grantor to help support
the business case for a national health information
infrastructure
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Wisconsin Privacy Project: Phase 1
(July 2006 - March 2007)
Thank You!
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Privacy Project Phase 1: Recommendations
1.
Standardize patient identifiers
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2.
Propose changes to the HIPAA Privacy Rule
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3.
Clarify minimum necessary standard
Alter requirements re: research and Business Associate Agreements
Amend Wisconsin Statute 51.30 (sensitive information)
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4.
Create model policies and procedures re: capture, verification, & match of
patient identifiers with patient information in a health care system
Adopt national standards once defined and accepted
Allow exchange of specific information among providers for treatment purposes without consent
Convene a representative workgroup to identify specific elements
Amend Wisconsin Statute 146 (general information)
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Treat re-disclosure like primary disclosure
Remove documentation requirements beyond HIPAA
Allow disclosure to family and individuals involved with care and
treatment with agreement vs. consent per HIPAA
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Modifying Wis. Stat. 51.30:
Mental Health, AODA, Developmental Disabilities
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Wisconsin Statute Chapter 51.30 Today

Informed Consent Requirement

Treatment records created in the course of providing services to individuals for
mental illness, developmental disabilities, or alcohol or drug dependence at a
treatment facility require consent before disclosing in most situations
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What are some exceptions to s. 51.30’s consent requirement?
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In a medical emergency (undefined)
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The following elements in a related health care entity:
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Patient’s name
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Medications
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Address
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Allergies
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Date of birth
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Other relevant demographic information
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Date of service (s)
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Name of mental health provider (s)
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Diagnosis
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When Does s. 51.30 Apply Today?
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Registration/treatment records which are maintained by
departments, boards and staffs, and treatment facilities that
provide services for mental health, AODA, and developmental
disabilities.
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Generally not to mental health, alcohol and drug abuse and developmentally
disabled treatment records that originate outside of a treatment facility
Generally not to treatment by solo practitioners
Reasonable minds may disagree on application…
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Example: patient presents to family practitioner with complaints of severe
depression requesting an anti-depressant
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Premise for Proposing Modifications to 51.30
 Broadening exchange without consent can:
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Improve the safety and quality of patient care
Increase providers’ ability to give patients optimal care
Reduce the cost of care
Reduce variation in law
Reduce variation in interpretation of law
Facilitate increased enforcement of law
Increase Wisconsin’s potential to participate in multi-state
exchanges
Safeguards can continue to protect patient privacy
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Recommendation 1 (11/06):
Consumer Interests Advisory Group
Amend Wisconsin law governing disclosure of health information to
providers to be consistent with HIPAA, which does not require
patient consent to disclose information to providers about mental
health and developmental disabilities for treatment purposes.
Note: This recommendation was not unanimously supported.
eHealth Board Response
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Strong support for recommendation as submitted
Noting potential controversy and dissatisfaction of some stakeholders,
recommended holding for further consideration in the Privacy Project (first
phase)
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Recc. 2: Privacy Project Implementation Workgroup
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Form a representative workgroup charged with identifying specific elements
that can be exchanged among providers for treatment purposes without
patient consent.
Use the work of phase one as a starting point. Options include:
Proposed Change
Shared without consent
1-Expand
8g
Expand sharing of specific elements permitted under Wis. Stat.
51.30(4)(b)8g* from within a related health care entity to providers
within and outside such an entity.
Specific elements permitted under
Wis. Stat. 51.30(4)(b)8g*
2-Clarify
law
Redefine elements protected by 51.30 to meet provider and consumer
expectations in a more consistent manner.
Specific content and/or elements
TBD.
3-Mirror
146.82
Mirror 146.82 such that treatment records can be exchanged for
treatment purposes without consent.
Contents of treatment records for
treatment purposes. **
4-Match
HIPAA
Modify 51.30 to comport with HIPAA such that treatment records can be
exchanged for purposes of treatment.
Contents of treatment records for
treatment, except psychotherapy
notes per HIPAA. **
* Name, Address, Birth date, Name of mental health provider (s), Date of service (s), Diagnosis, Medications,
Other relevant demographic information
** “Minimum necessary” may still apply if HFS 92.03(n) is retained
Allergies,
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51.30 Workgroup
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Invited Stakeholders
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Mental Health Advocates
Mendota Mental Health Institute
Waukesha County Department of Health and Human Services
AODA Advocates and Administrators
Developmental Disability Advocates
Central Wisconsin Center for the Developmentally Disabled
Physicians (General Practitioner and Psychiatrists)
Privacy Officers/Legal Experts
Information Technology Experts (Vendors and Providers)
Consumer
Data Use Organization
Payer
Large Provider Systems
Wisconsin Hospital Association (WHA)
Wisconsin Medical Society (WMS)
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51.30 Summary
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Key Activities
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Four workgroup meetings in August and September
Workgroup member discussions with colleagues and constituencies for
consideration by the group
Anticipated Outcomes
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Recommended modification of s. 51.30 that allows easier sharing of
necessary health information among providers for treatment purposes
for consideration by the eHealth Board
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Elements that can be exchanged among providers for treatment purposes without
patient consent
Other key areas for consideration
Timeline for completion
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Final 51.30 Workgroup meeting September 28th
Staff follow-up October and beyond
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Clarifying 42 CFR Part 2:
Drug and Alcohol Treatment
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42 C.F.R. Part 2

Federal law that requires consent for the release of records
related to drug and alcohol treatment, except to medical
personnel in a medical emergency

Protections apply to records created in the course of providing
drug and/or alcohol treatment conducted in a program that is
regulated or receives assistance (directly or indirectly) from any
department or agency of the United States
As the more protective law, 42 CFR Part 2 would still control
release of AODA information if there were a change to Wis.
Stat. 51.30. Thus, WI is supporting IN’s efforts to clarify
application of 42 CFR Part 2.
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42 CFR Part 2 Summary
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Key Activities
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Anticipated Outcomes
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Privacy project staff serving on Indiana HISPC’s Multi-State Steering
Committee (Sept – Dec)
Clarification of 42 CFR Part 2
Deepened partnership with Indiana and other states serving on the
multi-state steering committee
Timeline for Completion
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IN to schedule meeting with Substance Abuse and Mental Health
Services Administration (SAMHSA) by Dec. 2007
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Modifying Wis. Stat. 146:
General Healthcare Information
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Privacy Project Implementation Workgroup Recommended
Modifications to s. 146.82
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Intent of proposed changes:
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Eliminate barriers to exchange
Bring Wisconsin law more in line with current practice
Increase consistency with HIPAA
Area.
Current Law
Proposed Change
Documentation
Document all disclosures (written, oral,
etc.) with or without consent.
documentation becomes a legal part of
the patient’s record. *
Require limited documentation of disclosures that
enable the patient to determine who has accessed
his/her health information and when.
(per 45 CFR 164.528)
Re-disclosure
When information is disclosed without
patient consent, the recipient must keep
the information confidential and may not
re-disclose it. **
Add language that allows re-disclosure with
patient consent or otherwise allowed by law.
(per HIPAA)
Disclosure to
individuals
involved in the
care or
treatment of
the patient
Patient consent is required to disclose
health information to individuals involved
in the care or treatment of the patient in
writing or verbally.
Rewrite to allow oral disclosure to individuals
involved in the care or treatment of the patient
with patient agreement. Retain requirements for
patient consent to disclose any copy of a patient’s
medical record.
* Wis. Stats. 146.82(2)(d), 146.83(3)
** Wis. Stat. 146.82(2)(b)
*** Wis. Stats. 146.82 and 146.83
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146.82 Summary

Key Activities
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Discuss proposed changes with selected stakeholder groups, such as:
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Anticipated Outcomes
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Care Everywhere Working Group
Consumer advocacy organizations
WHIE
HIPAA-COW
WHA
WMS
Policy language amending Wisconsin Statute Chapter 146 for consideration
by the eHealth Board
Stakeholder position summary regarding proposed policy language
Timeline for Completion
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Stakeholder meetings held through mid-October
Statutory language to follow
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Consumer Outreach and Education
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Consumer Education and Outreach Summary
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Key Activities
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Town hall meetings focused on increasing consumer comfort with, and
understanding of, electronic health records and health information exchange
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Increased presence of eHealth staff and volunteers at local and national
meetings
Anticipated Outcomes
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Emphasis on privacy and security capabilities
Three geographic locations
Promoted through strategic placement of eHealth Initiative (eHI) materials
Increased public awareness of eHealth and privacy and security capabilities
Comments for consideration by eHealth Board and its Advisory groups
Timeline for Completion
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Town hall meetings held by December, 2007
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Privacy Project Collaborative
Interstate Data Exchange Policy
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Collaborative: Key Activities
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RTI (Grantor) requires participation multi-state collaborative(s)
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Participation includes:
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Planning phase, future ONC funding will support state collaborative
implementation
Monthly calls
Attendance at September in-person meeting
Contributions to Collaborative products
Collaborative: Interstate Data Exchange Policy
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Consent/authorization from patients for use & disclosure of his/her data
Consent/authorization from data sources for use and disclosure of information
provided by the data source
Development of standard consent language and/or consent form
Development of guidelines for opt-in/opt-out decisions that would allow for
exchange between states and/or others
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Transforming Medicaid
Advance regional health information
exchange for the Medicaid population
 Bring benefits of electronic health
records to our Medicaid population
 Reform Medicaid reimbursement system
 Design programs to improve the health
care delivery system and engage
consumers in managing their own health
care
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Governor’s 2007-09 Budget Health Provisions
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Electronic Medical Records Tax Credit (Paper
324):
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Health Care Quality and Patient Safety Council
and Grant Program (Paper 372):
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http://www.legis.state.wi.us/lfb/200709budget/Budget%20Papers/June%208_taxes.htm
http://www.legis.state.wi.us/lfb/200709budget/Budget%20Papers/June%208.htm
Wisconsin Health and Educational Facilities
Authority (no paper completed):
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http://www.legis.state.wi.us/lfb/20079budget/Budget%20Papers/Cover%20sheets/whefa.
pdf
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For more information on the WI eHealth
Initiative

Go to:
http://ehealthboard.dhfs.wisconsin.gov/

DHFS Contacts:
Kathy Farnsworth, eHealth Chief of Staff
[email protected]
(608) 267-2082
Denise Webb, Policy Initiatives Advisor,
Health Care IT
[email protected]
(608) 267-6767
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