Transcript Presenters - Wisconsin State Legislature

Wisconsin eHealth Initiative
Presenters:
Denise Webb, eHealth Program Mgr
Tim Bartholow, MD, Prairie Clinic
Partner
October 17, 2008
Wisconsin eHealth Overview
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Background
Health Information Technology (HIT)
Adoption
Health Information Exchange (HIE)
Health Information Privacy
Health Care Transparency and Public
Reporting
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Background: Executive Order 129
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Issued by Governor Jim Doyle, Nov 2005
Created eHealth Care Quality and Patient
Safety Board
Directed Board to:
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Develop and implement a 5-year Action Plan
Annually assess HIT adoption rate by Wisconsin
heath care providers
Annually report on Board’s plans, activities,
accomplishments, and recommendations
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Background: eHealth Goals
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Make health information available at point of care for all patients
Prevent medical errors
Avoid redundant, unnecessary medical procedures
Improve coordination of care
Promote wellness and prevention
Track and manage chronic disease
Early detection of infectious disease outbreaks
Further health care research
Engage and enable consumers to effectively participate in their
health care decisions
Control health care costs
Measure and publically report on health care quality, safety, and
efficiency
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Background:
eHealth Board 2006 Workgroup Structure
eHealth Board
Chair: DHS
Secretary
Executive
Committee
Patient Care
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Information
Exchange
Consumer
Interests
Financing
Governance
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Background: eHealth Action Plan
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Public-private collaboration for widespread adoption
and use of HIT and HIE
Support for acquisition and use of EHR by small
provider groups and safety-net providers
Creation of a business and technical architecture for
HIE, including a state-level HIE organizational and
governance structure
Updating provisions for security and privacy
Link HIT and HIE to population health improvement
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Background:
Key eHealth Activities thru 2008
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Developed and delivered the 5-year eHealth
Action Plan to Governor Doyle
Completed two annual WI HIT surveys
Completed a health information security and
privacy collaboration project, resulting in
legislation to revise Wisconsin’s health
information privacy laws
Developing regional and state-level HIE
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption and Use
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Goal: Achieve 100% adoption and use of
certified EMR systems and other HIT by
Wisconsin health care providers
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption and Use—Benefits
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Quality
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Reminds physicians about appropriate preventive care
Indentifies harmful drug interactions or possible allergic
reactions to prescribed medications
Helps physicians manage patients with complex chronic
conditions
Can readily provide relevant health literature/handouts from
the EMR system to the patient
Enables patients to interact with their physicians through the
Internet
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption and Use—Benefits
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Efficiency
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Eliminates use of medical transcription
Eliminates or substantially reduces need to
physically pull medical charts for office visits
Provider prompts to prescribe generic
medications instead of costly brand names
Reduces the duplication of diagnostic tests
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption and Use
How are we doing in Wisconsin?
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WI Physician Practice Statistics
Physicians (MD, DO)
PCP
Non-PCP
Physician Distribution
by Group Size
70%
63%
60%
43%
50%
40%
57%
30%
N=13,071
20%
10%
Source: WMS, Oct 08
0%
13% 15%
7%
6%
1
2-9
10-49
50-99
>100
N=13,071
Source: WMS, Oct 08
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Major Health Care Systems
Marshfield Clinic
Affinity
Aspirus
Aurora
Dean
Gundersen
Douglas
Bayfield
Mayo
Burnett
Minnesota
St. Mary's
Lincoln
Taylor
Menominee
St. Croix
Pierce
Marshfield Clinic
Laboratory Only
Oconto
Shawano
Marathon
Pepin
Buffalo
Marinette
Langlade
Chippewa
Dunn
Wheaton
Forest
Price
Rusk
Polk
Theda
UW Health
Florence
Oneida
Barron
St. Luke's
Vilas
Sawyer
Prevea
X
Ashland
Washburn
Ministry
Oakleaf
Michigan
Iron
Eau Claire
Door
Waupaca
Clark
Outagamie
Wood
Portage
Jackson
Trempealeau
Adams
La Crosse
Waushara
Kewaunee
Brown
Winnebago Calumet
Marquette
Monroe
Green
Lake
Juneau
Sheboygan
Fond du Lac
Vernon
Richland
Crawford
Iowa
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Data compiled by Ziegler Capital Markets Group in conjunction
with Systems & Processes Dept, December 2007
Manitowoc
Ozaukee
Columbia
Sauk
Dodge
Dane
Iowa
Jefferson
Grant
Washington
X
Waukesha
Walworth
Lafayette
Green
Rock
Milwaukee
Racine
Kenosha
WI Ambulatory HIT Survey, 2006-2007
Wisconsin Physicians with Electronic Medical Records
Physicians
represented
%
Physicians
Large
systems
Large
systems
physician
%
Ind/small
systems
Small
systems
physician
%
All electronic
2247
36.4%
2154
39%
88
14%
Partially
electronic
2900
47.0%
2749
50%
150
23%
No electronic
records
1022
16.6%
608
11%
410
63%
Don’t know
Total
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1
6170
1
5511
100%
649
Protecting and promoting the health and safety of the people of Wisconsin
100%
10/17/08
WI Ambulatory HIT Survey, 2006-2007
Wisconsin Physicians with Electronic Medical Records
17%
36%
All Electronic
Partially Electronic
None
47%
N=6,170 (47% of WI physicians)
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption Conclusions
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Adoption rates are higher in larger WI
practice sites
Overall adoption rates still low, especially in
smaller group practices
EMR users in WI generally have a positive
impression of the impact the EMR has on
many aspects of their practice
Predominant barrier to adoption--economics
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT Adoption and Use Strategies
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Tax credits
Grants
Loans
Donations/underwriting
Consortia/shared services
Technical assistance—e.g.,MetaStar’s Doctor’s
Office Quality-Information Technology (DOQ-IT)
Incentive payments—e.g. CMS EMR Demonstration
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
HIT – Consumer Perspective
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Need for more education and marketing on
electronic medical records and their benefits
Generational gap—cyber natives vs. cyber
immigrants
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
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Health Information Exchange (HIE)
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State-Level HIE
Regional Level HIE- Emergency Department
(ED) Linking Project
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Achieving Sustainable HIE Industry
in Wisconsin
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Technology and Adoption:
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Business Models:
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Sustainable business models
Governance and Oversight:
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Widespread HIT adoption
An interoperable architecture
Exchange of real-time or near real-time information
A governance body for electronic HIE
A management structure
Accountability structures
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
State-Level HIE Planning and Design
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Task #1—Stakeholder Assessment and Environmental Scan
Task #2—Inventory and assess statewide public and private
technical assets and resources for use in state-level HIE
Task #3—Select and prioritize business use cases for HIE
Task #4—Propose feasible business and technical
architecture options for state-level Wisconsin HIE
Task #5—Develop detailed business and technical plans for
the state-level Wisconsin HIE option selected and approved
by eHealth Board
Task #6—Inform and educate Wisconsin HIE stakeholders on
current market and capabilities of commercially available HIE
solutions and products
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Regional-Level HIE – ED Linking
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Wisconsin Health Information Exchange (WHIE)—
southeast Regional Health Information Organization
(RHIO) covering nine counties
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One-stop, regional health-information search network
Providing access initially to Milwaukee County’s 10 hospital
ED’s, one Milwaukee Federally Qualified Health Center
(FQHC), and three public health departments
Medicaid and hospital systems are funding first phase of
community exchange
Microsoft is contributing development and hosting services
Base product—Microsoft Amalga
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
ED Linking Workflow
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Available data displayed on pick list for clinicians or
support staff
Automatic regional query initiated by registration
message
Returns patient summary info from both local
hospital and outside facilities and Medicaid
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Admission, Discharge, Transfer (ADT) data
Clinically-relevant Medicaid claims data
Review online or print to attach to paper chart
Protecting and promoting the health and safety of the people of Wisconsin
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ED Linking Status
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The health information exchange is receiving live ADT data
from 12 greater Milwaukee metro area hospitals and their
associated service points/clinics
Live in three hospital ED’s and public health with ADT data
only
Go live with Medicaid Data – Nov 2008
Evaluation being conducted by UW-Madison and Medical
College of Wisconsin
ED physicians and public health response is positive
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Health Information Privacy
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Privacy Legislation (enacted April 1, 2008)
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WI Stat. 146, General Health Information
WI Stat. 51.30, Sensitive Health Information (eff.
10/1/08)
Health Information Security and Privacy
Collaboration (Phase III project)
Continued analysis of state’s privacy policy
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Health Care Transparency and
Public Reporting
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Measuring and publishing information on
health care quality, safety, and efficiency
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Wisconsin Collaborative for Healthcare Quality
(WCHQ)
Wisconsin Hospital Association (WHA)
Wisconsin Health Information Organization
(WHIO)
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
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wchq.org
WCHQ Members
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Affinity Health System
Aspirus Wausau Hospital
Aurora Advanced Healthcare
Aurora Health Care
Aurora UW Medical Group
Bellin Health
Columbia St. Mary's
Dean Health System
Franciscan Skemp Healthcare - Mayo
Health System
Froedtert & Community Health
Gundersen Lutheran
Hospital Sisters Health System
LakeShore Medical Clinic
Luther Midelfort-Mayo Health System
Marshfield Clinic
Medical Associates Health Centers
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Medical College of Wisconsin
Mercy Health System
Meriter Hospital
Monroe Clinic
Prevea Health
ProHealth Care
St. Joseph's Hospital
St. Marys Hospital Medical Center
ThedaCare
University of Wisconsin Hospital and
Clinics
University of Wisconsin Medical
Foundation
West Bend Clinic - Froedtert &
Community Health
Wheaton Franciscan Healthcare
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WCHQ Measures
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Breast Cancer Screening
Cervical Cancer Screening
Colorectal Cancer Screening
Diabetes: Blood Sugar (A1c)
Testing
Diabetes: Blood Sugar (A1c)
Control
Diabetes: LDL Cholesterol
Testing
Diabetes: LDL Cholesterol
Control
Diabetes: Kidney Function
Monitored
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Diabetes: Kidney Function
Monitored
Diabetes: Blood Pressure Control
Uncomplicated Hypertension:
Blood Pressure Control
Cardiovascular Conditions: LDL
Cholesterol Testing
Cardiovascular Conditions: LDL
Cholesterol Control
Adults with Pneumococcal
Vaccinations
Tobacco Use Screening
Postpartum Care
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Wisconsin Hospital Association (WHA)
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WHA
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Voluntary statewide public reporting program
Reporting by 122 (or 98%) of Wisconsin
hospitals on health care quality and safety
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Public Reporting on WI Hospitals
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Wisconsin Health Information
Organization (WHIO)
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Voluntary partnership of health care stakeholders
Membership is intentionally diverse to reflect the
varied perspectives of the Wisconsin healthcare
marketplace
Non-profit § 501(c)(3) organization
Formed to create a trusted data source with which to
generate provider performance reports and perform
other health care analytics
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Goals of WHIO
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To aggregate health care data from sources across
the State of Wisconsin to create a single reliable
data source that can be used by multiple
stakeholders to examine variations in efficiency,
quality, safety, and cost
To improve the quality, cost, safety, and efficiency of
Wisconsin health care by sharing the results with
providers, purchasers and consumers
To support provider quality improvement initiatives
To empower consumers to make value-based health
care choices
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WHIO
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Where does WHIO fit?
Who benefits from WHIO ?
Who participates in WHIO?
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WHIO’s Members
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Anthem Blue Cross Blue
Shield of Wisconsin
Greater Milwaukee Business
Foundation on Health
Humana
Employers Health Care
Alliance Cooperative
United Healthcare of
Wisconsin
WEA Trust
WPS Health Insurance
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The Wisconsin Collaborative
for Healthcare Quality
Wisconsin Medical Society
Wisconsin Department of
Health Services
Wisconsin Department of
Employee Trust Funds
Wisconsin Hospital
Association
Group Health Cooperative –
South Central Wisconsin
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
WHIO Data Mart Details
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Initial feeds from Anthem BCBS, United Healthcare, Humana,
WEA Trust and Wisconsin Physicians Service
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27 months of member and claim data
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1.9 million members (fully insured and self funded)
3 additional data sources (including Medicaid) will be added in
2009
January 2006 through March 2008
De-identified Payor, Purchaser/Employer and Member
information
Identified Provider Practice Group but not individual provider
Data Mart delivery (planned 12/08)
Protecting and promoting the health and safety of the people of Wisconsin
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WHIO Data Mart Details (cont.)
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Charged or billed amounts included in data
Ingenix’s Impact Intelligence software
provides access to the data in the data mart
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Software accessible via internet portal
Over 500 pre-programmed measures/analytics
included
Data extracts are supported and accessible
through Excel, SAS or Access.
Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
Wisconsin eHealth Summary
HIT + HIE = BETTER, SAFER, EFFICIENT CARE
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08
QUESTIONS
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Protecting and promoting the health and safety of the people of Wisconsin
10/17/08