1. March 15, 2007
Minnesota e-Health Initiative Regional and Cross-Border Considerations in eHealth
Wisconsin eHealth Implementation Summit
March 15th, 2007 – Madison Wisconsin
Marty LaVenture, MPH, PhD,
Director, Center for Health Informatics
Minnesota Department of Health
Minnesota e-Health Initiative - Marty LaVenture

2. Cross-Border Considerations
March 15, 2007
Cross-Border Considerations
Providing Strategic Leadership
Protecting Communities, Public Health
Ensuring Privacy and Security
Enabling Exchange
Leveraging Funding and Incentives
Improved practice results in improved health of populations
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture 2

3. Wisconsin/Minnesota Border Context
27 Counties border
~ 1.5 Million Citizens
3 Large City Areas
~ 4 emerging RHIO’s
~165 Clinics
~26 Hospitals
Plus LTC, Public Health, Home Care agencies and more
MDH - Minnesota e-health initiative

4. Minnesota e-Heath: A Summary of Key Milestones
March 15, 2007
Minnesota e-Heath: A Summary of Key Milestones
2003: Governor’s Health Cabinet established
2004: E-Health Records Work Group
Report to Legislature, January 2005, outlines vision and roadmap for strategic action
2005: MN e-Health Advisory Committee
4 year commitment of statewide leadership
2006: Governor Proposed $12 Million in matching grants. Legislature Funded $1.5 Million for 2006.
2007 and Beyond: Continued work and progress
Our Approach has also been incremental over several years.
You all know how critical it is to have strong buy-in and support from the Governor and from legislative leaders. That commitment has been steadily growing in Minnesota, beginning with a charge to my agency to work with others in creating a broad vision for e-Health. This year, the Governor’s Health Cabinet identified e-Health as a top priority across all agencies. Governor Paawlenty’s commitment to this issue is substantial and very heartening.
This year, the Governor called for $12 million in his State of the State address for matching grants that would support adoption of EHRs in clinic serving rural and underserved populations.
In the legislative session that just ended, the initiative was funded at $1.5 million. While not the $12 million requested by the Governor, it is still important progress because it shows bi-partisan legislative support during a non-budget year. Legislators had asked for concrete details so they can see the barriers, value, and benefits of HIT. With the funding that was passed, we can now fund pilots to build a success story – and document the remaining needs and gaps -- that can be brought back to the legislature to develop future funding initiatives.
This is a continuing priority
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

5. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year. 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

6. Strategic Leadership: MN e-Health Advisory Committee
March 15, 2007
Strategic Leadership: MN e-Health Advisory Committee
Co-Chairs: Mary Brainerd, Mary Wellik
Members Representing
Hospitals * Health plans
Physicians * Primary Care
Nurses * Purchasers (Public and Private)
Long Term Care * Academic/Research
Pharmacies * Public health (Local and State)
Citizens * Labs
Quality improvement Organization
Other Experts (5)
The MN statewide steering committee is represented by key stakeholders groups
This committee consists of 26 senior level executives, leaders and experts representing:
hospitals, small and large appointed by the MN HA
health plans – appointed by council of health plans
Physicians – appointed by MN Medical Assoc.
nurses, - by the MNA
other healthcare providers,
academic institutions,
state government purchasers,
local and state public health agencies,
citizens, and others with expert knowledge of health information technology and electronic health record systems
As represented by this slide.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

7. MDH - Minnesota e-health initiative
Strategic Leadership
Strategic Leadership Includes…
Clear Vision and Scope
Road Map for Action
Help Focus and Set Priorities
Public Funding and Policy
Assess, Evaluate and Monitor Progress
MDH - Minnesota e-health initiative

8. Minnesota e-Health Initiative Vision & Multi-Dimensional Model
March 15, 2007
Minnesota e-Health Initiative Vision & Multi-Dimensional Model
“… 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.”
This Minnesota Advisory Committee adopted a common goal and vision among a variety of stakeholders statewide
This vision for e-Health, that is:
“to accelerate the adoption and use of health information technology to:
Improve healthcare quality;
Increase patient safety;
Reduce health costs; and
Enable individuals and communities to make the best possible decisions.
Note that the focus on both individuals and communities.
We are committed to keeping a strong consumer and public health focus to our initiative in Minnesota.
Also Note the picture adopted by the committee:
This reflects the overlapping domains within the outline of the state of Minnesota,
a model you’ll no doubt recognize being adapted from the 2001 report by the National committee on vital and health statistics.
The intersecting domains are:
Clinical – representing clinical / Medical related information.
Consumer – representing Personal health information.
Research and policy – representing information essential for research and policy decisions.
Public Health - / Population Health representing information to assure healthy communities.
Source: Committee Report to the Legislature, January 2005
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

9. Minnesota e-Health Focus
March 15, 2007
Minnesota e-Health Focus
Empower Consumers with the information they need to make informed health decisions
Inform and Connect Healthcare Workers so they have access to the information they need.
Protect Communities with accessible prevention resources, and rapid detection and response to community health threats.
Ensure Infrastructure needed to fulfill the e-Health vision
Our e-Health initiative has four key components to its mission. These are the areas in which we are focusing our resources in order to make demonstrable progress toward the vision.
We seek to empower consumers by providing ready and timely access to the information they need to make informed health decisions.
We also want to make sure that healthcare workers have the information they need, to make accurate, safe and appropriate care decisions for their patients.
Protecting communities is a third key component of our mission, ensuring that prevention and self-care resources are available in the community, as well as effective emergency preparedness resources.
And because we know we cannot achieve the first three mission areas without improvements in our health information technology infrastructure, we have established a goal area to specifically address the improvements our advisory committee believes we need in that area.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

10. Examples of Some 45+ Projects Emerging Statewide
March 15, 2007
Examples of Some 45+ Projects Emerging Statewide
Informatics Education
St. Scholastica
University of MN
Exchange Projects
MnHCC – Statewide coordination
CHIC/SISU – Northeast MN
Shared Abstract: (AHRQ grant)
MIIC – Immunization registry
Medications – e-prescribing through the HIPAA Collaborative
Winona community exchange project
Itasca County Health Network
Community Collaborative Grants (3)
Personal Health Records
Fairview
HealthPartners
Children’s Hosp
Willmar Project
This figure shows some of the many many projects occurring in communities across the state.
We had a chance to hear from many of these projects this year.
All are all very exciting and showing important progress
There are many more projects under way and the advisory committee has cataloged these projects.
The catalog is available on our website.
Significant Progress in being made in communities across the state
Public Health
MN PHIN
Fast Forward
EHR Adoption/Use
DOQ-IT Project
Grants Program
Telehealth
University of MN
Minnesota e-Health Initiative - Marty LaVenture

11. Stratis Health Primary Care Clinic Survey
March 15, 2007
Stratis Health Primary Care Clinic Survey
Electronic Health Record Use in Minnesota’s Primary Care Clinics
Stratis Health conducted a survey of adult primary care clinics to assess the current status of EHR implementation. Seventy-five percent of 603 total adult primary care clinics completed the survey from June 2005 to October The survey showed that 46% of respondents have implemented, or are in the process of implementing, an EHR (Figure 1).
At the other end of the spectrum, 27% indicated “not implemented,” with no plans of EHR implementation within the next 24 months. Large clinic providers, which are most likely urban, are much more likely to have fully or partially implemented electronic health record systems than are smaller providers, which are most likely rural. The survey found that approximately 57% of Minnesota’s larger clinics have EHRs fully or partially implemented, compared to 25% for smaller clinics.
The survey respondents identified three government policy actions that would impact their decision to implement EHR:
provide grant funds to assist in the purchase of an EHR;
provide tax credits for investment in EHR; and
provide low interest loans for the purchase of an EHR.
According to survey respondents, the top three barriers that have slowed/prevented implementation of an EHR in these clinics were:
lack of capital resources to invest in an EHR;
concern about loss of productivity during transition to EHR system; and
concern about physician ability to input data into a computerized medical record.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

12. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year. 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

13. Minnesota e-Health and MN-PHIN
March 15, 2007
Minnesota e-Health and MN-PHIN
Interoperability and Health Information Exchange
MN Public Health Information Network (MN-PHIN) – improving State-Local effectiveness & efficiency
As you can see, Minnesota e-Health encompasses a comprehensive health information infrastructure, including clinical, population, personal, and research dimensions.
Minnesota e-Health has started with two key areas areas:
the Interoperability and Exchange of vital Health Information ( e.g Access to history of lab tests, a complete medication history, communicable diseases reporting, and Immunizations.
Minnesota PHIN – with an emphasis on improving electronic exchange between agencies to improve the state-local effectiveness and efficiency.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture 13

14. Public Health Clinical Care
March 15, 2007
11/11/2018
Public Health Data to Inform Clinical Practice Example: Influenza ELR Surveillance Provides Clinical Care Decision Support (Diagnosis and Treatment)
Decision Support
Public Health
Clinical Care
Slide 9
Public Health’s current way of thinking and operation is largely as a receiver of clinical health information. The example here is electronic laboratory reporting of influenza test results to public health for real time influenza surveillance. But with an integrated health information network that fully supports the population health domain, a real-time feedback loop is possible. A public health view can be displayed back to clinicians to assist in diagnosis and treatment decision support.
Surveillance ELR
Adapted from: Larry Hanrahan PhD MS, Wisconsin division of Health
Minnesota e-Health Initiative - Update
Minnesota e-Health Initiative - Marty LaVenture 14

15. MDH - Minnesota e-health initiative
March 15, 2007
Why do we need MN-PHIN?
Limited ability to electronically exchange data with community partners (e.g., providers, hospitals, LTC, jails).
Inability to consolidate data for comprehensive view of community/ population health
Silo information systems; little interoperability
Inefficient/sub-optimal client services because of fragmented data
The last bullet highlights what public health has to overcome is we are to be an integral part of the e-Health transformation. The current limits to our ability to exchange data is one reason MN-PHIN is focusing early on adopting data standards.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

16. MDH - Minnesota e-health initiative
The Frustrations and Dreams of Local Staff
Day-long interviews with eleven agencies highlighted areas MN-PHIN needs to focus on to break down silos.
MDH - Minnesota e-health initiative

17. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
Privacy & Security
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year. 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

18. Privacy Barriers to HIEs
Implementation of Minnesota’s Patient Consent Requirements
Patient consent required for nearly all disclosures of health records – including treatment
Patients need to give written consent
Consent generally expires within one year
Limited exceptions to consent
Medical emergency
Within “related health care entities
Consents that do not expire
Disclosures to providers being consulted
Disclosures to payers for payment
MDH - Minnesota e-health initiative

19. Patient Consent - Variations and Barriers
Minnesota’s patient consent requirements cause a barrier to the electronic exchange of health information because:
Health care providers cannot agree on “when” and “how” patient is required to exchange patients’ health information
Minnesota’s requirements were designed for paper-based exchanges and are not conducive to a real-time, automated electronic exchange
MDH - Minnesota e-health initiative

20. Legislative Solutions
10 Statutory Modifications for Legislative Consideration
Clarify undefined terms and ambiguous concepts:
Define “Health Record”
Define “Medical Emergency”
Define “Related Health Care Entity”
Clarify “Current Treatment”
Apply consent requirements to new concepts:
Introduce and define “Record Locator Service”
Introduce and define “Identifying Information”
Apply consent requirements to a Record Locator Service
MDH - Minnesota e-health initiative

21. Legislative Solutions (cont)
10 Statutory Modifications for Legislative Consideration
Update mechanisms that facilitate the electronic exchange:
Create ability of a provider to rely on another provider’s representation of having obtained consent
Develop a legal framework for allocating liability between disclosing and requesting providers
Permit representation of consent to be transmitted electronically when requesting patient information
Recodify Minnesota’s patient consent statutes to make the requirements easier to understand for patients and health care providers
MDH - Minnesota e-health initiative

22. Security: 4As: What Are They?
March 15, 2007
Security: 4As: What Are They?
Authorizing individuals to access patient data
Authenticating individuals when accessing patient data
Setting Access controls to appropriately limit authorized individuals’ access to patient data
Coordinating Auditing activities across organizations to assure patient data has not been inappropriately accessed
Authorization refers to the official management decision to permit access to information systems and patients’ health information.
Authentication refers to the basic processes and mechanisms for validating that someone is who they claim to be. The authentication process is usually based on one or more of the following factors:
Something a person knows (e.g., account/user name, password, PIN, ID number);
Something a person has (e.g., token, bank card, driver’s license, passport); or
Something a person is (e.g., biometrics, fingerprint, retina, DNA, signature).
Access Controls refers to the policies, procedures, processes, and mechanisms for granting or denying specific requests to obtain and use patients’ health information through information systems.
Auditing refers to the review and examination of records and activities to assess the adequacy of systems controls for ensuring compliance with established policies and operational procedures for appropriately accessing patients’ health information.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

23. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
Privacy & Security
Exchange: Mn Health Care Connection
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year. 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

24. Interoperability is More than Wires
MDH - Minnesota e-health initiative

25. Minnesota Health Care Connection
March 15, 2007
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

26. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
Privacy & Security
Exchange: Mn Health Care Connection
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year.
Funding & Incentives: 12 Grants 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

27. Minnesota E-Health Grant Program
March 15, 2007
Minnesota E-Health Grant Program
2006: $1.5 million in one time grants
Matching Grants to Communities for interoperable EHR
Focus is on rural providers and underserved areas of the state.
2007 Governors $29.5M Proposed e-Health Grants Initiative
The Governor recommends $29.5 million over three years for investments in health information technology to improve patient safety, interconnect clinicians and communities, and strengthen and improve public health in Minnesota.
The initiative:
Provides matching grants to rural health care providers and underserved areas of Minnesota for adoption of interoperable electronic health records, health information exchange and personal health records.
Supports implementation of the Minnesota Public Health Information Network project to upgrade local health department information systems.
Supports technical assistance to grantees and local health departments.
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

28. Key Projects Initiated (Policy – Funding – Implementation)
March 15, 2007
Key Projects Initiated (Policy – Funding – Implementation)
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
Privacy & Security
Exchange: Mn Health Care Connection
This slide is intended to show over time the relationship of the advisory committee to other activities.
For example in red is the The Statewide advisory committee. This committee is chartered until 2009.
Our approach has been to incubate and support spin off projects.
Two spin off projects shown in this figure are the Minnesota Health Care Connection and the Minnesota public health information network.
Our hope is that these project will be ongoing.
Other projects like the Privacy and Security projects will operate for a set period of time.
The committee has identified a number of new projects that we anticipate will be launched as in the coming year.
Funding & Incentives: 12 Grants
More…. 06 07 08 09 10 11 12
Years
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture

29. Opportunities for Collaborative Action
Metrics / Assessment
Catalogue our border issues
Action plans for common projects
Modernizing Disease outbreak systems
MDH - Minnesota e-health initiative

30. Opportunities for Action (continued)
Collaborate model consent forms
Collaborate on consumer information material
Develop model practices for security
Develop action plans for common projects
Collaborate model for value proposition
MDH - Minnesota e-health initiative

31. MDH - Minnesota e-health initiative
March 15, 2007
Thank You!
Key Contacts for More Information:
Minnesota Department of Health
Marty LaVenture, PhD– Director of Health Informatics
Bill Brand– Deputy Director, Health Informatics
Thank you
MDH - Minnesota e-health initiative
Minnesota e-Health Initiative - Marty LaVenture