1. Regional Health Information Exchange: Getting There
Ed Barthell – Wisconsin Health Information Exchange
Hugh Zettel, GE Healthcare

2. Questions What are RHIOs? Why RHIOs?
What are clinical drivers for RHIOs in WI?
What must happen to permit exchange?
What should we be preparing to do?

3. Medical Trading Areas

4. US Administration’s Cornerstones for Care
Connecting the System: Every medical provider has some system for health records. Increasingly, those systems are electronic. Standards need to be identified so all health information systems can quickly and securely communicate and exchange data.
Measure and Publish Quality: Every case, every procedure, has an outcome. Some are better than others. To measure quality, we must work with doctors and hospitals to define benchmarks for what constitutes quality care.
Measure and Publish Price: Price information is useless unless cost is calculated for identical services. Agreement is needed on what procedures and services are covered in each “episode of care.”
Create Positive Incentives: All parties - providers, patients, insurance plans, and payers - should participate in arrangements that reward both those who offer and those who purchase high-quality, competitively-price health care. [ ]

5. WI 5 Year Pathway Create eHealth technology platform
Increase HIT adoption and use
Foster regional Health Information Exchange
Establish statewide services
Value-based healthcare purchasing
Enhance prevention and disease management

6. WI Assets & Readiness
At least 17 operational projects exchanging personal health information electronically, with 11 more planned
Almost 70% of practice sites have at least partially electronic records
BUT
No common data standards
No common patient index

7. LEAPING INTO THE FUTURE
THE WISCONSIN HEALTH INFORMATION EXCHANGE

8. April 27, 2004
Executive Order 13335
Commitment to the promotion of health information technology to improve efficiency, reduce medical errors, improve quality of care, and provide better information for patients and physicians.
Widespread adoption of interoperable electronic health records (EHRs) within 10 years so that health information will follow patients throughout their care in a seamless and secure manner.
Establishment of Office of National Coordinator for Health Information Technology (ONC)

9. Two Critical Challenges
Interoperability and portability of healthcare information
Encouraging electronic health record adoption

10. HHS - ONC Contracts Standards harmonization – HITSP
Interoperability specs this fall
Compliance certification – CCHIT
EHRs and infrastructure components
National architecture – NHIN (four)
Prototypes for interoperability
Security and privacy – RTI International
Wisconsin participating

11. Interoperability showcase - HIMSS07 in New Orleans.
60 organizations demonstrating interoperability in a clinical workflow.
Based on Integrating the Healthcare Enterprise (IHE) implementation guides.

12. Meta-Community using existing IHE Profiles
Common
PIX Server
Community B
(1)
(1)
Patient Identity
Source
(1)
(3)
XDS Registry
Community A
Cross
Community
Bridge
Patient Identity
Source
(4)
XDS Repository
(4)
(4)
XDS Registry
Community C
Patient Identity
Source
(2)
(6)
(5)
XDS Registry
XDS Repository
Document
Consumer
XDS Repository
(6)
(6)

14. eHealth Care Quality and Patient Safety Board 2007

15. E Health Report to governor November 2006
Governor submits budget
First Quarter 2007
Legislature approves budget First half 2007

17. Wisconsin Health Information Exchange AN OPPORTUNITY TO LEAD
High profile
Local problems
Local talent
Technical infrastructure
Willing partners

18. WHIE Business Plan The value proposition:
The benefits obtained from the exchange of clinical information across institutional boundaries exceed the costs of implementing the exchange.

19. Organizational Infrastructure
Legal agreements
Project Priorities - Pilots
PHASE ONE
Govt funding, Grants
Dues
Organization Early Operations
Priority Projects
Evaluation and ROI Definition
PHASE TWO
Payor funding or transaction fees
Organization Mature Operations
Expand Services and Participants
$ PPM Model with ROI to Payors
PHASE THREE
Potential funding from secondary data sales
Possible Secondary Data Uses
Expanded Decision Support and Quality Tools
PHASE FOUR

20. Actors Systems Clinical User Authentication and Auditing
Clinical Results Source Systems
Sys Admin
Result and Document Delivery System
Patient Record Location and Aggregation
Clinician
Registration Systems
Registration and Claims Repository
Claims Systems
Public Health
Medication Allergy Immunization Repository
PBM, Pharmacy Systems
Patient User Authentication and Auditing
Payor Care Mgt
Patient Pre - Registration System
Decision Support Systems
Patient
Patient Access to Medication System

21. Public Health Surveillance
WHIE ED Linking Project
HIS
HIS
HIS
HIS
HL7 Registration Message
Claims data
WHIE ED Linking System
Azyxxi
Public Health Surveillance
Clinical End Users

25. Wisconsin Health
Information Exchange

26. QUESTIONS ??