1. Creating an Informatics Profile in Minnesota to Assess Readiness for Interoperability and Use of Standards
PHIN 2008 Conference
Atlanta, August 28, 2008
Perspectives in Interoperability Session
Marty LaVenture, PhD, MPH
Priya Rajamani, PhD
Jennifer Ellsworth, MPH
Minnesota Department of Health

2. Topics E-Health Context in Minnesota Creating an Informatics Profile
Initial Findings
Recommendations for State Health Departments

3. Minnesota e-Health Initiative Vision
“… accelerate the adoption and effective 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 vision for the MN e-Health Imitative was created in 2004 and has guided us ever since:
“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 the focus on both individuals and communities. We are committed to keeping a strong consumer and public health focus to our initiative in Minnesota.
This vision is closely aligned with the goals of health care reform and transformation in that they both focus on increasing quality, safety and access for the benefit of us as purchasers and consumers of health care.
Source: e-Health Initiative Report to the MN Legislature, January 2004

4. 2007/08 Minnesota Legislative Action
State mandate that all healthcare providers have interoperable electronic health records by 2015
Mandate applies to public health both as a provider of care and exchange partner of electronic health information
Establish uniform health data standards by 2009
Develop a statewide plan to meet the 2015 mandate

5. Minnesota’s Statewide Plan Components of the Plan
Part 1: Background
Part 2: Minnesota Model for EHR Adoption
Part 3: Emerging Issues
Part 4: Recommendations
Appendices
Guide 1: Common Barriers
Guide 2: MN. e-Health Standards
Special Interest Area:
# 1 Long Term Care
# 2 Public Health

6. Recommendations for Public Health
Collaboratively define the specifications
Develop business and resource plans
Ensure workforce informatics competency
Identify and seek needed resources
For public health, the recommendations are similar:
Collaboratively define the specifications for making public health information systems more standards-based and interoperable
Develop business and resource plans for modernizing information systems, making them both more integrated and interoperable.
Identify and seek needed resources
Ensure that staff have the informatics knowledge and skill they need to improve the design and use of the information systems

7. Purpose of Informatics Profile
To identify systems of priority interest
To understand the exchange needs / partners
To assess readiness for interoperability and use of standards
To identify barriers and resources needed to increase levels of interoperability and integration

8. Conceptual Model MDH Informatics Profile
Minnesota Department of Health
Information Systems
Includes infrastructure, data sets and applications
Data Partners
(Data Collection by MDH)
Data Partners
(Data Recipients from MDH)
Applications
Data Sets
Collecting Data
Sending Data
Cross cutting issues across all components
Standards
Electronic Exchange Capabilities

9. Informatics Profile Inclusion Criteria
Approx 83 datasets which hold person name level information
Approximatelly 60+ data sets which fulfill ehealth and common ground criteria 9

10. MDH Systems of Priority/Interest
by Type of Program
Minnesota Department of Health Systems #
Acute disease 8
Maternal and child health 4
Chronic disease 3
Injury 2
Vital statistics 1
Laboratory information management system
Total 20
Many public health information systems of interest
MDH is collecting data on various public health systems (related to standards, exchange capabilities and needs, interoperability, and modernization plans for the future)
Close to completion of collection at MDH, next steps will include local health departments and Department of Human Services
Current total is 31 various systems of interest 10

11. Informatics Profile Questionnaire Domains
Core information about system
Number of clients/individuals and transactions/year
Type of information exchanged
Exchange Partners
Exchange methods
Standards – exchange, representation
Integration interest
Interoperability
Readiness for exchange
Barriers/resources
Approximately 40 questions in the survey 11

12. Interoperability of Minnesota’s Public Health Information Systems June 2008
MDH System Interoperability Level
Current / Capability
Level 1
Non electronic data (paper, mail, phone) 4
Level 2
Machine transportable data (fax, , unindexed documents)
Level 3
Includes web based interface. Human action required.
FTP file uploads. 8
Level 4
No human action required. Machine to machine exchange of data (structured messages, standardized content) including HL7 messages 4*
* In process, will increase by 1, in Fall Total = 20
We categorized interoperability levels on current use and planned/capability levels for the systems in 4 incremental changes in interoperability based on the National Alliance for Health Information Technology definition. This information was self-reported for each of the systems based on current use of their system (including current exchange partners) and does not represent interoperability with future/ideal exchange partners – as those numbers would be lower.
Level 4 - Systems currently are / will be so in next 3 years are WIC, BLIS, MIIC, MCSS
Level 3 – Refugee Health, STD Infonet, eHARS, Trauma registry, TBI, stroke registry , MEDSS, Vital Records,
Based on current collection on 19 MDH systems, we know that:
* There is great variability at MDH as it relates to current system interoperability levels – Some systems are currently operating at a high interoperability level or have plans in the near future (based on current modernization plans), but many systems are far from achieving a level 4 interoperability. This is based on a number of factors:
1) Limitations of exchange capabilities of external exchange partners
2) Resource issues (funding, staff/time)
3) Lack of an agency-wide coordinated interoperability plan and/or understanding of what needs to be done
But in reality we have a long ways to go, especially when we what needs to happen to have interoperability with EHRs (in cases where it is appropriate to do so).
Interoperability levels are based on the National Alliance for Health Information Technology definition and based on self-assessment of current system use including current exchange partners. The numbers do not reflect future or desired exchange partners/sources (e.g., EHRs). 12

13. Informatics Profile – Initial Findings
High variability of interoperability levels
Not all functions have equal exchange capability
Not all stakeholders have capability
Strong desire (100%) want to improve exchange capability with stakeholders
Many challenges to improving level of interoperability
Capabilities of external partners
Resources (funding, staff, skill set)
Need for a agency-wide coordinated interoperability plan 13

14. Utilization of Standards For exchange and representation of data
Standards for exchange of data
HL7 standards
Current use: 4 of 20 (20%)
Future: 6 of 20 (30%)
No plans yet: 10 of 20 (50%)
PHIN-MS transport
Standards for representation of data
14 of 20 systems (70%): Use national standards for certain fields for data representation
4 systems (20%): only use CDC provided codes
2 systems (10%): No standards/codes
HL7 & PHIN-MS currently used mainly for lab data (LARS)
Variability extend to this set as well.
ICD – 9 and 10 ,
E.g., immunization registry (CPT, CVX and MVX codes) & cancer registry [ICD-9-CM, CPT, SNOMED-CT and ICD-O (for oncology)] 14

15. Desired Exchange Partners
(Through Better Integration or interoperability with other systems)
MDH Systems
N = 20
This graphs denotes the desired exchange partners (either through better integration or interoperability with other systems). There is a great desire for better interoperability with private providers and hospital, especially through their EHR systems. In addition, there is a great interest in better integration within MDH on related systems (e.g., better integrated child health systems).
MDH = 12 out of 20 systems mentioned wanting to be able to exchange information internally. Of those 12 systems:
5 systems want to be able to exchange with MEDSS
4 systems want to be able to exchange with Vital Statistics
3 systems want to be able to exchange with STD InfoNet
3 systems want to be able to exchange with eHARS
3 systems want to be able to exchange with STD MIS
2 systems want to be able to exchange with WIC
2 systems want to be able to exchange with BLIS (blood lead)
2 systems want to be able to exchange with MIIC
1 system wants to be able to exchange with MCHSN EHDI
1 system wants to be able to exchange with MCSS
Type of Organization / System

16. Barriers to Information Exchange
MDH Systems
N = 20
“Other” category includes:
- Lack of unique personal identifier across systems
- Limitations in capabilities of exchange partners (e.g., local public health, providers)
- Lack of interoperability, difficulty coordinating with entities we exchange with, many silo systems – not connected
- Benefits of enhanced systems are hard to communicate/explain (in some areas cost will go up, in some areas cost will go down, but exact benefit may not come to MDH, e.g., LIMS)
- Political constraints
17 out of 20 programs (85%) mentioned lack of resources as a barrier to efficient exchange of information
Perceived Barriers

17. Barriers – Other Observations
Limitations in capabilities of exchange partners (e.g., local public health, providers)
Lack of interoperability and difficulty coordinating with internal and external exchange partners
Benefits of enhanced systems are difficult to communicate
e.g., in some areas cost will go up, in some areas cost will go down, but exact benefit may not come to a specific system
Political constraints
Lack of unique personal identifier across systems 17

18. Resources Needed for Exchange Perceived Resources Needed
MDH Systems
N = 20
“Other” category includes:
- Agency wide strategic plan for interoperability, coordinated unified approach, plan for implementing PHIN-MS
- Master client index
- Political support, political will, and agency commitment from the top
- Getting providers to have the capability to send HL7 messages
- Political clarifications on who has access to data and what’s permissions to disclose
- Need for adequate IT staff located within program
Perceived Resources Needed

19. Conclusions and Implications for Public Health and Informatics
An informatics profile is feasible & useful for:
Strategic and tactical planning around interoperability
Identify barriers and needs to achieving integration and interoperability.
Increasing awareness for existing projects helping create opportunities for collaboration
Identify needs related to informatics competencies'
Assessing preparedness for integration (internal) and interoperability (external) for executive leadership and policy makers 19

20. Recommendations for Action Create Public Health and Informatics
Assess the informatics status for integration and interoperability
begin now if you have not done so
use a profile or similar tool to help in your process
If you have done an profile or similar, share your tools and findings
Participate in efforts to improve the informatics methods, and tools that help us measure our informatics capacity
Create an organizational focus for Informatics such as a center for health informatics to address interoperability and integration issues and provide agency wide coordination and community exchange partners (a focal point)
Educate your self and others on public Health informatics
Public health havs to be pat of this environment 20

21. Thank You! For more information: www.health.state.mn.us/ehealth
Contact Information:
Priya Rajamani
Jennifer Ellsworth
For more information on the MN e-Health Initiative, here is our website, and here is my contact information for further questions.
Thank you!