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

2. MDH - Minnesota e-health initiative Cross-Border Considerations  Providing Strategic Leadership  Protecting Communities, Public Health  Ensuring Privacy and Security  Enabling Exchange  Leveraging Funding and Incentives

3. MDH - Minnesota e-health initiative 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

4. MDH - Minnesota e-health initiative 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

5. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee

6. MDH - Minnesota e-health initiative 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)

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

8. MDH - Minnesota e-health initiative 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.” Source: Committee Report to the Legislature, January 2005

9. MDH - Minnesota e-health initiative 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

10. Examples of Some 45+ Projects Emerging Statewide Personal Health Records Fairview HealthPartners Children’s Hosp Willmar Project 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) Telehealth University of MN Informatics Education St. Scholastica University of MN Public Health MN PHIN Fast Forward EHR Adoption/Use DOQ-IT Project Grants Program

11. MDH - Minnesota e-health initiative Stratis Health Primary Care Clinic Survey

12. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee Public Health: MN PHIN – Fast Forward

13. MDH - Minnesota e-health initiative Minnesota e-Health and MN-PHIN Interoperability and Health Information Exchange MN Public Health Information Network (MN-PHIN) – improving State-Local effectiveness & efficiency

14. Public Health Data to Inform Clinical Practice Example: Influenza ELR Surveillance Provides Clinical Care Decision Support (Diagnosis and Treatment) Clinical Care Public Health Surveillance ELR Decision Support Adapted from: Larry Hanrahan PhD MS, Wisconsin division of Health

15. MDH - Minnesota e-health initiative 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

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.

17. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee Privacy & Security Public Health: MN PHIN – Fast Forward

18. MDH - Minnesota e-health initiative 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

19. MDH - Minnesota e-health initiative 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

20. MDH - Minnesota e-health initiative 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

21. MDH - Minnesota e-health initiative 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

22. MDH - Minnesota e-health initiative 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

23. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee Privacy & Security Public Health: MN PHIN – Fast Forward Exchange: Mn Health Care Connection

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

25. MDH - Minnesota e-health initiative Minnesota Health Care Connection

26. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee Privacy & Security Public Health: MN PHIN – Fast Forward Funding & Incentives: 12 Grants Exchange: Mn Health Care Connection

27. MDH - Minnesota e-health initiative 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

28. MDH - Minnesota e-health initiative Key Projects Initiated (Policy – Funding – Implementation) 04 0506071009110812 Years Strategic Leadership: Advisory Committee Privacy & Security Public Health: MN PHIN – Fast Forward More…. Funding & Incentives: 12 Grants Exchange: Mn Health Care Connection

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

30. MDH - Minnesota e-health initiative 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

31. MDH - Minnesota e-health initiative Key Contacts for More Information: www.health.state.mn.us/ehealth  Minnesota Department of Health Marty LaVenture, PhD – Director of Health Informatics 651 201-5950 martin.laventure@health.state.mn.usmartin.laventure@health.state.mn.us Bill Brand– Deputy Director, Health Informatics 651-201-5508 bill.brand@health.state.mn.usbill.brand@health.state.mn.us Thank You!