Wisconsin eHealth Initiative

1. Wisconsin eHealth Initiative Presenters: Denise Webb, eHealth Program Mgr Tim Bartholow, MD, Prairie Clinic Partner October 17, 2008

2. Wisconsin eHealth Overview • 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

3. Background: Executive Order 129 • Issued by Governor Jim Doyle, Nov 2005 • Created eHealth Care Quality and Patient Safety Board • Directed Board to: • 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

4. Background: eHealth Goals • 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

5. Background: eHealth Board 2006 Workgroup Structure Protecting and promoting the health and safety of the people of Wisconsin

6. Background: eHealth Action Plan • 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

7. Background: Key eHealth Activities thru 2008 • 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

8. HIT Adoption and Use • 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

9. HIT Adoption and Use—Benefits • Quality • 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. HIT Adoption and Use—Benefits • Efficiency • 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

11. HIT Adoption and Use How are we doing in Wisconsin? Protecting and promoting the health and safety of the people of Wisconsin

12. WI Physician Practice Statistics Physician Distribution by Group Size N=13,071 Source: WMS, Oct 08 N=13,071 Source: WMS, Oct 08 Protecting and promoting the health and safety of the people of Wisconsin

13. Major Health Care Systems Marshfield Clinic Affinity Aspirus Aurora Dean Douglas Bayfield Michigan Gundersen Iron Mayo Ashland Vilas Washburn Ministry Sawyer Oakleaf Florence Burnett Oneida Forest Prevea Price Rusk Barron St. Luke's Minnesota Polk Lincoln Marinette St. Mary's Langlade Chippewa Theda Taylor Menominee Dunn Oconto UW Health St. Croix Shawano Marathon Door Wheaton Claire Eau r Pie ce Waupaca Pepin Marshfield Clinic Buffalo X X Clark Kewaunee Outagamie Laboratory Only Wood Brown Portage Jackson Trempealeau Calumet Winnebago Waushara Manitowoc Adams Marquette Crosse La Monroe Sheboygan Green Juneau Lake Fond Lac du Vernon Ozaukee Columbia Richland Sauk Washington Dodge Crawford Dane Milwaukee Iowa X X Iowa Jefferson Grant Waukesha Walworth Racine Kenosha Green Rock Lafayette Data compiled by Ziegler Capital Markets Group in conjunction with Systems & Processes Dept, December 2007

14. WI Ambulatory HIT Survey, 2006-2007 Protecting and promoting the health and safety of the people of Wisconsin

15. WI Ambulatory HIT Survey, 2006-2007 N=6,170 (47% of WI physicians) Protecting and promoting the health and safety of the people of Wisconsin

16. HIT Adoption Conclusions • 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

17. HIT Adoption and Use Strategies • 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

18. HIT – Consumer Perspective • 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

22. Health Information Exchange (HIE) • State-Level HIE • Regional Level HIE- Emergency Department (ED) Linking Project Protecting and promoting the health and safety of the people of Wisconsin

23. Achieving Sustainable HIE Industry in Wisconsin • Technology and Adoption: • Widespread HIT adoption • An interoperable architecture • Exchange of real-time or near real-time information • Business Models: • Sustainable business models • Governance and Oversight: • A governance body for electronic HIE • A management structure • Accountability structures Protecting and promoting the health and safety of the people of Wisconsin

24. State-Level HIE Planning and Design • 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

25. Regional-Level HIE – ED Linking • Wisconsin Health Information Exchange (WHIE)—southeast Regional Health Information Organization (RHIO) covering nine counties • 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

26. ED Linking Workflow • 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 • 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

28. ED Linking Status • 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

29. Health Information Privacy • Privacy Legislation (enacted April 1, 2008) • 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

30. Health Care Transparency and Public Reporting • Measuring and publishing information on health care quality, safety, and efficiency • 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

32. wchq.org

33. 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 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 WCHQ Members Protecting and promoting the health and safety of the people of Wisconsin

34. 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 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 WCHQ Measures Protecting and promoting the health and safety of the people of Wisconsin

35. Wisconsin Hospital Association (WHA) Protecting and promoting the health and safety of the people of Wisconsin

36. WHA • 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

37. Public Reporting on WI Hospitals Protecting and promoting the health and safety of the people of Wisconsin

38. Wisconsin Health Information Organization (WHIO) • 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

39. Goals of WHIO • 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

40. WHIO • Where does WHIO fit? • Who benefits from WHIO ? • Who participates in WHIO? Protecting and promoting the health and safety of the people of Wisconsin

41. 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 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 WHIO’s Members Protecting and promoting the health and safety of the people of Wisconsin

42. WHIO Data Mart Details • Initial feeds from Anthem BCBS, United Healthcare, Humana, WEA Trust and Wisconsin Physicians Service • 1.9 million members (fully insured and self funded) • 3 additional data sources (including Medicaid) will be added in 2009 • 27 months of member and claim data • 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

43. WHIO Data Mart Details (cont.) • Charged or billed amounts included in data • Ingenix’s Impact Intelligence software provides access to the data in the data mart • 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

44. Wisconsin eHealth Summary HIT + HIE = BETTER, SAFER, EFFICIENT CARE Protecting and promoting the health and safety of the people of Wisconsin

45. QUESTIONS Protecting and promoting the health and safety of the people of Wisconsin