wisconsin health information exchange

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Wisconsin Health Information Exchange shares burden of electronic
medical records
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Lincoln BrunnerMay 11, 2005 Comments Send article Digg this story
Reprints RSS/subscribe Add to Delicious As America's health care costs
continue to rise, the need for the health-care industry to harness the
information exchange potential of the Internet has never been more
urgent.

In that spirit, the Wisconsin Health Information Exchange (WHIE) has
joined more than 150 statewide and regional efforts across the country
in the mammoth task of creating localized systems in which clinics,
hospitals, nursing homes and home health-care providers can share
patient information electronically.

WHIE is one of nine projects nationwide that received funding last
year from the Connecting Communities for Better Health (CCBH) program,
which provided WHIE with $100,000 in seed money. CCBH is funded by a
cooperative agreement with the federal government's Health Resources
and Services Administration Office for the Advancement of Telehealth.
Its overall purpose is to provide startup funds and tech support to
collaborative efforts that use electronic health information exchanges
to drive improvements in health care.

More than 30 health-care providers in nine southeast Wisconsin
counties belong to WHIE. Right now, the organization's big push is to
create the relationships necessary to the voluntary exchange of
information that to date has been considered proprietary by most
providers.

"Our belief is that competing health-care organizations need a
trusted, neutral organization to govern health information exchange,"
said Seth Foldy, who is leading WHIE's efforts as principal
investigator for the CCBH grant. WHIE will function as a membership
organization in which providers control it along with other
stakeholders, Foldy said.Advertisement "What is clear is that WHIE is
not interested in being the owner of data, but of facilitating
exchange between willing partners," Foldy said. "Government and public
health will have an interest. Quality improvement organizations will
have an interest. Patients will have an interest."

One of those quality improvement organizations is MetaStar Inc., a
Madison-based company that, among its other contracts, is in charge of
improving quality of care for Medicare beneficiaries in the state.
MetaStar's Jay Gold, a member of WHIE's Working Group, said that one
of the benefits of such an exchange will be real-time patient alerts
for conditions such as a medication allergy.

"There are a lot of different systems out there, and they don't always
talk to each other," said Gold, who was one of Foldy's professors at
the Medical College of Wisconsin years ago. "We've had a history of
working with paper systems, and frequently that's meant that
information isn't available either because the chart isn't there, it's
on another system or the studies haven't been transferred."

"When a patient comes to the emergency room, it would be a very good
thing if the people at the emergency room could go into their computer
and find out about their patient, whether you're talking about
allergies, whether you're talking about labs, or whether you're
talking about past medical history," he said.

Information networks such as WHIE would also be a boon to public
health efforts. Foldy, who was the health commissioner for the city of
Milwaukee from 1998 to 2004, noted that the type of seamless
information exchange envisioned by WHIE and other such groups, loosely
known as regional health information organizations, might have helped
the city respond more quickly to the 1993 cryptosporidium outbreak
that killed more than 100 people and struck more than 400,000 with
severe diarrhea.

"If public health had a tap into that kind of information, it could
have led to earlier recognition," Foldy said. "The outbreak would
already have happened, but people might have been told to boil water
quicker, and some morbidity might have been prevented. You had a
situation where half the metropolitan area simultaneously had severe
diarrhea, and the health department did not know an outbreak was going
on. This is even when half the health department has diarrhea."

Following up on President Bush's call for nationwide electronic
medical records (EMRs) within a decade down to the nurse scrambling
for a paper chart that's tucked away somewhere across the clinic,
rapid electronic exchange of health-care information has captured the
attention of the health-care industry. But getting there is a matter
of developing a system that exchanges structured data rather than just
documents, said John Traxler, another member of WHIE's Working Group.

"There are different levels of interoperability," said Traxler, the
program director for the Milwaukee School of Engineering and Medical
College of Wisconsin's joint master of science in medical informatics
program. "If you're a doctor and I send you a patient's information in
a PDF file, it's about the same as faxing it. The machine can't do
anything with that information."

"If I send you structured data, where each data element is
machine-recognizable, the machine can perform some logical functions
on it," he continued. "It can detect whether the potassium level that
the lab just sent is too low, and it can send out an alert or a
reminder, maybe even to my pager. That's a whole level up. Just
getting the information available, even if it was by a PDF file, would
be an advantage. The real value will come, though, when we have
completely structured data."

That kind of data bridging can cost major dollars, a fact of which
Foldy and his WHIE cohorts are all too aware. Foldy estimates that
WHIE will need $1 million to $2 million per year for several years to
implement its system. "The moment you start building any information
infrastructure, we are talking real money," he said.

Where will it come from? Up-front costs likely will be shouldered by
government agencies, foundations, insurers and employers, Foldy said.
Sustaining the system probably should be the job of health-care
providers and other organizations, such as pharmacies and
laboratories, that also are likely to see a decrease in their costs.

"Purchasing a lot of health information systems internally,
organization by organization, without being able to share information
between them, negates a lot of the value," Foldy said. "Many of them
know information exchange is required in the long run to get the full
value from their investment in health information technology. Even
though they don't know for sure that we will succeed, they're still
investing millions and millions of dollars in health information
technology; so they need us to succeed."

Efforts similar to and larger than WHIE already are. The Indiana
Health Information Exchange in Indianapolis, in the works for several
years, was another of the CCBH's group of nine beneficiaries and now
is considered the model regional health information organization in
the country. The IHIE really has been up and running only since
January, said Dave Matheson, senior vice president of Boston
Consulting Group, which oversaw creation of the IHIE.

Matheson said that while writing the bridge software for the IHIE cost
the IHIE tens of millions of dollars, it was still less than the $100
million it might cost a hospital to install a full system for
electronic medical records and was not even the most significant
hurdle the IHIE had to leap in getting itself fully operational.

"The real obstacle is political will and the competitive dynamic
between health-care institutions and the city (of Indianapolis),
whether they are willing to expose themselves to some of the risks
that come from making their operations transparent to one another,"
Matheson said. "What this really does is allow the performance of one
hospital and physician group to be compared very directly to one
another. Lots of things become transparent that have been very
opaque."

Lincoln Brunner is a WTN contributing editor and can be reached at
lincoln@wistechnology.com. Send article Reprints RSS/Subscribe Add to
Delicious Digg this story Slashdot It!

Comments
--------

Jim Rice responded 4 years ago: #1
----------------------------------

It is astounding what would happen if we could all agree that the
ownership of the medical record is the patient’s and is carried on the
person like a driver’s license. Stepping back and viewing the problem
from afar, it is clearly not a technological problem that we do not
have a portable and complete medical record that could be used in
computer assisted diagnosis. The technology was available and proven
15 years ago. The problem is political, ideological and sociological.
I am convinced that the market would solve the problem in a few short
years of regulation were to get out of the way.

kaila l owens responded 2 years ago: #2
---------------------------------------

In an age when doctors would rather see their patients die than face
them in court...how accurate is the technology for medical records and
where is the availability of the patients rights to retain ownership
of their own medical records to ensure QUALITY CONTROL to prevent, not
only discrimination, but further abuses and attrocities. In an age
where Scientology minded confabulation of facts to retain the
supremecy of an elite few drives WIS-PIC and like minded guerilla
tactics and money machines, where does the domination and suppresion
of the individual stop?

You people disgust me. Not only have you made me physically ill by
your incompetence, but sick to my soul as well.

Have a ##### day.

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