Minnesota e-Health Initiative Regional and Cross-Border Considerations in eHealth

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Minnesota e-Health Initiative Regional and
Cross-Border Considerations in eHealth
Wisconsin eHealth Implementation Summit March
15th, 2007 Madison Wisconsin

• Marty LaVenture, MPH, PhD,
• Director, Center for Health Informatics
• Minnesota Department of Health

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Cross-Border Considerations

• Providing Strategic Leadership
• Protecting Communities, Public Health
• Ensuring Privacy and Security
• Enabling Exchange
• Leveraging Funding and Incentives

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Wisconsin/Minnesota Border Context

• 27 Counties border
• 1.5 Million Citizens
• 3 Large City Areas
• 4 emerging RHIOs
• 165 Clinics
• 26 Hospitals
• Plus LTC, Public Health, Home Care agencies and
  more

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Minnesota e-Heath A Summary of Key Milestones

• 2003 Governors 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

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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
04 05
06
07
10
09
11
08
12
Years
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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)

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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

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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
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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

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Examples of Some 45 Projects Emerging Statewide

• Informatics Education
• St. Scholastica
• University of MN

• 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)

• Personal Health Records
• Fairview
• HealthPartners
• Childrens Hosp
• Willmar Project

• Public Health
• MN PHIN
• Fast Forward

• EHR Adoption/Use
• DOQ-IT Project
• Grants Program

• Telehealth
• University of MN

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Stratis Health Primary Care Clinic Survey
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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
Public Health MN PHIN Fast Forward
04 05
06
07
10
09
11
08
12
Years
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Minnesota e-Health and MN-PHIN
Interoperability and Health Information Exchange
MN Public Health Information Network
(MN-PHIN) improving State-Local
effectiveness efficiency
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Public Health Data to Inform Clinical
PracticeExample Influenza ELR Surveillance
Provides Clinical Care Decision Support
(Diagnosis and Treatment)
Decision Support
Public Health
Clinical Care
Surveillance ELR
Adapted from Larry Hanrahan PhD MS, Wisconsin
division of Health
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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

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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.
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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
Public Health MN PHIN Fast Forward
Privacy Security
04 05
06
07
10
09
11
08
12
Years
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Privacy Barriers to HIEs

• Implementation of Minnesotas 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

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Patient Consent - Variations and Barriers

• Minnesotas 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
• Minnesotas requirements were designed for
  paper-based exchanges and are not conducive to a
  real-time, automated electronic exchange

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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

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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
  providers 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 Minnesotas patient consent statutes to
  make the requirements easier to understand for
  patients and health care providers

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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

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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
Public Health MN PHIN Fast Forward
Privacy Security
Exchange Mn Health Care Connection
04 05
06
07
10
09
11
08
12
Years
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Interoperability is More than Wires
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Minnesota Health Care Connection
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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
Public Health MN PHIN Fast Forward
Privacy Security
Exchange Mn Health Care Connection
Funding Incentives 12 Grants
04 05
06
07
10
09
11
08
12
Years
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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

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Key Projects Initiated(Policy Funding
Implementation)
Strategic Leadership Advisory Committee
Public Health MN PHIN Fast Forward
Privacy Security
Exchange Mn Health Care Connection
Funding Incentives 12 Grants
More.
04 05
06
07
10
09
11
08
12
Years
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Opportunities for Collaborative Action

• Metrics / Assessment
• Catalogue our border issues
• Action plans for common projects
• Modernizing Disease outbreak systems

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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

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Thank You!

• 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_at_health.state.mn.us
• Bill Brand Deputy Director, Health Informatics
• 651-201-5508 bill.brand_at_health.state.mn.us