11 May Wisconsin Health Information Exchange shares burden of electronic medical records
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.
“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.”