08 May DHC 2007: Hayden says technology creates magic moment for healthcare delivery
Editor’s note: Kevin Hayden, secretary of the Wisconsin Department of Health and Family Services and the former president and chief administrative officer for Dean Health Systems, described the progress Wisconsin is making to advance the use of health information technology, particularly Wisconsin’s eHealth Initiative, a statewide planning effort to promote health IT adoption.
His 23-year career in healthcare administration allowed him to be on the ground floor of both the challenges and the opportunities arising from the use of electronic medical records. “I’ve got a pretty deep systems understanding of how work flows and how clinicians provide care and how the care teams provide care,” he explained. “I’ve not had to learn how the delivery system works and what we can do to improve that as a much better state partner.”
Here are excerpts from the interview.
WTN: Earlier this year, the Governor announced the state would invest $30 million in the adoption of electronic health records. What’s the most effective way to spend that money?
Hayden: Well, the details are in front of the Legislature in terms of the specific direction they may want. The governor believes that this should be prioritized toward smaller providers and other not-for-profit providers that might traditionally have access-to-capital challenges.
WTN: How would it be spent with those particular entities?
Hayden: The details have not yet been worked out. There will be legislation enacted and there will be specific criteria defined for that. I would assume that we would use, consistent with other procurement methodologies, we would look to have a competitive process and try to award those dollars based on the most need.
WTN: Regarding the concept of patient data exchange and RHIOs, what is the bigger challenge – technology interoperability issues between health facilities, or varying medical records handling procedures between health facilities and between states?
Hayden: With the emergence, at the federal level, of federal standards that are being developed to really deal with sort of the technical challenges of System A talking to System B, I think you’ve identified the larger problem, which is the variation between systems and their internal processes and procedures, and aligning those around a common standard, once [it is] defined.
The state is a very vibrant partner in that discussion, and we have, through the eHealth Board, one of the work groups is really focused in on information exchange and making certain that we are really understanding, in the purest sense of public private-partnership, how you get this stuff done because all of us are affected by this.
The work group, which is led by Hugh Zettel from GE Healthcare, is currently contemplating that so, no, we don’t have a finished product to share. What I would like you to know is that we will share all that with you as it develops.
WTN: Is a national or even a regional patient data exchange system really achievable, or should we be content to accommodate patient data exchange within communities or within states?
Hayden: It’s very achievable, and in Wisconsin, the eHealth Board is contemplating four to five regional exchanges. Again, while we’re still in the design phase in some of this, emerging ideas are really centered on the fact that we have, in all parts of the state, large regional integrated networks, not networks in the computer sense but [health] delivery networks that will allow us to leverage existing assets.
WTN: Regarding the eHealth Initiative, last year the governor told a gathering of health professionals attending the eHealth Summit that they need to overcome barriers like organizational jealousies and jurisdictional and proprietary boundaries so that medical records can be transferred. What evidence is there to suggest that they took the message to heart?
Hayden: I think the evidence is the huge amount of collaboration between traditional, competitive health systems to focus in on developing common solutions to the idea of health and health information exchange, and recognizing that the patient data does belong to the patient.
We need to find ways to move that information when a patient, maybe in another geographic area of the state, can get good care where he is not actually a patient. So if I’m in Madison, for instance, and I become ill in Minocqua, that information could be accessed through the Minocqua provider.
WTN: Overall, how would you assess the progress of the eHealth Initiative?
Hayden: 2006 was a planning year to develop the actual report. We now have set a series of annual milestones over the next five years to achieve that. I’m very happy with the progress. A critic might say that we don’t have enough content developed, but that’s the nature of it. This is a very, very complex thing.
In my personal view, this is equivalent to the Internet of the 1990s and the impact electronic medical records will have as they transform the healthcare delivery channels. It’s an absolutely incredible opportunity for us.
The reports set out a series of deliverables. For instance, right now with privacy and security laws, we’re looking at what specific statutory changes would have to take place to, in effect, align current privacy and security rules with health information exchange issues.
WTN: Where does information technology fit in with the governor’s “Health Care for All” agenda to provide health insurance coverage to 98 percent of Wisconsin residents?
Hayden: Well, the governor believes that in five years, the vast majority of all health providers should have access to electronic medical records and be using that. And so that is very much aligned with improved quality and safety goals rather than who will have access to affordable health insurance. When you look at it, we’ve really knitted together all of the key elements.
WTN: What do you want people to take away from your presentation at DHC?
Hayden: This is a magic moment in time to really transform the Wisconsin health delivery landscape. Health information technology and health information exchange are two key ingredients to get that done, and I’m very impressed with the collaborative nature of traditional competitive health systems working together to develop a common answer.
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