02 Dec Gov. Doyle establishes new eHealth Board for statewide information exchange; experts raise concerns
Milwaukee – Developing a framework for sharing patient medical records was set into motion Tuesday with the signing of an executive order by Wisconsin Governor Jim Doyle, creating the Wisconsin Relay of Electronic Data (WIRED) for Health Board.
The goal is to establish a structure for statewide exchange of health information records by June 1. However, some experts have concerns as to the cost, timeline and sustainability of the business and operational model.
Wisconsin is receiving $9.44 million in federal Recovery Act funds to support efforts to create a state heath information exchange. The estimated cost to establish a fully operating health information exchange statewide was set at $1.2 billion by the Finance Committee of the original Wisconsin e-Health Board, according to Peter Stombom, former CIO for Meriter Hospital in Madison and a founder and past Chair of the national CIO healthcare association CHIME.
“Nine million [dollars] is not even a drop in the bucket to achieve what the Governor is talking about,” said Strombom who has previously raised concerns about what he believes is a fast timetable for Wisconsin’s Department of Health Services projects.
“To have all health care systems in Wisconsin participating in this – it can’t happen,” Strombom said. “It can’t happen in five years. And what about the 60 to 80 rural hospitals in Wisconsin that don’t have [an electronic] health records system?”
The model for what is being proposed to share patient information in Wisconsin is based on Regional Health Information Organizations (RHIO), and Strombom says that RHIOs are essentially a failed model. Across the nation, RHIOs have suffered from a lack of community acceptance and viable business plans to sustain them.
“It is telling that only a handful of RHIOs continue in business from the several hundred that were founded on initial seed money only to fail when those funds became exhausted,” said Strombom, president of a consulting firm, Strombom Associates. “Well over 200 RHIO’s have failed over the last five years.”
“The key thing is, we don’t need to do this,” he added. “Interoperability has already been proven where access can be made from hospital to hospital. We don’t need these large sums of money to achieve interoperability of health care records.”
While acknowledging that many health information exchanges have been unsuccessful in becoming sustainable, the exchanges are called for as part of “meaningful use” of medical care under the American Recovery and Reinvestment Act, says Kim Pemble, executive director of Wisconsin Health Information Exchange, a regional health exchange in Southeast Wisconsin that allows for sharing of patient medical records that includes five separate health systems, one community health center, and a total of 22 hospitals.
“It (ARRA) specifically calls for health information exchanges as part of meaningful use,” Pemble said. “The interoperability goals of electronic health care across organizational and vendor lines really call for a structure like this. What services we are providing and how we are providing it is yet to be determined.”
Governor Doyle selected Aurora Sinai Samaritan-Milwaukee Heart Institute, an inner city hospital in downtown Milwaukee to make the announcement, presumably as an example of how sharing medical records is already working. One of the many ways that sharing patient medical records can help is in inner city hospitals, where low income residents tend to make frequent and often unnecessary emergency room visits. By having a patient’s medical information available, it can curtail these types of visits, and also prescription drug abuse, said Dr. John Whitcomb, director for patient records access at Sinai Samaritan.
Doyle said that a secure electronic exchange will make it easier to transfer needed medical records from one hospital to another, benefiting patient safety while reducing duplication in medical tests and decreasing administrative costs.
The WIRED for Health Board replaces the eHealth Care Quality and Safety Board, and is charged with developing a formal plan for a statewide health information exchange by June 1. The new board is expected to:
- Outline provisions for oversight and accountability
- Identify, secure and provide funding to build capacity and ensure long-term sustainability.
- Provide a technical infrastructure
- Help health care providers use and exchange electronic records
- Provide for the operation and flow of information.
- Create a common set of rules for exchanging health information while protecting patient interests.
The Board, which has yet to be named, will consist of 14 members representing a commercial payer, a patient or consumer organization, hospitals, physicians, the business community, pharmacies, laboratories, higher education, quality/health organizations, public health, Medicaid and the State Chief Information Officer. To learn more about the board seat descriptions and committee and to apply see http://dhs.wisconsin.gov/ehealth/WIREDforHealth/index.htm.
Doyle’s executive order also sets a framework for legislative action to establish a permanent infrastructure for using and exchanging electronic records when the Legislature reconvenes in 2010.
Dr. Barry Chaiken, MD chief medical officer of Boston- based DocsNetwork, and Chair of HIMSS, (Healthcare Information and Management Systems Society) says the effort to exchange health information is a political challenge, with many competing interests that want to be involved in creating the structure.
“This is the first step in identifying the structure, the architecture, the key technical issues, and the key stakeholders,” said Chaiken, who has worked on quality improvement studies, health IT clinical transformation projects, and clinical investigations for the National Institutes of Health, U.K. National Health Service, and Boston University Medical School.
“But this is probably extremely ambitious – the actual date that Wisconsin will have a functioning health exchange we will be quite some time after 2010,” Chaiken said. “This is just a preliminary step in getting this to happen. I would hope that the new board would review the experiences of others states and apply it to their own plan.”
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