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
Marty LaVenture, MPH, PhD, Director, Center for Health InformaticsMinnesota Department of Health
Wisconsin eHealth Implementation Summit
March 15th, 2007 – Madison Wisconsin
MDH - Minnesota e-health initiative
Cross-Border Considerations
Providing Strategic Leadership Protecting Communities, Public Health Ensuring Privacy and Security Enabling Exchange Leveraging Funding and Incentives
MDH - Minnesota e-health initiative
Wisconsin/Minnesota Border Context
27 Counties border~ 1.5 Million Citizens 3 Large City Areas~ 4 emerging RHIO’s~165 Clinics~26 HospitalsPlus LTC, Public Health,
Home Care agencies and more
MDH - Minnesota e-health initiative
Minnesota e-Heath: A Summary of Key Milestones
2003: Governor’s 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
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
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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)
MDH - Minnesota e-health initiative
Strategic Leadership
Strategic Leadership Includes…Clear Vision and ScopeRoad Map for Action Help Focus and Set PrioritiesPublic Funding and PolicyAssess, Evaluate and Monitor
Progress
MDH - Minnesota e-health initiative
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
MDH - Minnesota e-health initiative
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
Examples of Some 45+ Projects Emerging Statewide
Personal Health Records• Fairview• HealthPartners• Children’s Hosp•Willmar Project
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)
Telehealth• University of MN
Informatics Education• St. Scholastica• University of MN
Public Health • MN PHIN • Fast Forward
EHR Adoption/Use• DOQ-IT Project• Grants Program
MDH - Minnesota e-health initiative
Stratis Health Primary Care Clinic Survey
Figure 1 : MN Clinics: Electronic Health Record by Implementation Stage (75% of 603 primary care clinics responded to Stratis Health survey)
17%
29%
11%
16%
27%
0%
5%
10%
15%
20%
25%
30%
35%
Fully Implemented In process In next 12 months In next 13-24 months
Not Implemented
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
Public Health: MN PHIN – Fast Forward
MDH - Minnesota e-health initiative
Minnesota e-Health and MN-PHIN
Interoperability and Health Information Exchange
MN Public Health Information Network (MN-PHIN) – improving State-Local effectiveness & efficiency
Public Health Data to Inform Clinical Practice
Example: Influenza ELR Surveillance Provides Clinical Care Decision Support (Diagnosis and Treatment)
Clinical Care Public Health
Surveillance ELR
Decision Support
Adapted from: Larry Hanrahan PhD MS, Wisconsin division of Health
MDH - Minnesota e-health initiative
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
MDH - Minnesota e-health initiative
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.
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
Privacy & Security
Public Health: MN PHIN – Fast Forward
MDH - Minnesota e-health initiative
Privacy Barriers to HIEs
Implementation of Minnesota’s 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
MDH - Minnesota e-health initiative
Patient Consent - Variations and Barriers
Minnesota’s 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
– Minnesota’s requirements were designed for paper-based exchanges and are not conducive to a real-time, automated electronic exchange
MDH - Minnesota e-health initiative
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
MDH - Minnesota e-health initiative
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 provider’s
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 Minnesota’s patient consent statutes to make the requirements easier to understand for patients and health care providers
MDH - Minnesota e-health initiative
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
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
Privacy & Security
Public Health: MN PHIN – Fast Forward
Exchange: Mn Health Care Connection
MDH - Minnesota e-health initiative
Interoperability is More than Wires
MDH - Minnesota e-health initiative
Minnesota Health Care Connection
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
Privacy & Security
Public Health: MN PHIN – Fast Forward
Funding & Incentives: 12 Grants
Exchange: Mn Health Care Connection
MDH - Minnesota e-health initiative
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
MDH - Minnesota e-health initiative
Key Projects Initiated(Policy – Funding – Implementation)
04 05 06 07 1009 1108 12Years
Strategic Leadership: Advisory Committee
Privacy & Security
Public Health: MN PHIN – Fast Forward
More….
Funding & Incentives: 12 Grants
Exchange: Mn Health Care Connection
MDH - Minnesota e-health initiative
Opportunities for Collaborative Action
Metrics / AssessmentCatalogue our border issuesAction plans for common projectsModernizing Disease outbreak systems
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Opportunities for Action (continued)
Collaborate model consent formsCollaborate on consumer information
material Develop model practices for security Develop action plans for common
projectsCollaborate model for value proposition
MDH - Minnesota e-health initiative
Key Contacts for More Information:
www.health.state.mn.us/ehealth
Minnesota Department of HealthMarty LaVenture, PhD– Director of Health
Informatics651 201-5950 martin.laventure@health.state.mn.usBill Brand– Deputy Director, Health Informatics651-201-5508 bill.brand@health.state.mn.us
Thank You!
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