The Wisconsin Health Information Exchange, or WHIE, a not-for-profit regional collaborative effort in the greater Milwaukee County area, enables collaboration and information sharing across multiple healthcare organizations. The WHIE’s vision is to improve the quality, safety, efficiency and accessibility of healthcare and public health. Working in collaboration with a multistakeholder membership and 21-seat advisory board of directors, the WHIE recognizes that healthcare exists in a community, rather than within a single delivery network. Collaboration to enable secure delivery of timely, accurate electronic health information to authorized users across institutional boundaries is the mission of the WHIE.
An initial step toward a connected framework, Emergency Department Linking was implemented as a collaborative effort with the Milwaukee Health Care Partnership and a private-public relationship with the Wisconsin Department of Health Services. The framework for ED-Linking employs an innovative data centralization platform, matching patients across the community of participating organizations, providing emergency physicians with an automatically generated view of a patient’s medical history when presenting for care. Data currently integrated include allergy, primary-care physician, chief compliant/diagnosis and Medicaid pharmacy claims.
Currently, 14 hospitals and over 100 hospital service areas/clinics provide data and 10 EDs are using the data in patient-care delivery. In this model, each of the participating delivery networks has their data stored separately, allowing for a participating organization to “leave” the exchange if necessary. The centralized storage model enables secondary data use, not possible without centralized data stores.
Gaining a comprehensive view of a patient enables ED clinicians to make more informed decisions about the patient’s care. For example, physicians participating in the WHIE discovered that a female patient in her 30s received care at a cardiology clinic for congestive heart failure three days prior to an ED visit, prompting a more specific diagnostic/treatment course than what might have been decided without that information. A more complete picture of a patient’s medical history provides context, allowing clinicians to avoid unnecessary redundant procedures/testing, and may reduce unnecessary inpatient admissions because of incomplete patient history.
In addition to real-time clinical use, the WHIE extends an aggregated de-identified view to support public-health surveillance activities. This process provides public health staff a tool that historically would have required extensive additional work from ED staff and time delays in processing. As an example, public health staff easily applied its use of the WHIE for recent H1N1 surveillance and reporting.
The data aggregation platform of the WHIE serves as the framework on which the community can build new health solutions, which will occur in conjunction with, or as a result of, establishment of sustainability models, providing value to payers, providers, public health departments and patients. For example, adding ECGs to form a “baseline ECG repository” now only involves providing data to an existing patient encounter foundation. Other patient-specific community-based documents being considered include:
- Physician orders for life-sustaining treatment.
- Care plans/pain contracts.
- Referral forms, enabling bi-directional online communication between ED and clinic staff, leveraging the referral as a learning point during future ED visits.
- Patient consent forms.
“The impact on quality of care and conservation of resources is undeniable. In fact, over the past several weeks I have been inundated with requests from my partners to have this tool available for [another] ED,” said physician Cory Wilson, chairman of the emergency medical department of St. Francis Hospital.
“Data accessible through the WHIE helps our team of clinicians provide safer care for our patients in a more-efficient manner. Access to historical data is particularly useful for patients suffering from chronic diseases. Ready access to information from previous visits helps reduce clinically unnecessary redundant testing, saving both the patient and ED staff valuable time and expense,” said physician Howard Croft, medical director of Columbia St. Mary’s Milwaukee campus.
“Clinician feedback is a critical touchstone to success and impact of changed workflow/information management tools,” said Kim R. Pemble, executive director of the WHIE. “WHIE is influencing care delivery in Milwaukee County, and we have only just scratched the surface.”
In addition to financial and technology investment, participating organizations provide in-kind donations in the staff time applied to interface work, workflow integration and changes, education and support. For instance, emergency department staff of each participating organization has worked closely with the WHIE to help evolve their workflow. Currently, there are about 450 user accounts across the 10 emergency departments using the WHIE. WHIE employs through three full-time staff, one part-time staffer and external consultants as needed.
The WHIE continues to work to establish sustainable business models beyond initial funding through a state Department of Health Services contract for $1.7 million (Medicaid Transformation Grant), and start-up funding from participating organizations in Milwaukee County. Late in 2008, an agreement with Humana established funding to support WHIE and physician access, triggered when a Humana covered life had an encounter in an ED facility using WHIE. Additional models, applying value observed and opportunities identified to date, are being established including decreasing “hyper use” of ED services, decreasing ED care costs and “unnecessary” inpatient admissions from ED. In addition, expanded secondary use with public health adds value. WHIE is also working with the state’s DHS and others to assess opportunities available through the American Recovery and Reinvestment Act of 2009 to support HIE operations and growth, as well as regional centers for HIT services, and is investigating grant opportunities focusing on chronic-disease management and enhanced care coordination.
Kim Pemble
Executive director
Wisconsin Health Information Exchange
Mequon
