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Wiscosnin’s eHealth Initiative September 21, 2007 Wisconsin eHealth Action Plan Value-based Purchasing eHealth Technology Platform Prevention and Disease Management eHealth Care Quality and Patient Safety Board Department of Health and Family Services Transforming Health Care in the US: medical perspective IOM - 6 Characteristics of Quality Care: Patient-Centered Safe Equitable Timely Effective Efficient 2 Transforming Health Care in the US: Why Health Information Technology? Need easily accessible data/information in order to: Improve Quality Reduce Errors (Improve Safety) Reduce Cost Increase Administrative Efficiencies Reduce Paperwork Expand access to affordable health care Robert M. Kolodner, MD National Coordinator ONCHIT 3 Transforming Health Care in the US: Why Interoperable HIT? In addition to improved individual patient care, it will also bring many public health benefits including: Early detection of infectious disease outbreaks around the country; Improved tracking of chronic disease management; and Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared. 4 Transforming Health Care in the US: the market-driven perspective – Value-Driven Health Care Initiative of the Bush Administration Consumers deserve to know the quality and cost of their health care. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value. Providing reliable cost and quality information empowers consumer choice. Consumer choice creates incentives at all levels, and motivates the entire system to provide better care for less money. Improvements will come as providers can see how their practice compares to others. 5 Four Cornerstones of Value-driven Health Care: Interoperable Health Information Technology Measure and Publish Quality Information Measure and Publish Price Information Promote Quality and Efficiency of Care (pay for performance) 6 National HIT Agenda: …foster widely available services that facilitate the accurate, appropriate, timely, and secure exchange of health information …information that follows the consumer and supports clinical decision-making John Loonsk Office of the National Coordinator for HIT DHHS 7 State Activities: Health Information Security and Privacy Collaboration (HISPC) State Level HIE Jodi Daniel ONCHIT/DHHS Thomasian and Nolan NGA Center for Best Practices 8 WI’s eHealth Action Plan Where is Wisconsin going with eHealth? 9 The WI Health Care Environment eHealth Care Quality and Patient Safety Board Wisconsin Collaborative for Healthcare Quality (WCHQ) Wisconsin Health Information Organization (WHIO) Wisconsin Hospital Association (WHA) Provider HIT adoption DOQ-IT Rural Health Cooperative Wisconsin Health Information Exchange (WHIE) 10 eHealth Care Quality and Patient Safety Board 2007 eHealth Board Chair: Kevin Hayden Executive Committee Chairs of the Board and advisory group Patient Care Advisory Group Chair: Ed Barthell Consumer Interests and Privacy Advisory Group Chair: Cathy Hansen Public Health Advisory Group Chair: Bevan Baker Statewide Health Information Exchange Advisory Group Chair: Hugh Zettel Operations 11 eHealth Board Members Chair: Kevin Hayden, Secretary, Department of Health and Family Services Betsy Abramson, Elder Law Attorney and Consultant Christopher Alban, MD, Clinical Informaticist, Epic Systems Corporation Bevan Baker, Commissioner of Health, City of Milwaukee Health Department Edward Barthell, MD, Executive Vice President, CIO, Infinity Healthcare Gary Bezucha, Administrator, Boscobel Area Health Care Patricia Flatley Brennan, Professor of Nursing and Industrial Engineering Catherine Hansen, Director, Health Information Services, St. Croix Regional Medical Center Ravi Kalla, CEO and President, Symphony Corporation Don Layden, Executive Vice President, Corporate Development, Metavante Corporation Dan Schoof, Deputy Secretary, Department of Administration Lois Murphy, IT Specialist, Veterans Administration Candice Owley, RN, President, Wisconsin Federation of Nurses and Health Professionals Debra Rislow, CIO and Director of Information Systems, Gundersen Lutheran Peg Smelser, Chief Operating Officer, Wisconsin Education Association Trust Lon Sprecher, Sr. VP and COO, Deant Health Insurance Eric Stanchfield, Secretary, Employee Trust Funds John Toussaint, MD, President and CEO, ThedaCare Justin Starren, MD, PhD, Marshfield Clinic Research Foundation Hugh Zettel, Director, Government and Industry Relations, GE Healthcare Technologies 12 Wisconsin eHealth Initiative Public-private collaboration for widespread adoption of HIT/HIE Wisconsin’s eHealth Action Plan includes: Create a technical infrastructure Establish a governance structure for health information exchange Develop options for addressing privacy and security issues Support the acquisition of EHR systems by small provider groups and safety-net providers 13 eHealth Technology Platform—Current Focus HIT adoption Encourage adoption and investment in electronic health record systems Regularly monitor adoption progress Health information exchange Foster creation of regional health information exchanges Simultaneously focus on state-level health information exchange services Focus early on providing patient information timely and at point of care 14 eHealth Action Plan—Current Activities Transition from planning to implementation eHealth Board advisory groups Implementing Medicaid Transformation Grant project Addressing privacy concerns Governor’s 2007-09 Biennial Budget and Health Provisions 15 Wisconsin Privacy Project: Phase 1 (July 2006 - March 2007) 33 states and Puerto Rico funded through DHHS Office of the National Coordinator via Research Triangle Institute (RTI) to: Assess variations in organization-level business policies and state laws that affect health information exchange Propose practical solutions that protect privacy and security of health information and permit interoperable exchange Develop plans to implement solutions State-level data combined by the grantor to help support the business case for a national health information infrastructure 16 Wisconsin Privacy Project: Phase 1 (July 2006 - March 2007) Thank You! 17 Privacy Project Phase 1: Recommendations 1. Standardize patient identifiers 2. Propose changes to the HIPAA Privacy Rule 3. Clarify minimum necessary standard Alter requirements re: research and Business Associate Agreements Amend Wisconsin Statute 51.30 (sensitive information) 4. Create model policies and procedures re: capture, verification, & match of patient identifiers with patient information in a health care system Adopt national standards once defined and accepted Allow exchange of specific information among providers for treatment purposes without consent Convene a representative workgroup to identify specific elements Amend Wisconsin Statute 146 (general information) Treat re-disclosure like primary disclosure Remove documentation requirements beyond HIPAA Allow disclosure to family and individuals involved with care and treatment with agreement vs. consent per HIPAA 18 Modifying Wis. Stat. 51.30: Mental Health, AODA, Developmental Disabilities 19 Wisconsin Statute Chapter 51.30 Today Informed Consent Requirement Treatment records created in the course of providing services to individuals for mental illness, developmental disabilities, or alcohol or drug dependence at a treatment facility require consent before disclosing in most situations What are some exceptions to s. 51.30’s consent requirement? In a medical emergency (undefined) The following elements in a related health care entity: Patient’s name Medications Address Allergies Date of birth Other relevant demographic information Date of service (s) Name of mental health provider (s) Diagnosis 20 When Does s. 51.30 Apply Today? Registration/treatment records which are maintained by departments, boards and staffs, and treatment facilities that provide services for mental health, AODA, and developmental disabilities. Generally not to mental health, alcohol and drug abuse and developmentally disabled treatment records that originate outside of a treatment facility Generally not to treatment by solo practitioners Reasonable minds may disagree on application… Example: patient presents to family practitioner with complaints of severe depression requesting an anti-depressant 21 Premise for Proposing Modifications to 51.30 Broadening exchange without consent can: Improve the safety and quality of patient care Increase providers’ ability to give patients optimal care Reduce the cost of care Reduce variation in law Reduce variation in interpretation of law Facilitate increased enforcement of law Increase Wisconsin’s potential to participate in multi-state exchanges Safeguards can continue to protect patient privacy 22 Recommendation 1 (11/06): Consumer Interests Advisory Group Amend Wisconsin law governing disclosure of health information to providers to be consistent with HIPAA, which does not require patient consent to disclose information to providers about mental health and developmental disabilities for treatment purposes. Note: This recommendation was not unanimously supported. eHealth Board Response Strong support for recommendation as submitted Noting potential controversy and dissatisfaction of some stakeholders, recommended holding for further consideration in the Privacy Project (first phase) 23 Recc. 2: Privacy Project Implementation Workgroup Form a representative workgroup charged with identifying specific elements that can be exchanged among providers for treatment purposes without patient consent. Use the work of phase one as a starting point. Options include: Proposed Change Shared without consent 1-Expand 8g Expand sharing of specific elements permitted under Wis. Stat. 51.30(4)(b)8g* from within a related health care entity to providers within and outside such an entity. Specific elements permitted under Wis. Stat. 51.30(4)(b)8g* 2-Clarify law Redefine elements protected by 51.30 to meet provider and consumer expectations in a more consistent manner. Specific content and/or elements TBD. 3-Mirror 146.82 Mirror 146.82 such that treatment records can be exchanged for treatment purposes without consent. Contents of treatment records for treatment purposes. ** 4-Match HIPAA Modify 51.30 to comport with HIPAA such that treatment records can be exchanged for purposes of treatment. Contents of treatment records for treatment, except psychotherapy notes per HIPAA. ** * Name, Address, Birth date, Name of mental health provider (s), Date of service (s), Diagnosis, Medications, Other relevant demographic information ** “Minimum necessary” may still apply if HFS 92.03(n) is retained Allergies, 24 51.30 Workgroup Invited Stakeholders Mental Health Advocates Mendota Mental Health Institute Waukesha County Department of Health and Human Services AODA Advocates and Administrators Developmental Disability Advocates Central Wisconsin Center for the Developmentally Disabled Physicians (General Practitioner and Psychiatrists) Privacy Officers/Legal Experts Information Technology Experts (Vendors and Providers) Consumer Data Use Organization Payer Large Provider Systems Wisconsin Hospital Association (WHA) Wisconsin Medical Society (WMS) 25 51.30 Summary Key Activities Four workgroup meetings in August and September Workgroup member discussions with colleagues and constituencies for consideration by the group Anticipated Outcomes Recommended modification of s. 51.30 that allows easier sharing of necessary health information among providers for treatment purposes for consideration by the eHealth Board Elements that can be exchanged among providers for treatment purposes without patient consent Other key areas for consideration Timeline for completion Final 51.30 Workgroup meeting September 28th Staff follow-up October and beyond 26 Clarifying 42 CFR Part 2: Drug and Alcohol Treatment 27 42 C.F.R. Part 2 Federal law that requires consent for the release of records related to drug and alcohol treatment, except to medical personnel in a medical emergency Protections apply to records created in the course of providing drug and/or alcohol treatment conducted in a program that is regulated or receives assistance (directly or indirectly) from any department or agency of the United States As the more protective law, 42 CFR Part 2 would still control release of AODA information if there were a change to Wis. Stat. 51.30. Thus, WI is supporting IN’s efforts to clarify application of 42 CFR Part 2. 28 42 CFR Part 2 Summary Key Activities Anticipated Outcomes Privacy project staff serving on Indiana HISPC’s Multi-State Steering Committee (Sept – Dec) Clarification of 42 CFR Part 2 Deepened partnership with Indiana and other states serving on the multi-state steering committee Timeline for Completion IN to schedule meeting with Substance Abuse and Mental Health Services Administration (SAMHSA) by Dec. 2007 29 Modifying Wis. Stat. 146: General Healthcare Information 30 Privacy Project Implementation Workgroup Recommended Modifications to s. 146.82 Intent of proposed changes: Eliminate barriers to exchange Bring Wisconsin law more in line with current practice Increase consistency with HIPAA Area. Current Law Proposed Change Documentation Document all disclosures (written, oral, etc.) with or without consent. documentation becomes a legal part of the patient’s record. * Require limited documentation of disclosures that enable the patient to determine who has accessed his/her health information and when. (per 45 CFR 164.528) Re-disclosure When information is disclosed without patient consent, the recipient must keep the information confidential and may not re-disclose it. ** Add language that allows re-disclosure with patient consent or otherwise allowed by law. (per HIPAA) Disclosure to individuals involved in the care or treatment of the patient Patient consent is required to disclose health information to individuals involved in the care or treatment of the patient in writing or verbally. Rewrite to allow oral disclosure to individuals involved in the care or treatment of the patient with patient agreement. Retain requirements for patient consent to disclose any copy of a patient’s medical record. * Wis. Stats. 146.82(2)(d), 146.83(3) ** Wis. Stat. 146.82(2)(b) *** Wis. Stats. 146.82 and 146.83 31 146.82 Summary Key Activities Discuss proposed changes with selected stakeholder groups, such as: Anticipated Outcomes Care Everywhere Working Group Consumer advocacy organizations WHIE HIPAA-COW WHA WMS Policy language amending Wisconsin Statute Chapter 146 for consideration by the eHealth Board Stakeholder position summary regarding proposed policy language Timeline for Completion Stakeholder meetings held through mid-October Statutory language to follow 32 Consumer Outreach and Education 33 Consumer Education and Outreach Summary Key Activities Town hall meetings focused on increasing consumer comfort with, and understanding of, electronic health records and health information exchange Increased presence of eHealth staff and volunteers at local and national meetings Anticipated Outcomes Emphasis on privacy and security capabilities Three geographic locations Promoted through strategic placement of eHealth Initiative (eHI) materials Increased public awareness of eHealth and privacy and security capabilities Comments for consideration by eHealth Board and its Advisory groups Timeline for Completion Town hall meetings held by December, 2007 34 Privacy Project Collaborative Interstate Data Exchange Policy 35 Collaborative: Key Activities RTI (Grantor) requires participation multi-state collaborative(s) Participation includes: Planning phase, future ONC funding will support state collaborative implementation Monthly calls Attendance at September in-person meeting Contributions to Collaborative products Collaborative: Interstate Data Exchange Policy Consent/authorization from patients for use & disclosure of his/her data Consent/authorization from data sources for use and disclosure of information provided by the data source Development of standard consent language and/or consent form Development of guidelines for opt-in/opt-out decisions that would allow for exchange between states and/or others 36 Transforming Medicaid Advance regional health information exchange for the Medicaid population Bring benefits of electronic health records to our Medicaid population Reform Medicaid reimbursement system Design programs to improve the health care delivery system and engage consumers in managing their own health care 37 Governor’s 2007-09 Budget Health Provisions Electronic Medical Records Tax Credit (Paper 324): Health Care Quality and Patient Safety Council and Grant Program (Paper 372): http://www.legis.state.wi.us/lfb/200709budget/Budget%20Papers/June%208_taxes.htm http://www.legis.state.wi.us/lfb/200709budget/Budget%20Papers/June%208.htm Wisconsin Health and Educational Facilities Authority (no paper completed): http://www.legis.state.wi.us/lfb/20079budget/Budget%20Papers/Cover%20sheets/whefa. pdf 38 For more information on the WI eHealth Initiative Go to: http://ehealthboard.dhfs.wisconsin.gov/ DHFS Contacts: Kathy Farnsworth, eHealth Chief of Staff [email protected] (608) 267-2082 Denise Webb, Policy Initiatives Advisor, Health Care IT [email protected] (608) 267-6767 39
