From the President & CEO...
Health information exchange takes a front seat

Chris Queram, President and CEO

The issue of health information technology and exchange has taken on new prominence in the state of Wisconsin. The federal government has designated approximately $9.44 million in Recovery Act funds to support efforts to create a state exchange and additional monies are pegged for provider incentive payments for the use of electronic records. Wisconsin is now on a fast track to take advantage of these opportunities.

As a newly appointed member of the Wisconsin Relay of Electronic Data (WIRED) for Health Board, I have been given the privilege to contribute to a process designed to develop both a strategic and an operational plan for how health information technology and exchange will be accomplished in Wisconsin. The Board was created as the first phase of the State-Level Health Information Exchange (SLHIE) planning and design project which is supported by Recovery Act funds.

In addition, recent health information technology and exchange developments at the federal level have placed an emphasis on WCHQ’s ability to assume a key role in discussions in this critical area.

Wisconsin’s health information technology & exchange plan
Wisconsin’s WIRED for Health Board consists of 15 members representing both public and private stakeholders. The scope of the Board’s work will include a number of technical components such as issues related to privacy and security, data architecture and how data is shared among health care organizations for point of care decision making. We will also look at how data is collected and stored for more static uses like decision support, performance measurement, public health reporting, and surveillance and immunization registries.

A significant amount of work will go into specifying technical architecture. Decisions will need to be made regarding how much of the work will be accomplished through established groups like WCHQ, the Wisconsin Health Information Organization (WHIO) or the Wisconsin Health Information Exchange (WHIE) and how much will be done centrally through policies and services applied across the state as a whole.

Critical questions regarding the funding to operate this new infrastructure will also need to be answered. The initial dollars being made available through the stimulus legislation will not be sufficient to further the development of this concept or sustain the initial financial investments that will be made to participating health care provider organizations.

A significant aspect of this public/private partnership in Wisconsin is the collaborative role state government will take in working with private entities to accomplish this task. Over the last 10 years, much of the leadership in the health information exchange area has come through the private sector. Organizations such as WCHQ, WHIO, the Wisconsin Hospital Association (WHA) and the Wisconsin Medical Society (WMS) have made substantial investments in human, financial and political capital to lay the foundation on which the new stimulus money will be overlaid. How this plays out from a governance and operational standpoint will be an important issue over the next few months.

WCHQ’s role
Besides representation on the WIRED for Health Board, one of the key opportunities for WCHQ to make an impact on health information exchange development is the work we’ve done around performance measurement. In order for providers to be declared meaningful users of electronic health records (EHR) technology under the recent proposal by the Centers for Medicare & Medicare Services (CMS), they must collect data and publicly report performance on a specified set of measures.

There may be a significant opportunity for WCHQ’s RBS tool to emerge as a clinical data repository for the administrative data and clinical data needed to measure actual outcomes of care for a substantial number of physicians in the state. The RBS data could then be stored and linked with some of the other appropriate databases for static analytical reporting functions. In addition, providers could report performance through an entity like WCHQ and its public website in order to be deemed compliant and eligible for the maximum incentive under the meaningful use requirements.

We are steadily moving toward a system where health care organizations collect data and measure performance on a standard set of indicators that are endorsed nationally and uniformly compared across the country. I believe WCHQ is in a prime position to contribute to this process of national comparison, as we have developed a strong competency in performance measurement. However, regional differences in measurement construction at present make it difficult to compare performance to national providers.

The initial draft of federal meaningful use regulations includes almost all of the measures WCHQ tracks. We now have an opportunity to align our measurement specifications with the meaningful use requirements to begin to move toward uniform performance measures that can be used to compare organizations nationally. At the same time, we will shift the focus of our ACS work group to the development of specialty measures.

We will continue to update you on the progress of the state’s WIRED Board and new developments affecting our membership in the area of health information technology and exchange. Our new Online Community (see “WCHQ’s Interactive Community Launched” in this issue) will also afford us the chance to easily exchange ideas, problems and solutions in this area as well as many others. We look forward to moving ahead together to improve the exchange of vital health care information.

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