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Connecting Public Health with Health Information Exchanges
Proposal Narrative
Organization: Wyoming Health Information Organization
BACKGROUND
In 2003 the Wyoming Legislature created the Wyoming Healthcare Commission (WHCC) and in 2004 passed Enrolled Act 31 directing the Commission to create an Information Technology Technical Management Subcommittee (IT2) to study and paln for a statewide electronic health records inmplementation by Oct. 15, 2005.
John Snow, Inc (JSI) was selected by WHCC and IT2 to assess Wyoming’s electronic health records readinsess and make recommendations for rapidly increasing the utilization to access patient health information. On June 29, 2005 as part of the IT2’s vision resulting from the JSI study process – the WHCC recommended to Governor Dave Freudenthal and the Legislature’s Joint Interim Labor, Helath and SOcial Services COmmittee that Wyoming form a self-sustaining regional health information organization (RHIO) to facilitate an intrastate, regional interstate and national federal partnership for the rapid deployment of Wyomings’ electronic health information.
On July 18, 2005, in Casper – the center of Wyoming – more than 50 representatives of local, state and federal governement, business, medical care providers and healthcare purchasers and payers gathered and agreed to form a RHIO to ready Wyoming for health information technology standards, funding and implementation assistance.Memorandums of Understanding were immediately submitted by a majority of the attendees and a second meeting was held Aug. 11 to nem the RHIO (now being registered with the Wyoming Secretary of State’s Office and the Internal Revenue as the nonprofit Wyoming Health Information Organization (WYHIO). The stakeholders
chose on that night an interim board of directors representing a broad cross-section of the state’s investors in the healthcare delivery system. A consensus was reached that the WYHIO can serve as the catalyst for the facilitation of health information technology demonstration projects, can foster collaboration on electronic health information infrastructure and will evaluate and endorse projects and processes that will integrate with the health information network.
The WYHIO’s 7 interim board members are:
Dr. Geoffrey Smith, Casper radiologist (chairman)
Dr. Robert Fagnant, Rock Springs Obstetrician-Gynecologist (provider representative)
Lee Clabots, Deputy Director Wyoming Department of Health (state government representative)
Andrew Fisher, Assistant Director Great West Life and Health (payer representative)
Dana Barnett, Director, Outreach Services, United Medical Center
Steve Chasson, Director, Wyoming Primary Care Association (provider representative)
Larry Madsen, Vice President Blcak Hills Bentonite (purchaser representative)
Carol Jenkins, Buffalo Healthcare Delivery Systems Consultant (WHCC
ex-officio)
Stakeholders who have signed Memorandums of Understanding:
Community Health Center of Central Wyoming
Ivinson Memorial Hospital
Johnson County Healthcare Center
MBA of Wyoming
Memorial Hospital of Converse County
Memorial Hospital of Sweetwater County
Mountain Pacific Quality Health Foundation
Niobrara Life and Health Center
West Park Hospital
Jack Webb, IT Director
WIN Health Partners
Wyoming Department of Health
Wyoming Lodging and Restaurant Association
Wyoming Medical Center
Wyoming Medical Society
Wyoming Primary Care Association
Wyoming Rural Development Council
Wyoming State Board of Pharmacy
VISION
Currently, the U.S. health care system is highly fragmented and paper-based, with critical information about the patient stored in a variety of forms across hospitals, laboratories, pharmacies, physician offices, and administrative data systems within health plans. Wyoming is no different and as a result of this current state, clinicians often don’t have comprehensive information about the patient when and where it is needed most—at the point of care.
At the same time, reports from a wide range of philanthropic, private sector and non-profit organizations, as well as several agencies in the public sector, recognize the value of health information technology and the mobilization of data in addressing the quality, safety and efficiency challenges in the U.S. health care system. Interest has now turned to the development of policies and practices for accelerating the effective implementation and use of such systems in a way that will assure that expected quality, safety and efficiency of outcomes will be achieved.
There are over 100 emerging state, regional and community-based initiatives focused on the mobilization of health care information across organizations within their respective locales. Based on a survey conducted by eHealth Initiative in December 2004, such initiatives are in a wide range of readiness states. It is the goal and vision of WYHIO to become the catalyst in Wyoming to this information exchange by enabling:
1. Anytime, anywhere health care information and decision support.
2. Immediate availability of complete medical record (compiled from all sources)
3. Up-to-Date decision support at any point of care
4. Selective reporting (e.g. for public health)
5. Use of tools to facilitate delivery of care (e.g. e-prescribing)
6. Allow patients to control acccess to their information
7. Align/direct incentives to those who create value
8. Allow each care facility to maintain its own data
9. Minimize cost(s) and risk
10. Use proven implementation strategies where appropriate.
Wyoming is the 10th largest state in area but is least popluated in the nation. It includes within its borders an area of 97,818 miles. Winter weather is harsh and roads are often unpassable or closed due to storms. This makes the delivery of health a challenge a best. A patient who is admitted at one point of care often needs to be transferred to another facility or city where appropriate treatment is offered. Time is of the essence especially when critical situations arise, and often a patient must be transferred without a complete medical record because it is not accessible on short notice. The receiving caregiver is at a disadvantage without a complete medical history to provide the needed treatment. Lifesaving treatment may be interrupted untill records are recieved There is also the issue of unnecessary tests or duplicate tests being performed because previous results are not readily available to the caregiver. In bottom-line terms, the WYHIO can save lives and incredible amounts of money. A recent Vanderbilt University study indicated that a 600-bed hospital participating in a RHIO could save up to $5.6 million per year. These savings are a direct result of: Decreased number of duplicate laboratory tests (e.g. blood work, samples). Decreased number of duplicate radiology tests (e.g. x-rays, MRIs). Reduced number of in-patient hospitalizations. Fewer patient visits to the emergency department.
OBJECTIVES/KEY ACTIVITIES
A strategic business plan must be developed and maintained by the WYHIO and a team responsible for soliciting and managing funds must be formed and sustained. A technology plan that describes the technology infrastructure, support requirements, and phased build-out through iterative steps must be defined and supported. Revenue models for all initiatives must be defined, approved, and implemented. An Executive Director/Chief Information officer will be hired who will report directly to the board. This person must posess a variety ofhigh-levelskills in organizational development and leaderhsip, communications, decision-making, and health information technology. This person will be key to the development of health information technology initiatives of the WYHIO. One project director will be hired in the first year and will report to the Executive Director/CIO. One administrative support staff will also be hired in the first year and will be responsible for administrative and secretarial support to the WYHIO staff. A Systems Analyst will be hired in the first year also who will have the responsibility of to research and assist in developing plans, specifications, RFP’s and other documents for the information exchange intitiatives of WYHIO.
TARGET POPULATION
Recognizing that some Wyoming residents work in the mines of surrounding states, and conversely, residents of other states work in the mines of Wyoming this is one population that would benefit greatly from an electronic health record. There is an energy boom affecting the state at this time that is comprise of a largely transient population who do not have primary care physicians. The main target popluation of the WYHIO is every resident in the state of approx 500,000, as they are all potential patients of the healthcare system. Due to a larger proportion of the baby-boomer generation (born between 1946 and 1962), Wyoming’s population is aging rapidly. In 2000, the median age of 36.2 in the state passed the national average of 35.3. It will be particularly intensified in about ten years as this age cohort reaches retirement, which will create possible labor shortages and increased demand for health and social services.
LEADERSHIP AND COMMITMENT
Describe the organizational roles and qualifications of applicant agency personnel that will participate. Include level of time commitment (FTE) that these personnel will devote to the planning process and the roles they will play in that process. Discuss the role of the agency’s chief executive. Also, describe plans to continue participation in the health information exchange after the grant.
xxxxxx (your response goes here) xxxxxx
COLLABORATION
NOTE: A letter of support from the head (e.g. health officer) of the applying organization must be mailed to the Program Office. In addition, organizations applying on behalf of a state or local public health agency must supply a letter of support from that agency (or agencies). Letters of support from collaborating partners should also be mailed to the Program Office. See instructions on “Additional Documents Screen�.
List here the names of the collaborating organizations (health departments and members of the health information exchange) from whom we should expect to receive letters of support.
Please describe any collaborative relationships or arrangements related to this proposal, i.e. between local health departments and state health departments or between these health departments and the health information exchange. Discuss your agency’s role in such collaborations and in any other activities related to health information technology in your state. Also include any past successful collaborative efforts with these partners. Please include details on past collaborations.
xxxxxx (your response goes here) xxxxxx
READINESS OF THE HEALTH INFORMATION EXCHANGE
Please describe the degree to which the health information exchange has developed to provide a valuable opportunity for public health agencies to participate. What is the breadth of participation and the level of commitment on the part of the key stakeholders? Has the exchange developed a governance structure? What is the extent of its funding? For example, has the exchange received federal grants or contracts from the Agency for Healthcare Research and Quality or the Foundation for eHealth Initiative’s Connecting Communities for Better Health program? Have specific data sharing projects been planned or initiated? Has a business plan or multi-year strategic plan been completed?
xxxxxx (your response goes here) xxxxxx
CHALLENGES
The data gathering conducted by JSI has facilitated the compilation of a number of constraints that must be addressed by the recommendations put forward above and during the coming phases of this project. • There is a wide and significant variation across the State with regard to level of exposure to, understanding and adoption of health information technology (HIT) across all types of provider entities: physician practices, hospitals, pharmacies, and public health facilities. There is a very limited pool of HIT technical staff resources available to support providers in the acquisition, installation and maintenance of such systems. Of those organizations that have implemented some level of HIT, administrative systems are typically installed first and clinical information systems tend to be a secondary consideration. A very wide range of views exists with regard to the potential benefits and opportunities for implementing and utilizing HIT to improve the quality of healthcare services provided. Across both the physician and hospital segments, groups are looking to the State of Wyoming for guidance with regard to standards and/or “preferred vendor solutions� Broad resistance to the idea of mandated HIT implementation exists across the State. Expectation that appropriate incentives should be provided (mainly financial), in order to support the cost of implementing and sustaining HIT, particularly among the smaller physician practices in the State. Some resistance to the idea of creating a “centralized database of personal health information� exists. Opportunities exist to simultaneously develop both broad, statewide HIT initiatives, as well as those that are focused on HIT in local communities. Moving forward with HIT efforts in the State will require the constant and consistent attention of a central, coordinating organization working with multiple stakeholders.
SPECIAL CONSIDERATIONS
Summarize any special features that make your application unique and innovative. Describe how your project may serve as a model for other health departments.
Connecting Public Health with Health Information Exchanges
Proposal Narrative
Organization: Wyoming Health Information Organization
BACKGROUND
In 2003 the Wyoming Legislature created the Wyoming Healthcare Commission (WHCC) and in 2004 passed Enrolled Act 31 directing the Commission to create an Information Technology Technical Management Subcommittee (IT2) to study and paln for a statewide electronic health records inmplementation by Oct. 15, 2005.
John Snow, Inc (JSI) was selected by WHCC and IT2 to assess Wyoming’s electronic health records readinsess and make recommendations for rapidly increasing the utilization to access patient health information. On June 29, 2005 as part of the IT2’s vision resulting from the JSI study process – the WHCC recommended to Governor Dave Freudenthal and the Legislature’s Joint Interim Labor, Helath and SOcial Services COmmittee that Wyoming form a self-sustaining regional health information organization (RHIO) to facilitate an intrastate, regional interstate and national federal partnership for the rapid deployment of Wyomings’ electronic health information.
On July 18, 2005, in Casper – the center of Wyoming – more than 50 representatives of local, state and federal governement, business, medical care providers and healthcare purchasers and payers gathered and agreed to form a RHIO to ready Wyoming for health information technology standards, funding and implementation assistance.Memorandums of Understanding were immediately submitted by a majority of the attendees and a second meeting was held Aug. 11 to nem the RHIO (now being registered with the Wyoming Secretary of State’s Office and the Internal Revenue as the nonprofit Wyoming Health Information Organization (WYHIO). The stakeholders
chose on that night an interim board of directors representing a broad cross-section of the state’s investors in the healthcare delivery system. A consensus was reached that the WYHIO can serve as the catalyst for the facilitation of health information technology demonstration projects, can foster collaboration on electronic health information infrastructure and will evaluate and endorse projects and processes that will integrate with the health information network.
The WYHIO’s 7 interim board members are:
Dr. Geoffrey Smith, Casper radiologist (chairman)
Dr. Robert Fagnant, Rock Springs Obstetrician-Gynecologist (provider representative)
Lee Clabots, Deputy Director Wyoming Department of Health (state government representative)
Andrew Fisher, Assistant Director Great West Life and Health (payer representative)
Dana Barnett, Director, Outreach Services, United Medical Center
Steve Chasson, Director, Wyoming Primary Care Association (provider representative)
Larry Madsen, Vice President Blcak Hills Bentonite (purchaser representative)
Carol Jenkins, Buffalo Healthcare Delivery Systems Consultant (WHCC
ex-officio)
Stakeholders who have signed Memorandums of Understanding:
Community Health Center of Central Wyoming
Ivinson Memorial Hospital
Johnson County Healthcare Center
MBA of Wyoming
Memorial Hospital of Converse County
Memorial Hospital of Sweetwater County
Mountain Pacific Quality Health Foundation
Niobrara Life and Health Center
West Park Hospital
Jack Webb, IT Director
WIN Health Partners
Wyoming Department of Health
Wyoming Lodging and Restaurant Association
Wyoming Medical Center
Wyoming Medical Society
Wyoming Primary Care Association
Wyoming Rural Development Council
Wyoming State Board of Pharmacy
VISION
Currently, the U.S. health care system is highly fragmented and paper-based, with critical information about the patient stored in a variety of forms across hospitals, laboratories, pharmacies, physician offices, and administrative data systems within health plans. Wyoming is no different and as a result of this current state, clinicians often don’t have comprehensive information about the patient when and where it is needed most—at the point of care.
At the same time, reports from a wide range of philanthropic, private sector and non-profit organizations, as well as several agencies in the public sector, recognize the value of health information technology and the mobilization of data in addressing the quality, safety and efficiency challenges in the U.S. health care system. Interest has now turned to the development of policies and practices for accelerating the effective implementation and use of such systems in a way that will assure that expected quality, safety and efficiency of outcomes will be achieved.
There are over 100 emerging state, regional and community-based initiatives focused on the mobilization of health care information across organizations within their respective locales. Based on a survey conducted by eHealth Initiative in December 2004, such initiatives are in a wide range of readiness states. It is the goal and vision of WYHIO to become the catalyst in Wyoming to this information exchange by enabling:
1. Anytime, anywhere health care information and decision support.
2. Immediate availability of complete medical record (compiled from all sources)
3. Up-to-Date decision support at any point of care
4. Selective reporting (e.g. for public health)
5. Use of tools to facilitate delivery of care (e.g. e-prescribing)
6. Allow patients to control acccess to their information
7. Align/direct incentives to those who create value
8. Allow each care facility to maintain its own data
9. Minimize cost(s) and risk
10. Use proven implementation strategies where appropriate.
Wyoming is the 10th largest state in area but is least popluated in the nation. It includes within its borders an area of 97,818 miles. Winter weather is harsh and roads are often unpassable or closed due to storms. This makes the delivery of health a challenge a best. A patient who is admitted at one point of care often needs to be transferred to another facility or city where appropriate treatment is offered. Time is of the essence especially when critical situations arise, and often a patient must be transferred without a complete medical record because it is not accessible on short notice. The receiving caregiver is at a disadvantage without a complete medical history to provide the needed treatment. Lifesaving treatment may be interrupted untill records are recieved There is also the issue of unnecessary tests or duplicate tests being performed because previous results are not readily available to the caregiver. In bottom-line terms, the WYHIO can save lives and incredible amounts of money. A recent Vanderbilt University study indicated that a 600-bed hospital participating in a RHIO could save up to $5.6 million per year. These savings are a direct result of: Decreased number of duplicate laboratory tests (e.g. blood work, samples). Decreased number of duplicate radiology tests (e.g. x-rays, MRIs). Reduced number of in-patient hospitalizations. Fewer patient visits to the emergency department.
OBJECTIVES/KEY ACTIVITIES
A strategic business plan must be developed and maintained by the WYHIO and a team responsible for soliciting and managing funds must be formed and sustained. A technology plan that describes the technology infrastructure, support requirements, and phased build-out through iterative steps must be defined and supported. Revenue models for all initiatives must be defined, approved, and implemented. An Executive Director/Chief Information officer will be hired who will report directly to the board. This person must posess a variety ofhigh-levelskills in organizational development and leaderhsip, communications, decision-making, and health information technology. This person will be key to the development of health information technology initiatives of the WYHIO. One project director will be hired in the first year and will report to the Executive Director/CIO. One administrative support staff will also be hired in the first year and will be responsible for administrative and secretarial support to the WYHIO staff. A Systems Analyst will be hired in the first year also who will have the responsibility of to research and assist in developing plans, specifications, RFP’s and other documents for the information exchange intitiatives of WYHIO.
TARGET POPULATION
Recognizing that some Wyoming residents work in the mines of surrounding states, and conversely, residents of other states work in the mines of Wyoming this is one population that would benefit greatly from an electronic health record. There is an energy boom affecting the state at this time that is comprise of a largely transient population who do not have primary care physicians. The main target popluation of the WYHIO is every resident in the state of approx 500,000, as they are all potential patients of the healthcare system. Due to a larger proportion of the baby-boomer generation (born between 1946 and 1962), Wyoming’s population is aging rapidly. In 2000, the median age of 36.2 in the state passed the national average of 35.3. It will be particularly intensified in about ten years as this age cohort reaches retirement, which will create possible labor shortages and increased demand for health and social services.
LEADERSHIP AND COMMITMENT
Describe the organizational roles and qualifications of applicant agency personnel that will participate. Include level of time commitment (FTE) that these personnel will devote to the planning process and the roles they will play in that process. Discuss the role of the agency’s chief executive. Also, describe plans to continue participation in the health information exchange after the grant.
xxxxxx (your response goes here) xxxxxx
COLLABORATION
NOTE: A letter of support from the head (e.g. health officer) of the applying organization must be mailed to the Program Office. In addition, organizations applying on behalf of a state or local public health agency must supply a letter of support from that agency (or agencies). Letters of support from collaborating partners should also be mailed to the Program Office. See instructions on “Additional Documents Screen�.
List here the names of the collaborating organizations (health departments and members of the health information exchange) from whom we should expect to receive letters of support.
Please describe any collaborative relationships or arrangements related to this proposal, i.e. between local health departments and state health departments or between these health departments and the health information exchange. Discuss your agency’s role in such collaborations and in any other activities related to health information technology in your state. Also include any past successful collaborative efforts with these partners. Please include details on past collaborations.
xxxxxx (your response goes here) xxxxxx
READINESS OF THE HEALTH INFORMATION EXCHANGE
Please describe the degree to which the health information exchange has developed to provide a valuable opportunity for public health agencies to participate. What is the breadth of participation and the level of commitment on the part of the key stakeholders? Has the exchange developed a governance structure? What is the extent of its funding? For example, has the exchange received federal grants or contracts from the Agency for Healthcare Research and Quality or the Foundation for eHealth Initiative’s Connecting Communities for Better Health program? Have specific data sharing projects been planned or initiated? Has a business plan or multi-year strategic plan been completed?
xxxxxx (your response goes here) xxxxxx
CHALLENGES
The data gathering conducted by JSI has facilitated the compilation of a number of constraints that must be addressed by the recommendations put forward above and during the coming phases of this project. • There is a wide and significant variation across the State with regard to level of exposure to, understanding and adoption of health information technology (HIT) across all types of provider entities: physician practices, hospitals, pharmacies, and public health facilities. There is a very limited pool of HIT technical staff resources available to support providers in the acquisition, installation and maintenance of such systems. Of those organizations that have implemented some level of HIT, administrative systems are typically installed first and clinical information systems tend to be a secondary consideration. A very wide range of views exists with regard to the potential benefits and opportunities for implementing and utilizing HIT to improve the quality of healthcare services provided. Across both the physician and hospital segments, groups are looking to the State of Wyoming for guidance with regard to standards and/or “preferred vendor solutions� Broad resistance to the idea of mandated HIT implementation exists across the State. Expectation that appropriate incentives should be provided (mainly financial), in order to support the cost of implementing and sustaining HIT, particularly among the smaller physician practices in the State. Some resistance to the idea of creating a “centralized database of personal health information� exists. Opportunities exist to simultaneously develop both broad, statewide HIT initiatives, as well as those that are focused on HIT in local communities. Moving forward with HIT efforts in the State will require the constant and consistent attention of a central, coordinating organization working with multiple stakeholders.
SPECIAL CONSIDERATIONS
Summarize any special features that make your application unique and innovative. Describe how your project may serve as a model for other health departments.
posted by WyHIO at 7:29 AM
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