Minnesota e-Health Initiative Regional and Cross-Border Considerations in eHealth

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


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


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


Key Projects Initiated(Policy – Funding – Implementation)

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Strategic Leadership: Advisory Committee


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)


Strategic Leadership

Strategic Leadership Includes…Clear Vision and ScopeRoad Map for Action Help Focus and Set PrioritiesPublic Funding and PolicyAssess, Evaluate and Monitor

Progress


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


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


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



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Public Health: MN PHIN – Fast Forward


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


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


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.



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Privacy & Security



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


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


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


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


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



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Privacy & Security


Exchange: Mn Health Care Connection


Interoperability is More than Wires


Minnesota Health Care Connection



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Privacy & Security


Funding & Incentives: 12 Grants



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



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Privacy & Security


More….

Funding & Incentives: 12 Grants



Opportunities for Collaborative Action

Metrics / AssessmentCatalogue our border issuesAction plans for common projectsModernizing Disease outbreak systems


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


Key Contacts for More Information:

www.health.state.mn.us/ehealth

Minnesota Department of HealthMarty LaVenture, PhD– Director of Health

Informatics651 201-5950 [email protected] Brand– Deputy Director, Health Informatics651-201-5508 [email protected]

Thank You!

Minnesota e-Health Initiative Regional and Cross-Border Considerations in eHealth

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