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Scott Webb (Host):  Lori Manteufel is a Health IT Project Specialist at MetaStar. Since April 2015, Lori has worked primarily in the Health IT Extension Program assisting Wisconsin Medicaid Providers to improve health IT maturity and participate in the Medicaid Promoting Interoperability Program and Steve Rottmann, joined WISHIN as the Chief Operating Officer in July 2016. In this role, he works to expand the network through the states of Wisconsin and Minnesota implementing new solutions and capabilities that provide value to participants and promote the value of health information exchange throughout the healthcare delivery system. Lori and Steve are joining me today to discuss how patient care can be improved through interoperability. This is MetaStar Health IT Radio, the podcast from MetaStar. I’m Scott Webb. Thanks for joining me Lori and Steve. I’ve got so many questions for you. First for you Lori, what is health information exchange?

Lori Manteufel, BBA (Guest):  In laymen’s terms, health information exchange or HIE is the act of electronically sharing a patient’s health information between healthcare providers or healthcare settings, such as a patient goes to the hospital and then is transitioned to a clinic or long-term care facility. I might also add that HIE is a key component of both the Medicaid Promoting Interoperability Program, the stage three objectives as well as the quality payment program. HIE is also a term that’s used to describe an organization. An organization that provides services that enable that electronic and secure sharing of health related information electronically.

Here in the state of Wisconsin, just as an example, if I might add is WISHIN and WISHIN is Wisconsin’s statewide health information network. Does that make sense?

Host:  Yeah, it definitely does, and we are going to get into WISHIN when we talk to Steve but why is health information exchange so important?

Lori:  The reason why it’s so important is that the goal is really very simply. Provide the right health information at the right time to the right healthcare providers or team of providers to provide care delivery making it safer and more effective. Basically, ultimately to produce better health outcomes for the patient by having the information right there at the care team’s fingertips. That’s also know as interoperability and HIE is supported by the use of certified electronic health records, so our HER and these EHRs use nationally recognized standards to really further that enabling of interoperability or data sharing in a secure and confidential way so that a patient’s health information is protected as it ideally flows from one setting of care to another.

Today, what really is happening or continues to happen is that fax and phone calls are still used at a high rate to communicate between providers. And that works and has worked for many years. However, today with today’s technology; providers can have better information than what they traditionally would receive via fax or phone calls. Because many times, that information doesn’t give them the most timely view of a patient’s health status. Health information exchange can provide or fill that gap.

Host:  It sounds like there are a lot of benefits. Let’s go through some of them. Let’s talk about the benefits of leveraging health information exchange.

Lori:  Well in a ideal state, as the patient’s health information automatically flows with them, the healthcare providers, as well as the care team overall, have the best and most accurate information possible when they are making decisions about that patient’s care. And so, some of the benefits of health information is reduction in duplicate testing, avoiding medication errors, and really improving decision making all the way around, putting the patient right in the center of their own care. And that’s why true interoperability is such an important goal.

Host:  It definitely sounds like it is. So, what are the steps that a healthcare organization can take to get started?

Lori:  There’s a number of steps that really need to be taken and the first thing that a healthcare organization really needs to determine is what service providers are available to them and really best meet their needs. It’s essential to know what kinds of data can be exchanged. So, I’d recommend that first an organization talk with their EHR vendor to understand both what the capabilities are that are built into the HER as well as the limitations. Because there are some very important limitations to that as well.

For example, most EHRs do provide some kind of a platform for structured data exchange between providers, however, the usefulness of the information sent or received using the HER alone, varies greatly especially between different EHRs. Many times, the information received is not something that can easily go into a patient’s healthcare record. It may be available, but it might be available in a special file and not really incorporated fully. Also, talk with service providers in your region. For example WISHIN here in Wisconsin. It’s an HIE organization. And it’s important to know what organizations in your area or service providers who they currently connect through.

And what services are available especially those that go above and beyond what your HER is capable of. For example, through the organization, you may be able to automatically receive ADT notifications so admit, discharge and transfer notifications automatically when your patient is admitted or discharged from the hospital. I’m sure you can kind of see how that would really help a team of healthcare providers to proactively plan for that patient’s follow up care. So, those are a few of the steps that I would really recommend that an organization research and really understand what’s available for them in their area.

Host:  Definitely a lot of great reasons for them to get involved and get educated and also a great time to transition to Steve since you mentioned WISHIN. Steve, can you describe how WISHIN supports interoperability in Wisconsin?

Steve Rottmann, BS (Guest):  In Wisconsin, WISHIN supports interoperability by exchanging seamlessly healthcare information for more than six million patients across 1700 sites of care throughout the state. And that’s regardless of the care setting, an HER that’s being used or a technical capability of doctor or a provider or a health plan. This is flattening that exchange so that information can flow seamlessly. Lori mentioned a number of opportunities to leverage WISHN, our network, our secure network to exchange information confidently at the right time for the right individual to those that are providing healthcare in any facet for a patient.

That also includes care management and alerts so that at risk populations can be involved in their care immediately to find the appropriate site of care. As Lori mentioned, there is a great opportunity to avoid preventable repeat testing and put patients through that but then also alleviate that cost that is downstream and impacts the overall cost of healthcare in the state and throughout the nation.

HIE is that seamless access. It helps the provider and patient exchange and that real time access leading into patient satisfaction overall. It also improves the outcomes and quality measures that both providers and health plans aim to meet.

Host:  Well and patient satisfaction would seem like such a key thing and great that you are focused on that. Do you have any specific examples of how WISHIN can facilitate effective transitions of care?

Steve:  So, we see that there’s essentially two types of transitions. Planned and unplanned. Planned transitions are that coordination of care between one setting to another, from and ED, from an inpatient into an ambulatory setting or a post-acute setting or into a home health situation where people want to manage their care by themselves or with the support of others. What WISHIN does in that transition is replace the current paper exchange or inefficient access to information that requests and fulfillment. For example, I have this patient, can you send me some information for them? Ultimately, as Lori indicated, there’s a lot of faxing. Let’s eliminate the fax. A lot of this information lives digitally in an HER, let’s keep it there. It’s secure. And it’s controlled.

For unplanned, this is a situation where somebody walks into a facility, into an ED or into a post-acute setting and what is the visibility of this individual? So, we are helping answer the question who is this patient? Who is this resident? So, we provide a portal that organizations can access that have a treatment relationship with somebody either extending or new and immediately have access to their what we call longitudinal community health record. Information when it’s needed most to support that care at that right time.

In both situations, WISHIN facilitates as I mentioned, efficient admissions and that includes what are the current diagnoses for this patient, medications, allergies, recent labs, getting into is there a preventable test that we can avoid here, what are the radiology, what’s the insurance information for this patient? The list goes on and on. Does this patient have an advanced directive? Also there’s a bidirectional exchange component of WISHIN and health information exchange that’s needed for those smaller less sophisticated organizations to have a digital seat at the table. Now, a large health system can communicate to a post-acute facility, to a home health agency, to an FQHC and then it’s reciprocal. That information from those settings is shared so that at the point of care, as we mentioned previously, an ED doc could have access to see what is going on with the care outside of my purview.

And then the continuity of care. I mentioned previously, notifications. That would be a patient showed up in an ED, not only can that notify others on a care team; but that individual receiving that patient and providing care at that time can get some level of care instruction or care management so the continuity between the entire care delivery system is seamless. We are focusing then on the quality of care and reducing the overall cost of care.

Host:  Steve, that all sounds amazing. I can’t believe there are any organizations that wouldn’t want to be a part of this. But let’s go through what types of organizations can and should be using WISHIN?

Steve:  Today, there’s many organizations using WISHIN in different capacities. We have over 1700 sites of care so that includes acute, post-acute, clinics, and to be more specific, ED settings, health systems, hospitals, ambulatory clinics which would be a PCP, specialty clinics like an orthopedic or an ENT, care managers within health systems or health plans, case managers in health plans to provide that continuity of care including labs, which would be reference labs that clinics send out. Their labs so that they can get results back and share those results and pharmacists as well. So, for the purpose of med reconciliation and compliance to prescribed drugs from a PCP or from a health care provider. And I mentioned, health plans. So, health plans find great value in accessing WISHIN for a multitude of purposes.

Today there are more than 10,000 users using our web-based portal as a third party application in their workflow. As I mentioned, as a web-based portal, but also there is single sign on so within a workflow, within an HER or an EMR; individuals can single click into the longitudinal record and view the longitudinal record in the context of that clinical visit.

Host:  So, you were talking about access there. How can listeners find more information about WISHN?

Steve:  We have a great website full of resources, full of information. That website is www.wishin.org, W-I-S-H-I-N.org. Individuals can also sign up for our monthly newsletter and that will go out at WISHIN Connections and there’s also information about upcoming events that we host with our partners and other community resources and participants of WISHIN.

Host:  Lori, last question for you. Where can listeners go for more information or assistance regarding health information exchange?

Lori:  Listeners can learn more by visiting www.metastar.com. That’s M-E-T-A-S-T-A-R.com and check out especially the health IT extension program. This program is grant funded and it provides health IT support to Wisconsin Medicaid enrolled providers throughout this state. And we are really here to help organizations no matter what your size, explore HIE options and other health IT topics. So, if you aren’t already part of our program, we most certainly invite you to reach out to us today.

Host:  Lori and Steve, thanks for joining me today. That’s Lori Manteufel, Health IT Project Specialist at MetaStar and Chief Operating Officer at WISHIN, Steve Rottmann. For more information on this topic and to access resources that were mentioned, please visit www.metastar.com/podcast. And thanks for checking out this episode of MetaStar Health IT Radio. And if you found this podcast helpful, please share it on your social channels. And be sure to check out our entire podcast library for other topics that may interest you. I’m Scott Webb. Thanks for listening.