Health care: Linking electronic medical records statewide

Questions and answers with Joe Kachelski, CEO, Wisconsin Statewide Health Information Network (WISHIN)

Q: Joe, what is WISHIN?

A: It’s a 1-year-old, not-for-profit statewide organization that is a public/private partnership with the state of Wisconsin. It was founded by two main provider associations and two statewide quality reporting initiatives to develop a statewide health information network. We intend to connect EHR systems across the state so that medical records can follow patients wherever they seek care.

Q: We already have electronic health records (EHRs) in Dane County. Don’t we already have interagency traffic established for those as well?  

A: No. Patient expectation and reality are not the same. Consumer research indicates that patients expect their records to find their way to each provider from whom they seek care, and they think it is happening more than it actually is. One health care system cannot always readily access the records of another system. Not yet. It isn’t automatic or fluid or even possible in some areas of the state.

Q: Are doctors on board with this?

A: Change is always hard, though this shouldn’t be a big change in communication, given their familiarity with EMRs now. It should actually be a huge change in workflow and make things easier for them. It won’t succeed if it is a pain in the butt for doctors, honestly, so we need to make it seamless so they don’t have to learn a new system, but we integrate what they have now. Our idea is to solve problems, not create them, and to make it easy for clinical intake staff.

Q: You mentioned WISHIN is a year old, and I assume you built infrastructure in 2011. What are your plans for 2012?

A: We’ll contract with a vendor for the technical services and infrastructure to build the statewide health information network. And we’re looking to pilot our services in a small number of communities in the fall. Also, we’re engaged in a significant public education effort in the early and middle part of the year.

Q: There is a public cost for your program. What is the public benefit, at the end of the day?

A: Two gains: quality and cost savings. Making EHRs interoperable improves clinical decision-making, reduces administrative costs, and facilitates transitions of care.

Q: What do you mean, it will improve clinical decisions? How so?

A: Our services will provide access to clinically relevant information at the point of care. The physical or hospital can know – even if the patient can’t tell them – what recent tests, diagnoses, prescriptions, drug allergies, etc., they have. More complete and current information naturally can lead to better care and reduce unnecessary duplication. Unfortunately, in many cases, even though many records are maintained electronically, we have to reverse-engineer them to make them available to someone else. Every transition of care, from one provider to another or one venue to another, is an opportunity for problems. Handoffs are not always executed well, and this is an answer.

Q: Don’t many hospitals already share information electronically? What is the barrier to linking them quickly and efficiently?

A: Some do, in a limited fashion, but we’d like to make all of these existing pockets of HIE nodes on our networks and facilitate exchange to and from all participants in the network.

Q: How does the health information exchange environment in Wisconsin compare to that of other states?

A: Wisconsin is a very wired state in this regard. Probably 70-75% of our medical providers have implemented an EHR system, and because we have a lot of integrated systems – large multispecialty clinics with affiliated hospitals in many cases, some degree of health information exchange is already happening, and with a relatively smaller number of connections, we can have a truly statewide network.

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