WISHIN looking to the future of medical records sharing

Let’s say you live in Dane County, you’re traveling alone, and you’re involved in a car accident in Brown County that requires hospitalization, or at least a visit to an emergency room. Hospital personnel would treat you for what they determine to be your immediate injuries, but how would they know, if you’re unconscious, what health issues you have had, what medications you’re on, or what drug interactions might result?

Those are the concerns the Wisconsin State Health Information Network (WISHIN) is hoping to alleviate, according to CEO Joe Kachelski. WISHIN exists to help health care organizations like hospitals and clinics securely exchange health care information electronically, and it is currently working to attract health care organizations to its network.

In many cases, Kachelski explained, when health care organizations need to share information, it can be a labor-intensive, manual process. Records might be faxed, mailed, or even carried by the patient or a family member. “The [WISHIN] idea is, let’s make digitized health care information truly portable and allow that information to follow patients wherever they might seek care.”

Watertown takes the plunge

Wisconsin has done a very good job of digitizing health information, according to Kachelski. UW Health Partners Watertown Regional Medical Center is the first to sign onto the WISHIN network, and most major health systems in the state have committed to joining.

“We’re not selling cans of corn. We’re really selling connectivity to others, which offers a reciprocal benefit.” — Joe Kachelski, WISHIN

“We didn’t sign up to be the first,” said Jennifer Laughlin, vice president and chief information officer of the Watertown facility. “We happened to be first because we were ready.” In fact, UW Health Partners Watertown Regional Medical Center has long been recognized as a leader in the implementation of health information technology. The next step was having the ability to connect to other communities, which WISHIN provides. “Ultimately, the goal is to share information so our patients can get it anywhere in the country,” she added.

The medical records exist thanks to organizations like Epic, which has developed electronic health record software that’s used around the world. While many organizations use Epic software, even if they don’t, the records can be shared. “Once we have electronic information, we have it in a form that is readily and securely shareable and transferable,” Kachelski noted.

The Watertown group started uploading its patient data on July 12. “We’re the first to submit information into the exchange,” Laughlin noted, “and WISHIN’s technology staff is working with other organizations, like Aurora, to do the same thing. They’re learning from our lessons so they don’t have to re-create the wheel.” Now, physicians of any other group coming on live to the system will have access to the Watertown facility’s patient data, and vice versa, and that’s where the true exchange comes in.

But what of patient privacy? Will patients want their medical records to be accessible by any hospital or clinic around the state? Could records end up in the wrong hands? Could insurance companies access the records to decline coverage on prospective customers?

Opt in or opt out?

“Patients can opt out of the info-sharing option,” Kachelski said, “but that’s an all-or-nothing decision.” The system allows only authorized users on its site, with IDs and passwords set up through WISHIN. “It’s as secure as any other program and may be more secure than any other health care transaction,” he said. “Faxing records is not at all secure.” That said, he admits that nothing is foolproof.

“All of our clients take privacy very, very seriously,” Kachelski said. WISHIN provides two levels of security: technology and policy. Once an authorized user (physician) accesses a patient’s health care information, the policies kick in specifying exactly what they can and cannot do with the information. “We’ve got policies that every organization has to agree to, and they reflect HIPAA and other privacy laws. The network will also log every click and be able to track exactly who has accessed information anywhere in the network.

Entire medical histories will not be accessible, but basic data necessary for immediate care would be, according to Laughlin. “There would be a list of problems — medications, allergies, most recent lab tests, radiology results, pathology results. It just pulls enough information so attending physicians can see areas that could be impacted by treatment.”

Sharing a patient’s medical data could also eliminate duplication of tests and hold down costs. An expensive MRI, for example, would not necessarily have to be performed again if a patient’s record showed he or she had just had one a few days earlier. 

Emergency rooms are an obvious contact point for this type of record sharing, but Kachelski also sees WISHIN providing a great benefit in situations when there is a transition of care, or a handoff from one provider to another. “These are opportunities for quality problems,” he said. “If a handoff is incomplete or delayed, opportunities for vulnerabilities can occur.”

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For instance, a patient being discharged from a hospital to home or a rehabilitation facility needs a continuity of care that requires everyone to have access to the patient’s information. “Because Medicare is penalizing hospitals that have too many preventable readmissions, they have a stake in making sure someone they discharge doesn’t end up back in the hospital,” Kachelski said.

Like any startup, getting the first client was crucial. “We’re not selling cans of corn,” said Kachelski. “We’re really selling connectivity to others, which offers a reciprocal benefit. The value that the health care organizations get is directly related to the number of groups in the network.”

The key, he said, is attracting a group of early adopters who regard WISHIN as a strategic investment and “understand that in the early stages, the return to them won’t be immediate. It requires some faith on the part of the client.”

And money. WISHIN received initial funding from the American Recovery and Reinvestment Act of 2009 that helped cover the initial connectivity and one-time implementation expenses, but eventually, WISHIN will be self-sustained through annual subscription fees paid by the health care organizations — not the patients. “The cost is very nominal,” Laughlin insisted. “The savings, by not duplicating tests and creating other efficiencies, I think, will outweigh the cost.”

Kachelski said research conducted early on proved Wisconsin was primed for the next step. “To some extent, [we found] that many patients believe that electronic health record exchange is already happening more than it actually is. They often assumed that their doctor was already sharing their records electronically, but that hasn’t been the case.”

Laughlin agreed. “This is a natural progression. At the end of the day, [the network] can provide better patient care at a lower cost and a better experience overall for the patient.”

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