Health Care Vision 2020
West Michigan Health Information Exchange
Clinical Work Group
Meeting Minutes of October 2, 2007
1. Welcome and Introductions: B. White facilitated welcome and introductions. The meeting minutes of September were reviewed, discussed and approved. There was discussion regarding the difference between HIT and HIE and the related value of having an EMR.
2. Health Care Vision 2020 Updates: B. White provided an update on the other seven work group activities to date. The discussion regarding the 2006 MiHIN process and the Conduit to Care Report was deferred to the November meeting when Greg Forzley could provide his perspective on the process and the report.
3. Clinical Work Group Charter Review: There was discussion regarding the growing use of EMRs and PHRs suggesting that EMRs will progressively become mandatory to practice medicine. Also the value of portable PHRs (a few examples were cited such as All Scripts and Heath Metrics, Google and Health Vault from Microsoft) with self reported information as well as an edit loop for providers. The burden is currently on the physician’s office to enter all this data in the EMR; including consumers in this process needs to be considered. The MICR example was discussed but this also needs to feed the EMR directly from the registries as well to be more efficient.
4. Work Plan Review: There was discussion regarding the limitations of EMR and HIE and that technology is not the complete answer but can cause different challenges and unintended consequences; it was concluded that we must really focus on HIE and related process. W. Kohn referenced the AHRQ report on unintended consequences; he referenced the CPOE.org web site for this article to be reviewed by the work group at the next meeting.
E. Williams provided a review of the executive summary of other national models for HIE. This was followed by general discussion regarding functions and use cases for HIE. B. White will send out the summary of the IHIE September 14th presentation on its use cases (clinical messaging and ED).
It was summarized that it is the function of this work group to recommend 1) what kind of information should be exchanged, 2) how much information should be exchanged and 3) to whom and from whom should information be exchanged. This needs to be addressed in the context of quality processes and the impact on operational processes in the clinical settings to prevent unintended consequences. There was further discussion regarding use cases including examples of ER kiosk triaging or in PCP offices to increase efficiencies as well as related risks to this type of system. JCAHO mandates were discussed regarding medical records and other patient safety requirements. The importance of using HIT and HIE as a tool was emphasized, but not a substitute for quality processes, which needs to be the critical focus.
S. Duchemin will provide information on the HHS Four Cornerstone HIE survey questions and B. White will provide the eValue8 report summarizing health plan response to the survey questions.
Discussion turned to the value propositions and business case for HIEs and the need to engage consumers and employers in this process. B. White will provide the summary of the research that was done by the DCH at the next meeting. It will be important to make sure consumers are demanding the use of HIT and HIE. The risk is that consumers already think, for the most part, that the industry is already doing this, so it will be difficult to drive a market demand strategy.
The group agreed to begin to look at the scope of use cases including clinical messaging and ED. The CCR will be reviewed at the next meeting. S. Wakefield will investigate the HIE system used in Great Britain, C. Bethune will investigate Cincinnati Health Bridge, B. Bieber will investigate Wisconsin and J. Hodgins will investigate UP Michigan use cases