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WISHIN enters adulthood

WISHIN enters adulthood

The Wisconsin Statewide Health Information Network has “matured considerably” since its founding in late 2010, according to CEO Joe Kachelski.

“I think we’re entering our young adulthood now,” he said.

The statewide network connecting healthcare providers to exchange information continues to grow, with Kachelski eyeing uptake among emergency medical services and post-acute care providers.

It’s in the midst of an update to its platform too.

Meanwhile, a federal effort to establish a framework to help share health information is underway.

Kachelski recently spoke to Wisconsin Health News about the Trusted Exchange Framework and Common Agreement, also known as TEFCA, and WISHIN’s work.

Edited excerpts are below.

WHN: What is TEFCA? 

JK: The whole point of TEFCA is to create what they call a single on-ramp to allow clinical data to be shared across networks. So WISHIN is a network. CRISP in Maryland is a network. CliniSync in Nebraska is a network. We’ve come a long way since most of us got our start. And that involved building technical infrastructure and policies around the topic of electronic sharing of health information. So now we’ve got organizations like WISHIN in just about every state and in some cases more than one in a state. And those networks had to come first. Nationwide interconnectivity doesn’t really happen until you have these regional or state-based (health information exchanges). It doesn’t really work in reverse. You kind of have to go from the ground up.

There’s always been a vision that these networks can exchange information with each other. And that makes sense, right? There’s a varying number of circumstances in which a patient might be having a medical encounter somewhere other than where they normally are located. So we’ve always had that as a goal. And there were some early attempts to make that happen that didn’t work all that well, didn’t have a lot of adoption and participation. So I think TEFCA’s really kind of a do-over, and I think there’s been a lot more thought and a lot more, frankly, experience that went into the development of TEFCA. And I think that’s an indication that electronic (health information exchange) is maturing. It’s realistic now to think about that vision and make it real and widespread …

But even though we are where we are, I think it would be not accurate to say that we’ve arrived. I don’t think that’s the case. It’s going to be a process. But we’re closer than we ever have been to making that happen. So we have the technical standards. We have the standard payload. There’s the legal framework. And there’s these conceptual intermediary entities called QHINs. That’s all there. And so that means there’s the foundation for it to happen, but it’s going to take time until it’s fully mature. There are plenty of unknowns yet.

WHN: What are qualified health information networks? 

JK: I call them traffic cops or maybe hub airports. They are these intermediary points through which data would pass on its way to its destination from its source. So there is no arbitrary number of QHINs that might exist. And that’s one of the big mysteries. Are these things going to materialize? And if so, how many will there be? … Any network like WISHIN that wants to participate in TEFCA-style exchange will accomplish it through a QHIN, or perhaps more than one QHIN. There’s nothing that says a network like WISHIN couldn’t affiliate with more than one. But that’s how it’ll work.

In terms of WISHIN, WISHIN will not be a QHIN in the foreseeable future. I think we would affiliate with a QHIN because that’s how we would accomplish this exchange on behalf of our clients.

WHN: Where do things stand with WISHIN 2.0?

JK: I think we’re going to be live in our new environment soon … It’s a complicated process. It’s definitely taken more time than we would have hoped. But we’ve been populating both of our environments, our current environment that we will be transitioning from and the new system, for almost a year now. So the live data’s been populating both environments for a fairly long time. So that data is accumulating. We’ve had no interruption in service, and that’s not going to happen. There will be a day when, you know, today we’re in the old system and tomorrow we’re in the new system. And that will be seamless for our participants.

We’re working on the historical piece. There are 12 terabytes of historic data that we’ve got to get into the new environment. That’s something we have to get right and we have to take the time to get it all nailed down.

WHN: What are the improvements?

JK: We want to be in a technical and software environment that positions us in general to innovate, to be better at responding to the evolving needs of the market. So that’s a general principle. It’s not a specific functionality or use case, but it’s the ability to go in those directions when, if the opportunity arises. So we’re a stakeholder-driven organization. Our clients have a lot to say about what we do next. Certainly, there are some things that we’ve heard from our clients that they’d like to see. That’s in part driving our transformation. So we’ll just have a better ability to be lighter on our feet and be able to innovate because of the new technical environment that we’ll be occupying.

I would say in terms of specific improvements, the new system’s going to be much more user friendly, much more user configurable. So different users might have different needs and they can bring information that they typically would be looking for kind of the top and to the forefront. They can track certain patients. Like you create favorites on a browser, websites you go to a lot, well, they can create favorite patients. For example, a care manager, somebody who’s responsible for a chronic disease population like diabetics or congestive heart failure, those patients can be brought to the top for them. Those are their favorites, right?

We’ll have new freedom to deliver information, not just at the point of care, but at the population level. So that’s an important advancement for us … And we’re going to be in a much better position to deliver information actively, push data rather than passively making it available, but subject to a query, ‘I’m looking for patient x’ or whatever. So we’ll be able to be more user friendly in that way as well.

WHN: What’s next for WISHIN? Can you talk about your work with the Division of Public Health at the Department of Health Services? 

JK: There’s all kinds of attention on questions around health equity and social determinants of health. I think healthcare organizations are paying attention to that more and more. They are collecting data that is relevant to those kinds of questions and they are increasing their collaboration and partnership with healthcare-adjacent community organizations – food pantries, housing, things that fall under the heading of social determinants of health and a lot of research indicates have a pretty big impact on health outcomes. So I think we’re seeing the maybe blurring of the lines a little bit between healthcare and social services where there’s a recognition that they need to work together and communicate with each other. And so our view is that we’ve got a fair amount of technical infrastructure in place. We can share information with anybody. Obviously, there are some firewalls in terms of personal health information that can’t be accessed by non-healthcare people. We think that there’s infrastructure we have in place that can advance the ball in terms of improving health equity and enabling collaboration between healthcare and social services.

And with the Division of Public Health, I think we were happy to be asked by DPH back at the beginning of the pandemic to help them understand the breadth and depth of the pandemic. And we were able to supplement some of the clinical data that they routinely collect. And that got us thinking. There are probably some other things we can do in collaboration with DPH. And one of the things really came from participants of ours who have asked us, like they’re saying, ‘Look, we’re pushing a lot of clinical data through the pipe to WISHIN. Maybe it would be efficient if WISHIN was the transport mechanism for the subset of that information that needs to find its way to DPH.’ They have reporting requirements, and the sense is that what they need to send to DPH is a subset of the stuff they’re sharing with us. So maybe we could handle their reporting duties for them. And that seems to make some sense for us. It seems like a small thing.

I think one advantage of that is to the extent that DPH changes reporting specs – and those change over time – if that information was being managed by WISHIN, the specs could be changed at the WISHIN part of the pipe rather than making dozens or hundreds of organizations lift the hood on their (electronic health records) … there’s a change that we could administer that centrally and not put that burden on the data submitters themselves.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.

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