SCHIEPPH: Marshfield Clinic Health Information Exchange (HIE) Pilot Demonstration

Aaron Miller, PhD , Laurel Verhagen , Jacqueline Bohne , Joe Finamore , Taha Kass-Hout, MD MS , Simon Lin, MD 1 Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 2 Centers for Disease Control and Prevention, Atlanta, Georgia
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Contact
Aaron Miller Biomedical Informatics Research Center 1000 North Oak Avenue Marshfield, WI 54449 (715)-221-6429 miller.aaron@mcrf.mfldclin.edu http://www.marshfieldclinic.org/birc

Objective
The goal of the States, Communities, and HIEs for Prevention and Public Health (SCHIEPPH), led by the US Centers for Disease Control and Prevention (CDC), is to develop a pilot demonstration that illustrates how well current automated exchanges of healthcare information can be used to monitor and analyze the efficiency of preventive care interventions; collect valuable lessons learned; provide real-world feedback to the standards bodies involved; and lay the groundwork for a preventive care community of providers, Health Information Exchanges (HIEs), and public health organizations. Marshfield Clinic acts as a data provider, transmitting quality measures through NwHIN CONNECT.

Process for Health Information Exchange

Results
The initial challenge was the calculation and extraction of the measures themselves generated as part of MUse (phase 1). Once extracted and formatted to meet PQRI XML specifications, the second element involved installation and configuration of the CONNECT gateway to transmit the measures. Finally, the transmission of the NQF measures via the CONNECT gateway to public health was automated for continuous reporting over a one year period.

Discussion
The technical challenges in creating and regularly transmitting the NQF measures were dwarfed by the institutional challenges associated with automated reporting of the summary results contained in the data feed. Because this project involved (summary) patient records, the institutional review board (IRB) was involved from the outsetthough they ultimately determined that this project did not fall within the scope of research, but rather was appropriately considered a quality-improvement effort. There was some internal discussion about the value of participation in this type of project: was there risk in voluntarily sharing metrics that could, potentially, reflect negatively on the institution? The primary concern with automated reporting was patient confidentiality; this required substantial involvement from the legal department to verify that the data could be shared as part of the demonstration.

Background
Marshfield Clinic has been a pioneer in the development and implementation of Electronic Health Records (EHR). CattailsMD, the EHR that is used within the Marshfield Clinic system, was developed entirely in-house and is used to record and maintain all data associated with healthcare delivery. Marshfield Clinic utilizes the data stored in the EHR for a vast range of primary and secondary purposes. In spite of the institutional experience that Marshfield Clinic maintains in working with clinical data, there were substantial challenges associated with transmitting the National Quality Forum (NQF) measures to the central system.

Methods
Marshfield Clinic participates in SCHIEPPH to provide population health measures to respective public health department in the jurisdiction. Clinical quality measures previously calculated for Meaningful Use (MUse) from data available through the Marshfield Clinic Research Data Warehouse (RDW). These measures were formatted to be compliant with the NwHIN CONNECT infrastructure, and transmitted to public health for demonstration purposes.

Acknowledgements
Mary George, MD (Centers for Disease Control and Prevention), Kieran Dunne (Agilex), Matt Ewert (Marshfield Clinic), and Katelyn Weichelt (Marshfield Clinic) contributed towards this work. The authors thank Crystal Gumz and Cathy Schneider for assistance in preparation of this poster.

Biomedical Informatics Research Center

Centers for Disease Control and Prevention