March 2017
Have a WISHIN story you'd like to share? Let us know. 
"WISHIN is key to our backup processes"
Client Spotlight: Door County Medical Center
In the early hours of March 14th, the staff of Door County Medical Center (DCMC) was facing a nightmare situation: after a routine planned data migration, the hospital's electronic health record (EHR) system failed to restore.

"Our IT staff worked very closely with the EHR vendor and for the first several hours it seemed success was [going to happen] within the hour," said Nancy Davis, Director of Compliance and Safety at DCMC, "However, by late morning temporary measures were wearing thin."

Under the direction of DCMC's leadership the decision was made to activate the Incident Command Team under the Emergency Preparedness Plan. This ad hoc team is made of key stakeholders impacted by the emergency (hospital leaders, staff, providers, IT, HIM, etc.). The Incident Command Team set up operations and began to strategize and access backup processes to mitigate the situation and ensure continuity of patient care. While the EHR system was "down," staff and providers moved to paper backup processes with pre-printed forms, handwritten notes, and blank folders.

Then they thought of WISHIN. DCMC has been sharing clinical data with the WISHIN network for two and a half years.  Why not use WISHIN Pulse as a temporary replacement for the clinical history stored within DCMC's EHR?

"It was determined that facilitating clinic provider and staff access to WISHIN would be beneficial for [accessing] patient demographics including phone numbers, diagnostic studies, laboratory results, etc.," Davis said.

Although DCMC wasn't planning to go live with additional WISHIN Pulse end users that week, the crisis called for an expedited process. Laura Widder, WISHIN Project Director, gave Davis a crash course via webinar to instruct her how to set up new users.

"I was surprised at how quickly we could move forward with the information [Laura] provided," said Davis, "From that we were able to facilitate access [for] clinic providers and their staff quickly and the available information from WISHIN immediately solved problems with patient contacts, history, and diagnostic study availability."

Fortunately, DCMC's EHR was back online by 7:00 p.m.

"It was a long day," Davis recalled. "However, we were able to mitigate many issues by [accessing the] information available in WISHIN."

DCMC originally saw value in becoming a WISHIN participant because of Door County's status as a popular tourism destination.

"People from all over Wisconsin and other midwestern states travel to the area and unfortunately may need unplanned medical care," said Davis, "It was felt that having access to WISHIN would help us serve this population."

While WISHIN Pulse was available for users in the DCMC Emergency Department before the incident, Davis reported that afterward many other providers at the hospital and clinics (whose go-lives has been planned for a later date) were interested in continued access to the WISHIN Pulse community health record.
 
Davis added, "We have a planned downtime this weekend and WISHIN is key to our backup processes."

 
For more information on how WISHIN Pulse can work as a back up system for your organization give us a call at (608) 274-1820 or send an email to wishin.support@wishin.org. 
HIEs Can Play a Crucial Role in a Disaster-Recovery Plan
Health information exchanges (HIEs), like WISHIN, provide easy access to patients' clinical history from external sources and thus help inform clinical decision-making at the point of care. However, HIEs have also proven to be crucial tools in emergency situations when the local EHR may be temporarily unavailable due to a technical failure or a natural disaster.

When Hurricane Katrina hit the Gulf coast, most hospitals were still using paper records for patients' health histories. A 2005 story from Time magazine described the health care struggles seen in the aftermath of the hurricane including children separated from their parents with no knowledge of the medications they had been taking and thousands of displaced people needing access to ongoing treatment such as radiation for cancer or drug treatments for diseases such as HIV and AIDS, with no way to keep up care plans. While perhaps the largest factor in health care crises after Katrina was reliance on paper health records, what good would electronic records have been if they only existed within each specific hospital system?

This is where HIE is so important.

By 2012, health care providers across the nation had made huge investments in all sorts of health information technology. Hurricane Sandy hit the East coast with force but many New York hospitals were prepared. As Manhattan hospitals flooded they were able to evacuate patients to other locations in the city that still had power -- and internet access -- to retrieve patient records from the Statewide Health Information Network of New York (SHIN-NY).

In an interview given at the time, David Whitlinger, former executive director of New York eHealth Collaborative (NYeC), which oversees SHIN-NY, shared his thoughts with Healthcare IT News on how HIE should be seen as a public utility for shared benefits, including adding the statewide HIE to an organization's emergency backup plans.

"If everybody has to spend enormous financial resources on disaster recovery on their own, where they could rely on a state public utility resource for that, there could be some substantial savings," Whitlinger said, "...[the statewide HIE is] not a commercial enterprise, it's here for the public good, and this is an example.

Now, more than a decade after Hurricane Katrina, four out of every five hospitals have a basic EHR system and HIEs have proliferated across the country. WISHIN Pulse provides critical clinical history when everything is running smoothly, and it is even more important when catastrophe strikes.
Review: Your Questions from Our ePDMP Webinar
Thank you to everyone who joined us last Wednesday for "Beyond the ePDMP." Below are the questions we answered during and after the webinar. They can also be found on our website along other ePDMP FAQs.
Q: Do you send the user information on who queried WISHIN to the PDMP?
A: Yes, WISHIN sends monthly reports to the Wisconsin Department of Safety and Professional Services (DSPS), detailing who accessed the PDMP and the patient that was queried.
 
Q: What medication categories are covered by this requirement?
A: Medication categories are defined in Wisconsin statutes, ss .   961.16 ,  961.18 ,  961.20 , and  961.22 . In general, it includes:
  • State Controlled Substances in Schedule II, III, IV, or V that require a prescription order to be lawfully dispensed.
  • Federally Controlled Substances in Schedule II, III, IV, or V that require a prescription order to be lawfully dispensed.
Prescribers are required to check the prescription drug monitoring program prior to issuing a prescription for controlled substances. There are some exceptions to this, but not based on the drug schedule. More information can be found at the following sites:
 
Q: Are there plans to add advanced analytics to WISHIN view?
A: Yes, when we integrate with the new ePDMP, analytics will be included in the view. This integration is planned to be completed before the end of this year.
 
Q: WIN says WISHIN access will end in 2018. Is this accurate?
A: Any organization that was integrated with the PDMP prior to the new system must upgrade its connection to the new ePDMP before January 1, 2018. This change is WISHIN's top priority, and we fully intend to have the change completed by that date. WISHIN's access will not end.  
 
Q: If medical clinics are owned by a hospital, is there a $500 fee for each, or are they included in one fee?
A. The hospital system charge is $1,000, which includes all clinics owned by the system, if they share an EHR.
 
Q: Does the provider need to log into ePDMP?
A. Not to access it through WISHIN Pulse.
 
Q: Is it accurate that the requirement to consult the PDMP beginning April 1 is time limited?  Is it three years?
A. Correct. The requirement sunsets on March 31, 2020. See:  https://docs.legis.wisconsin.gov/statutes/statutes/961/III/385/2/cs/1
 
Q: Are there plans for WISHIN to integrate into electronic medical records (EMRs)?
A. WISHIN Pulse can be integrated into EMRs to avoid having to separately sign in to WISHIN Pulse and perform a separate patient search. Users are not required to sign in to ePDMP separately, either. When viewing a patient in an EMR, a user would select a WISHIN icon or link, which would open WISHIN Pulse in a pop-up window and display the patient's community health record, which includes PDMP data.
 
Q: Sometimes when I search for a patient I get an error message. I've been told that this message means that the patient has no data not that there is a true error. When will this be fixed?
A. This will be fixed prior to April 1, 2017.
 
Q: If you are a current WISHIN subscriber, is there an additional cost to access the ePDMP through WISHIN & if so, what is the cost for a community clinic (non-profit)?
A. The annual cost for a clinic is $500. This is per organization. Clinics with multiple branches are not required individual $500 fees as long as they share the same EHR.
 
Q: If a delegate uses WISHIN to view PDMP, how does that delegate get linked to the provider so the provider gets credit for checking?
A. WISHIN's current integration with the PDMP doesn't differentiate between providers and delegates, but keeps a record of the organization and user that performed the query. According to DSPS, the reports WISHIN provides satisfy the requirements for checking the PDMP.
 
WISHIN will work with DSPS and WIN to determine how this will be handled when it migrates to the new ePDMP interface.
 
Q: The ePDMP displays graphic prescription information & morphine equivalent graphs, will this be added to the WISHIN medications view?
A. If it's specific to an individual patient, then it will be displayed when WISHIN switches to the new ePDMP interface.
 
Q: What is the cost for moving from a WISHIN DirectPlus contract to a WISHIN Pulse contract?
A. WISHIN determines this based upon two different structures, depending on whether it's a hospital system or a clinic. Hospital system pricing is based upon net patient revenue, while clinic pricing is based upon the number of providers. If you would like specific pricing information, contact WISHIN at wishin@wishin.org or (608) 274-1820 for a quote.
 
Q: What is ADT?
A. Admission, Discharge, Transfer. It's an interface from your EHR system to WISHIN that identifies the patient and provides key demographic information for WISHIN's master patient index. Most ADTs also contain some clinical information like diagnoses and allergies.
 
Q: Can we see an example of the difference looking up ePDMP?
A. WISHIN does not have access to the ePDMP screens; however, the patient prescription history should display the same information in both systems. When WISHIN moves to the new ePDMP system, WISHIN will be displaying the same page that you would see in the ePDMP for a specific patient.
 
Q: How many sites are using WISHIN now?
A. WISHIN's network includes more than 1,400 points of care either live, onboarding, or contracted.
 
Q: Will this interface allow querying of other states' ePDMP?

A. The National Association of Boards of Pharmacy (NABP) does not allow access to multi-state PDMP queries through any integrated PDMP interface, including WISHIN's. Multi-state queries are only available through the ePDMP portal.

 
Q: How do we show a provider has accessed PDMP? Can that info come back to be filled in our EHR?

A. There are audit reports available within WISHIN Pulse that your organization can run. The reports can be based on the entire organization or per individual user, and for any time period. These reports can be generated as .csv files, which could then be imported into other programs.

 
Q: What is WIN?
A. WIN is the Wisconsin Interactive Network, LLC, which is the vendor that created the new ePDMP site. It is a subsidiary of NIC (National Information Consortium).
 
Q: Is Marshfield Clinic a part of WISHIN yet?
A. Not yet.  A hospital owned by Marshfield Clinic (Lakeview Medical Center in Rice Lake) is in the WISHIN network.

You can still watch a recording of the webinar, sign up here to receive the link.
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