Steve Rottman has bee CEO of the nonprofit Wisconsin Statewide Well being Data Community (WISHIN) since January 2024. He not too long ago met with Healthcare Innovation for a dialog about how the group is turning into extra nimble and providing new companies past its longitudinal neighborhood well being file and occasion notifications.
Healthcare Innovation: Might you discuss WISHIN’s historical past and its relationships with the hospitals and well being methods within the state?
Rottman: We return to 2009. Many HIEs have been born via the funding that was obtainable then. It concerned 4 Wisconsin-based organizations — the Wisconsin Medical Society, the Wisconsin Well being Data Group (WHIO), the Wisconsin Collaborative for Healthcare High quality, and the Wisconsin Hospital Affiliation — coming collectively, and thereafter via legislative processes WISHIN was designated the state well being info alternate.
We established a data-sharing participation settlement so that each one organizations would observe the identical guidelines of the street. The place we could be distinctive is that the state of Wisconsin didn’t create a mandate for participation. It’s utterly voluntary, and we see ourselves as a impartial information trustee in Wisconsin, the place we’re working with all organizations and lots of group varieties that present healthcare companies within the state.
HCI: Do you could have full participation or virtually full from the hospitals within the state?
Rottman: Roughly 80% of hospitals take part. There are some rural vital entry hospitals that aren’t collaborating. There’s one massive system that isn’t but collaborating, and one massive Minnesota-based system that has satellite tv for pc hospitals in Wisconsin.
HCI: I not too long ago watched a Civitas Networks for Well being webinar a couple of survey they did of well being info organizations, and I hope to examine in with you about the place Wisconsin is on among the points the survey requested about reminiscent of TEFCA. Of their survey, solely 22% of HIOs mentioned they’re already collaborating in TEFCA and 24% mentioned they don’t seem to be positive if they will take part sooner or later. I’m questioning if WISHIN remains to be contemplating its choices.
Rottman: We’re desirous about it. We’re observing at a distance how this might profit Wisconsin suppliers and affected person outcomes. Final June or July we labored with our board strategically on the governance fashions, the alternate functions and the place healthcare is being delivered, and what mechanisms we have already got in place to allow that information flowing. Trying on the Widespread Settlement a part of TEFCA and the place that aligns with our native governance, we weren’t snug with the broad capabilities of the Widespread Settlement or the alternate functions, as there gave the impression to be a scarcity of management, as that info was queried from TEFCA after which utilized by a distant companion which may not absolutely align with the WISHIN governance mannequin. We aren’t saying that in Wisconsin you need to use WISHIN to connect with TEFCA There are a lot of organizations which are utilizing the Epic QHIN.
HCI: Nicely, I believe the difficulty that you just simply described is on the coronary heart of a lawsuit that was filed by Epic and others alleging inappropriate use of knowledge.
Rottman: These have been among the many dangers we noticed. When Seema Verma was introducing this again in 2016 or so, we have been fairly enthusiastic about it. We thought this could possibly be a good way for HIEs to come back to the desk and join. That did not actually work out. The organizations that got here to the desk have been principally distributors.
HCI: The Civitas survey additionally requested in regards to the sorts of use circumstances mostly supplied by well being info organizations. Close to the highest was occasion notifications like ADTs. One was aggregating information from a number of sources to create a well being file about an individual; one other was query-based alternate. Is WISHIN’s record of use circumstances just like that, or are there different use circumstances which are turning into necessary?
Rottman: I might say all of our use circumstances are intently aligned to what Civitas has reported associated to the aggregation of medical info to current a patient-specific, vendor-agnostic view. Right here we name that product WISHIN Pulse. What that does is mixture all the knowledge within the again finish, and that information is shipped to us prospectively. Utilizing matching algorithms, we determine and make it possible for the correct affected person’s info is being offered on the proper time to the correct particular person, all in accordance with our information sharing participation settlement. We’ve got a portal that organizations can log into, or we are able to combine instantly inside a clinician’s workflow.
HCI: Is it pretty frequent that you’ve it built-in into their EHR workflow, or are most nonetheless logging into the portal?
Rottman: I might say the bulk are logging into the portal, however there are a number of organizations profiting from this single-sign-on integration we’ve got with EMR or care administration methods.
The notifications are foundational for care administration for our payers, suppliers, and ACO contributors, and we’re seeing a fair better uptick within the house well being businesses which have some liabilities associated to Medicaid, waste, fraud and abuse. They will obtain notices to make it possible for these sufferers and that billing they’re offering for these people are literally in a healthcare setting. For value-based ACO and palliative care, the place these organizations are taking all of that danger on themselves, a person could be searching for care, and the group that is managing them would not know. We’re alerting them, relying on our partnership. We’ve got companies ourselves, and we additionally companion with Bamboo Well being, and only recently, PointClickCare to allow these notification companies. So in Wisconsin, it’s basically a free market with notifications. Select what you need and WISHIN is within the background, enabling these companies.
HCI: What about post-acute care settings? Do you could have a fairly good utilization fee by these organizations?
Rottman: I might say the chance is nice. With this partnership with PointClickCare, we’re going to execute on these alternatives within the brief time period. We’ve got partnership alternatives that we additionally have to double down on, and it’s going to be a precedence for this group to align post-acute with acute information and allow these transitions.
HCI: What about behavioral well being suppliers throughout the state? Are there consent or privateness points that maintain individuals from collaborating?
Rottman: Wisconsin laws referred to as 51.30 gave the chance to allow information alternate for the needs of psychological well being. We’ve got a number of psychological well being and psychiatric hospitals, psychological and behavioral well being services, and all of the state-run services collaborating.
I do know that they’re nonetheless working via 42 CFR Half 2 to harmonize and scale back the consent burdens, however immediately that’s nonetheless an information level that we can’t obtain as a result of we do not have the consent administration processes in place. We work with our collaborating organizations to limit that information from coming in in any respect…..There are such a lot of consent and authorization obstacles that we err on the aspect of warning to not have that information transfer via the community.
HCI: I learn that the HIE participated in a program referred to as CA:tCH Wisconsin that concerned counties utilizing a digital platform to create security plans for people liable to a psychological well being disaster. Might you discuss at WISHIN’s position in that framework?
Rottman: The CA:tCH Wisconsin program was targeted on visibility to first responders, in order that these fireplace, EMS and police and sheriff’s workplaces may obtain the suitable info to de-escalate a state of affairs, versus attending to a website the place a person is combating a psychological well being disaster and placing cuffs on them and placing them in a squad automotive. The place there could possibly be some de-escalation, there could possibly be connections to individuals the person may open up to. That was oriented to 2 counties, Ashland and Bayfield, that are on the northernmost tip of Wisconsin bordering Lake Superior.
CA:tCH Wisconsin was foundational within the evolution towards the Minor Security Plan invoice that went via the legislative course of in mid- to late 2024 and into session via 2025. We labored very intently with Senator Jesse James, who’s a regulation enforcement agent himself. By means of these conversations, he started to know the worth of WISHIN and what we may present to ensure this can be a statewide initiative and a statewide platform that could possibly be deployed.
HCI: Within the Civitas survey, two-thirds of  respondents mentioned they’re capturing information on meals safety, housing, transportation, and to a lesser extent, employment standing and interpersonal violence. It shocked me that the quantity was that prime. Has WISHIN gotten concerned in gathering that sort of information?
Rottman: We see a few of that information coming via already, and our intention is to incorporate that throughout the neighborhood well being file or different information belongings as acceptable. That is likely one of the new use circumstances we’ve got. We had a number of new use circumstances authorised in late 2025 that are actually efficient as of January 17. We’re explicitly permitted to obtain after which re-disclose social driver and health-related social wants information on behalf of sufferers the place we’ve got that information.
We aren’t but working with any community-based organizations or instantly with neighborhood, info alternate distributors like Findhelp or Unite Us. I believe these alternatives will current themselves over time. Proper now, I might say that there are privateness insurance policies to navigate inside numerous organizations — how, when and for whom that info will get to us for us to re-disclose.
HCI: Are there different companies or use circumstances we have not talked about that you just’d wish to point out?
Rottman: We’re engaged on high quality reporting, and that is actually associated to HEDIS measurement information. WISHIN has for a number of years had NCQA Information Aggregator Validation (DAV) standing. It’s an enormously highly effective device that we are able to use to allow payers to entry in bulk format member information on a month-to-month foundation that they’ll then observe. On the finish of the yr, working with their HEDIS auditor, they’ll lean on that WISHIN information, which is major source-verified. The HEDIS auditor basically appears at that, appears on the accreditation, and says, you are good to go.
HCI: Considering again to the best way they used to have to do this, it in all probability concerned plenty of paperwork and faxes.
Rottman: That is precisely it. We have eliminated the executive burden on each side. The payers don’t must have all the paper or faxes going into the supplier workplaces. We’re enabling that digitally in close to actual time. And on the supplier aspect, now they do not must dedicate sources throughout September and March of every yr to accommodate these file requests. “Chart chase” is the time period they use, and it’s turning into extra environment friendly.
One other use case entails inhabitants well being and analytics — enabling insights into cohorts of sufferers which may have continual illnesses and managing these continual illness gaps in care.
With inhabitants well being, we’re already getting pleasure and anticipated worth out of this via participant conversations. There’s an urge for food for extra information that allows for higher care. With prior authorization efficiencies, we’re taking a look at how we are able to transfer from weeks and months of authorization to a matter of minutes by enabling that information alternate.
HCI: Ae you providing members entry to a pop well being and information analytics platform?
Rottman: We see this extra as an information warehouse or an information lake that we handle. Organizations have numerous belongings, reminiscent of Epic Cosmos or different EMR-related companies the place they’ve an excellent concentrate on the info they’ve. How can we complement that with the info they don’t have?
HCI: Another factor from the Civitas survey is that they talked about there wasn’t but a variety of exercise reported round the usage of FHIR.  However is that one thing that is on WISHIN’s roadmap?
Rottman: Sure. One strategic objective for this yr is to create and provide FHIR sources. There’s a course of for enabling that. FHIR has been an enormous speaking level for quite a lot of years. It’s enabling the suitable infrastructure and the back-end information asset to ship discrete information, reasonably than tons of of pages in a continuity of care doc. What does that radiologist want proper now for that affected person, with out all the noise?
We’ve got had a framework of what this appears like for fairly a while, and now we’re investing in what that infrastructure will seem like, after which the market will tell us what they need. We’re utilizing FHIR in a manner that allows the single-sign-on I discussed beforehand. So there are some light-weight FHIR sources we’re offering, however not but on the scale that strikes the transformation in healthcare.
