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  • May 10, 2017 11:32 AM | Sally Winkelman (Administrator)

    April 2017, WISHIN Connections

    Eight safety-net clinics in the Milwaukee area are upgrading clinical data-sharing capabilities thanks to a grant from the Greater Milwaukee Business Foundation on Health (GMBFH) to the Wisconsin Statewide Health Information Network (WISHIN).

    The grant, facilitated by the Milwaukee Health Care Partnership (MHCP), a public/private consortium, will provide two-year subscriptions to all services offered by WISHIN, and fund one-time implementation fees for those clinics that are new WISHIN participants.The GMBFH grant will enable the clinics to fully participate in the statewide health information exchange, improve care coordination and better serve their patients.

    "Enhancing the coordination of care, within and across the complex health care delivery system, is a priority strategy for the MHCP," said Joy Tapper, MHCP Executive Director. "We work to ensure access, improve health outcomes and reduce avoidable emergency-department utilization and associated costs for low-income populations. The GMBHF shares those same goals."

    MHCP health system members use WISHIN as an essential tool to help improve clinical decision-making and enhance care coordination for uninsured and under-insured patients in Milwaukee. Patients served at safety-net clinics often have complex health and social needs and frequently access care across multiple health care organizations. The WISHIN community health record helps clinics better manage and support their patients in a primary-care setting.

    The Milwaukee clinics benefiting from the grant are: the AIDS Resource Center of Wisconsin, Bread of Healing Clinic, Gerald Ignace Indian Health Center, Milwaukee Health Services Inc., Muslim Community Health Center, Outreach Community Health Centers, Progressive Community Health Centers, and Sixteenth Street Community Health Centers.

    WISHIN for Care Coordination

    The WISHIN Pulse Community Health Record is an aggregated, longitudinal, patient-centric view of a patient's clinical history (including Medicaid-paid prescriptions) that is supplemented by integrated access to state data sources like the Wisconsin Immunization Registry and the Prescription Drug Monitoring Program.

    Participating health care organizations feed information from their EHR systems to WISHIN in real time, and WISHIN makes it available for query by other members of the network. By using WISHIN, health care organizations don't have to make special arrangements to receive or send clinical information, or build point-to-point connections with all of their trading partners. One connection to WISHIN can connect them with every other organization in the network.

    "Users of the WISHIN Pulse system don't need to know where a patient may have received care elsewhere," said Joe Kachelski, CEO of WISHIN. "They just need the patient's name."

    Another feature of WISHIN Pulse that will be implemented for the safety-net clinics is the Patient Activity Report for clinics (PAR-C). The PAR-C is a daily notification triggered when clinic patients have an emergency department (ED) or inpatient admission or discharge anywhere in the WISHIN network. The report includes the most recent demographic and contact information about the patient and high-level clinical information about the hospital encounter. It is delivered in an electronic format that can be ingested into care-management systems or other patient databases, so that care managers can quickly provide outreach and follow-up care for their patients.

    "WISHIN has a substantial presence in Milwaukee," said Kachelski. "All of the Milwaukee-based health systems, the Milwaukee County Behavioral Health Division, and several independent clinics are participating in WISHIN. We are grateful to the Foundation for their contribution allowing us to extend our network to include Milwaukee's federally qualified health centers and other essential safety-net providers. As participation in WISHIN grows, all of our clients benefit."

    MHCP's Emergency Department Care Coordination Initiative

    Nearly half of ED visits in Milwaukee County are for non-emergencies, with a large percentage of those visits made by uninsured or underinsured individuals lacking a primary-care provider.

    Since 2007, MHCP's Emergency Department Care Coordination (EDCC) initiative has worked to decrease avoidable ED visits and related hospitalizations, reduce duplicative tests and procedures and use ED encounters to connect high-risk individuals with primary-care health homes and other health resources. With a target population that includes low-income patients with chronic conditions (asthma, COPD, diabetes, hypertension and HIV/AIDS), frequent ED users and pregnant women, the initiative facilitates the referral of about 500 ED visitors a month to primary care, dental and behavioral health clinics.

    Along with practicing standardized transition care management processes, the initiative uses health technology services, including WISHIN Pulse, to connect hospital EDs and community clinics in Milwaukee County.

    "We've seen the power of WISHIN as used in emergency departments to reduce avoidable utilization and connect or reconnect patients to medical homes and other health resources," said Tapper. "This WISHIN expansion will ensure that the largest safety-net providers in Milwaukee are able to improve care for Medicaid and uninsured patients and assist them in securing the right care, at the right place, at the right time."

    For more information, contact: Milwaukee Health Care Partnership -; Greater Milwaukee Business Foundation on Health -

  • May 10, 2017 11:27 AM | Sally Winkelman (Administrator)

    May 3, Wisconsin Health News

    The Senate and Assembly passed a number of bills that are part of Gov. Scott Walker's special session targeting opioid addiction Tuesday.

    The proposals originated from a preliminary report issued in January by a task force co-chaired by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch.

    "With the nine special session bills advanced today, the Senate has taken several great strides towards helping to combat our state's ongoing opioid crisis," Senate Majority Leader Scott Fitzgerald, R-Juneau, said in a statement. 

    But Democrats questioned whether the bills go far enough. "After years of struggles, we're taking baby steps when we should be making major strides to improve outcomes and strengthen community safety," Senate Democratic Leader Jennifer Shilling, D-La Crosse, said in a statement. 

    The Senate approved proposals that would:

    • prohibit the dispensing of schedule V controlled substances containing codeine, dihydrocodeine, ethylmorphine and other substances listed under the section of law the bill targets.
    • allow school district personnel and college and university residence hall directors to administer naloxone. 
    • provide $2 million a year for alternatives to prosecution and incarceration for those with substance use disorders, $150,000 a year to expand those alternatives to more counties and $261,000 a year for an additional pilot program. 
    • provide $50,000 to help establish a recovery charter school.
    • provide $63,000 a year to expand graduate medical training on addiction. 
    • provide $1 million a year to create more opioid treatment programs in the state. 
    • provide $500,000 a year to establish an addiction medicine consultation program.
    • provide $420,000 a year to hire four additional drug trafficking investigators at the Department of Justice.
    • provide $200,000 a year to expand substance abuse screening by the Department of Public Instruction.

    The Assembly approved the bills last month, so they now head to Walker's desk for his approval.  

    The chamber also approved two additional bills Tuesday that are part of the package but haven't been taken up by the Senate. Those measures would: 

    • provide limited legal immunity to overdose victims. 
    • allow those with substance abuse disorders to be involuntarily committed. 
  • May 08, 2017 10:34 AM | Sally Winkelman (Administrator)

    Parallel Parking and Aryepiglottic Folds
    by Bobby Redwood, MD, MPH

    I am really good at parallel parking; I pride myself on it. I went to medical school in Chicago and used to wedge my Volkswagen Jetta into parking spaces with less than a three inch gap on either bumper (we won't talk about the "love taps"). I recently bought a new car and, for the first time ever, I am now parallel parking with the assistance of a back-up camera. The precision is amazing. If needed, I can shrink that three inch gap down to one or two with no bumper to bumper contact whatsoever. The speed with which I parallel park has increased as well. A one-minute maneuver can reliably be done in 45 seconds with the assistance of the handy back-up camera. Still, some things seem a bit off. I've hit the curb a few times, which never happened before and I notice myself paying less attention to the traffic around me compared to my pre-back-up camera days. Basically, my level of situational awareness has decreased since I've been supplied with the luxury of direct rear bumper visualization. In inclement weather, when my back-up camera is fogged up or otherwise obscured, it feels clunky and awkward to go back to the old rubbernecking method. My once-lauded parallel parking skills are slipping.

    As an emergency physician, its hard to look at the little rectangular screen of the back-up camera and not be reminded of another innovation in my life: video laryngoscopy. Video laryngoscopy (VL) is certainly on the rise in U.S. emergency departments. Recent surveys report that about 30% of emergent intubations are performed with VL compared to only 1% a decade ago. In residency, I almost exclusively intubated using direct laryngoscopy (DL), using VL as a rescue method for difficult intubations. In my current practice, I find that I'm clinging to DL in order to keep my skills up, but increasingly reaching for VL first in a variety of scenarios including C-collars, severe kyphosis, trismus, and angioedema. In all honesty, I am inching my way towards a VL-dominated practice, but I want to be sure I don't lose my situational awareness during "inclement weather" (read: blood and vomit). As VL becomes more ubiquitous, I imagine many EPs across the state are experiencing a similar tug-of-war in their practice style, which of course begs the question: which is better?

    Like any reasonable emergency physician seeking an answer to a clinical question, I went to the literature...unfortunately, there's just not that much out there. An April 2016 non-blinded, non-randomized controlled trial at Hennepin County Medical Center ED found similar first past success rates between DL (86%) and VL (92%), even with difficult airways [difference was not statistically significant]. Similarly, a March 2017 meta-analysis on the same topic from the critical care literature included four randomized controlled trials and concluded that VL did not improve the rate of successful intubation on first attempt compared to DL. The EMRAP podcast made a statement that VL should be considered standard of care and the comment section exploded with DL supporters expressing a spectrum of emotions ranging from calm composed dissent to shock and righteous indignation. By any measure, the EM jury is still out on DL vs. VL.

    In a 2010 report, the Department of Transportation's National Highway Traffic Safety Administration reported that each year 210 people die and 15,000 are injured in light-vehicle backup incidents, with about 31% of the deaths among kids under age 5 and 26% adults over 70. They estimated that 58 to 69 lives will be saved each year (not including injuries prevented) if the entire on-road vehicle fleet had "rear-view visibility systems." Acting on this observational, retrospective evidence, the NHTSA, will soon require that all automobiles sold in the United States (beginning in May 2018) be equipped with back-up cameras.

    Government officials are not typically trained in the scientific method. Unlike the house of medicine, the NHTSA doesn't need a randomized controlled trial to make a judgement call. They feel pretty confident that back-up cameras make driving safer and also save lives. While the jury may still out on DL vs. VL for emergent intubations, that doesn't mean we at WACEP can't opine a bit. What has your experience been with VL? Has it become standard of care in your ED? Does a generation gap exist between DL and VL as it does with other forms of technology? Are there pros or cons that we have not discussed here?

    Let's get some (admittedly non-scientific) Wisconsin specific data on the subject. Please fill out the following survey and use the last free text field to answer any of the questions posed above. If we get greater than 25 responses, we'll report the data on the WACEP website and hopefully inspire an ongoing conversation about how Wisconsin EPs feel about DL and VL (...not to mention back-up cameras).


    Happy intubating!

    Bobby Redwood MD, MPH
    WACEP President

    Driver, BE et al. Direct versus video laryngoscopy using the C-MAC for tracheal intubation in the emergency department, a randomized controlled trial. Acad Emerg Med. 2016 Apr;23(4):433-9.
    Zhao, Bing-Cheng, Tong-Yi Huang, and Ke-Xuan Liu. "Video laryngoscopy for ICU intubation: a meta-analysis of randomised trials." Intensive Care Medicine (2017): 1-2.

  • May 08, 2017 8:47 AM | Sally Winkelman (Administrator)

    Emergency physicians who weren't able to participate in the WACEP 2017 Spring Symposium now have an opportunity to view the recorded presentation on responsible opioid prescribing. 

    Registration is open for physicians to view the session on demand. Participation in the webinar has been approved to meet the requirement for two hours of continuing education as mandated by the Wisconsin Medical Examining Board per Med 13.03(3) of the Wisconsin Administrative Code.

    Learn more and register online

  • May 02, 2017 4:16 PM | Sally Winkelman (Administrator)

    April 27, Wisconsin Health News

    Doctors and acupuncturists oppose a bill that would allow chiropractors to perform physical examinations for student athletes and practice "chiropractic acupuncture" and "chiropractic dry needling" if they receive additional training.

    The bill received a public hearing Wednesday before the Assembly Committee on Health.

    Under the proposal, schools that require a pupil to have a physical examination to participate in sports and other activities will have to accept a physical examination completed by a chiropractor the same way it accepts those completed by doctors. The chiropractor would have to hold a certificate in health or physical examinations.

    The same requirement would apply to the state's technical colleges or a two-year campus within the University of Wisconsin System that require physical examinations for students to participate in sports.

    "With some additional training, doctors of chiropractic could provide a high quality exam," Mark Cassellius, a chiropractor practicing in Onalaska, told lawmakers.

    Dr. Tosha Wetterneck, past president of the Wisconsin Medical Society, opposes the bill.

    The physical examination isn't just focused on the athletics, but on at-risk behaviors, immunizations and other factors that might impact sports participation, she said. That requires extensive training.

    "This is rocket science," she said. "This is difficult."

    The bill would also allow chiropractors to practice "chiropractic acupuncture" if they complete at least 200 hours of instruction and the acupuncture examination administered by the National Board of Chiropractic Examiners.

    The bill would also allow chiropractors to practice "chiropractic dry needling," which involves puncturing the skin with needles to treat "neuromusculoskeletal pain and performance," if they complete 50 hours of postgraduate study.

    Shawano-based chiropractor Brian Grieves said the bill could help address the opioid epidemic by increasing access to alternatives pain treatments.

    "We have very limited, proven, effective non-drug options to offer people for pain," he said. "Being able to augment that by offering chiropractic acupuncture would greatly expand that access."

    Elissa Gonda, chair of the legislative committee for The Wisconsin Society of Certified Acupuncturists, opposes the bill.

    "Acupuncture is a serious and rigorous profession," she said. "It's not a method or technique that can be employed on an occasional basis by another healthcare practitioner." 

    Steve Conway, executive director of the Chiropractic Society of Wisconsin, said they're generally supportive of the bill but they're still vetting it. 

  • May 02, 2017 4:07 PM | Sally Winkelman (Administrator)

    April 27, Wisconsin Health News

    Wisconsin will receive $7.6 million from the federal government to combat opioid addiction, the Department of Health and Human Services announced Thursday night.

    HHS is providing $485 million to all 50 states, the District of Columbia and six U.S. territories. The funding, made available under the 21st Century Cures Act, will go toward prevention, treatment and recovery services.

    States were awarded funding based on rates of overdose deaths and unmet need for treatment. Florida received the most money at $27.2 million, while five territories received $250,000 each.

    Gov. Scott Walker directed the Department of Health Services to seek the funding in an early January executive order. DHS can re-apply for additional funding next year. 

  • May 02, 2017 2:23 PM | Sally Winkelman (Administrator)

    April 25, Wisconsin Health News

    The Senate Committee on Education approved two bills Monday that are part of a special session ordered by Gov. Scott Walker to tackle the opioid epidemic.

    A bill that would provide $50,000 to help establish a recovery charter school, which would serve 15 high school students in recovery from substance use disorder, passed out of committee 6-1. Sen. Steve Nass, R-Whitewater, voted against it. 

    An additional proposal providing $200,000 a year to expand the use of a substance abuse screening by the Department of Public Instruction passed 7-0. The Assembly has already approved both measures.

  • May 02, 2017 1:03 PM | Sally Winkelman (Administrator)

    April 24, Wisconsin Health News

    The Medical Examining Board approved permanent rules last week that govern the practice of telemedicine and mandate continuing medical education requirements for doctors on opioid prescribing.

    The rules are expected to go into effect June 1, Department of Safety and Professional Services staff told board members.

    The final telemedicine rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on the use of telemedicine.

    The other rule requires doctors renewing their licenses to complete two hours of training on guidelines written by the board that relate to opioid prescribing. Doctors have to complete 30 hours of continuing medical education every two years.

  • May 01, 2017 4:05 PM | Sally Winkelman (Administrator)

    April 18, Wisconsin Health News

    Gov. Scott Walker has signed into law a bill ending state penalties for those who possess cannabidiol without psychoactive effect if they have written certification from a doctor.

    The bill also directs the state's Controlled Substances Board to reschedule CBD oil, which is derived from marijuana and sometimes used to treat seizures in children, within 30 days following a change at the federal level. The bill passed the Senate 31-1, and the Assembly 98-0.

    The bill builds on a 2014 law that aimed to make the drug available with a prescription in the state. But supporters said that providers weren't able to prescribe the drug, which is still illegal to obtain under federal regulations. 

  • April 20, 2017 2:51 PM | Sally Winkelman (Administrator)

    While Republicans may have walked away from the American Health Care Act, the healthcare debate is certain to continue. Will the Trump Administration fight to keep the Affordable Care Act afloat? Or will it use its power to hasten the law’s demise? Will lawmakers move left or right to forge a new deal?

    In the meantime, Gov. Scott Walker is pushing ahead with Medicaid reforms that likely would not have been approved a year ago.  What does it mean for the program? 

    National and regional healthcare experts will tackle these questions and more at the 2017 Wisconsin Health News Conference, July 19 at the Monona Terrace in Madison.  Registration is now open (link).