Steve Rottman has been CEO of the nonprofit Wisconsin Statewide Health Information Network (WISHIN) since January 2024. He recently met with Healthcare Innovation for a conversation about how the organization is becoming more nimble and offering new services beyond its longitudinal community health record and event notifications.

Healthcare Innovation: Could you talk about WISHIN’s history and its relationships with the hospitals and health systems in the state?

Rottman: We go back to 2009. Many HIEs were born through the funding that was available then. It involved four Wisconsin-based organizations — the Wisconsin Medical Society, the Wisconsin Health Information Organization (WHIO), the Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Hospital Association — coming together, and thereafter through legislative processes WISHIN was designated the state health information exchange.

We established a data-sharing participation agreement so that all organizations would follow the same rules of the road. Where we might be unique is that the state of Wisconsin did not create a mandate for participation. It is completely voluntary, and we see ourselves as a neutral data trustee in Wisconsin, where we’re working with all organizations and many organization types that provide healthcare services in the state.

HCI: Do you have full participation or almost full from the hospitals in the state?

Rottman: Roughly 80% of hospitals participate. There are some rural critical access hospitals that are not participating. There’s one large system that is not yet participating, and one large Minnesota-based system that has satellite hospitals in Wisconsin.

HCI: I recently watched a Civitas Networks for Health webinar about a survey they did of health information organizations, and I am hoping to check in with you about where Wisconsin is on some of the issues the survey asked about such as TEFCA. In their survey, only 22% of HIOs said they’re already participating in TEFCA and 24% said they aren’t sure if they’re going to participate in the future. I am wondering if WISHIN is still considering its options. 

Rottman: We are thinking about it. We are observing at a distance how this could benefit Wisconsin providers and patient outcomes. Last June or July we worked with our board strategically on the governance models, the exchange purposes and where healthcare is being delivered, and what mechanisms we already have in place to enable that data flowing. Looking at the Common Agreement part of TEFCA and where that aligns with our local governance, we weren’t comfortable with the broad capabilities of the Common Agreement or the exchange purposes, as there seemed to be a lack of control, as that information was queried from TEFCA and then used by a distant partner that might not fully align with the WISHIN governance model. We are not saying that in Wisconsin you have to use WISHIN to connect to TEFCA There are many organizations that are using the Epic QHIN.

HCI: Well, I think the issue that you just described is at the heart of a lawsuit that was filed by Epic and others alleging inappropriate use of data.

Rottman: Those were among the risks we saw. When Seema Verma was introducing this back in 2016 or so, we were pretty excited about it. We thought this could be a great way for HIEs to come to the table and connect. That didn’t really work out. The organizations that came to the table were mostly vendors.

HCI: The Civitas survey also asked about the kinds of use cases most commonly offered by health information organizations. Near the top was event notifications like ADTs. One was aggregating data from multiple sources to create a health record about a person; another was query-based exchange. Is WISHIN’s list of use cases similar to that, or are there other use cases that are becoming important?

Rottman: I would say all of our use cases are closely aligned to what Civitas has reported related to the aggregation of clinical information to present a patient-specific, vendor-agnostic view. Here we call that product WISHIN Pulse. What that does is aggregate all the information in the back end, and that data is sent to us prospectively. Using matching algorithms, we identify and make sure that the right patient’s information is being presented at the right time to the right individual, all in accordance with our data sharing participation agreement. We have a portal that organizations can log into, or we can integrate directly within a clinician’s workflow.

HCI: Is it fairly common that you have it integrated into their EHR workflow, or are most still logging into the portal?

Rottman: I would say the majority are logging into the portal, but there are several organizations taking advantage of this single-sign-on integration we have with EMR or care management systems.

The notifications are foundational for care management for our payers, providers, and ACO participants, and we’re seeing an even greater uptick in the home health agencies that have some liabilities related to Medicaid, waste, fraud and abuse. They can receive notices to make sure that those patients and that billing they’re providing for those individuals are actually in a healthcare setting. For value-based ACO and palliative care, where those organizations are taking all of that risk on themselves, an individual might be seeking care, and the organization that’s managing them doesn’t know. We’re alerting them, depending on our partnership. We have services ourselves, and we also partner with Bamboo Health, and just recently, PointClickCare to enable those notification services. So in Wisconsin, it is essentially a free market with notifications. Choose what you want and WISHIN is in the background, enabling those services.

HCI: What about post-acute care settings? Do you have a pretty good usage rate by those organizations?

Rottman: I would say the opportunity is great. With this partnership with PointClickCare, we are going to execute on those opportunities in the short term. We have partnership opportunities that we also need to double down on, and it is going to be a priority for this organization to align post-acute with acute data and enable those transitions.

HCI: What about behavioral health providers across the state? Are there consent or privacy issues that keep people from participating? 

Rottman: Wisconsin legislation called 51.30 gave the opportunity to enable data exchange for the purposes of mental health. We have several mental health and psychiatric hospitals, mental and behavioral health facilities, and all the state-run facilities participating.

I know that they are still working through 42 CFR Part 2 to harmonize and reduce the consent burdens, but today that is still a data point that we cannot receive because we don’t have the consent management processes in place. We work with our participating organizations to restrict that data from coming in at all…..There are so many consent and authorization barriers that we err on the side of caution to not have that data move through the network.

HCI: I read that the HIE participated in a program called CA:tCH Wisconsin that involved counties using a digital platform to create safety plans for individuals at risk of a mental health crisis. Could you talk at WISHIN’s role in that framework?

Rottman: The CA:tCH Wisconsin program was focused on visibility to first responders, so that those fire, EMS and police and sheriff’s offices could receive the appropriate information to de-escalate a situation, as opposed to getting to a site where an individual is struggling with a mental health crisis and putting cuffs on them and putting them in a squad car. Where there could be some de-escalation, there could be connections to people the individual could confide in. That was oriented to two counties, Ashland and Bayfield, which are at the northernmost tip of Wisconsin bordering Lake Superior.

CA:tCH Wisconsin was foundational in the evolution toward the Minor Safety Plan bill that went through the legislative process in mid- to late 2024 and into session through 2025. We worked very closely with Senator Jesse James, who is a law enforcement agent himself. Through those conversations, he began to understand the value of WISHIN and what we could provide to make sure this is a statewide initiative and a statewide platform that could be deployed.

HCI: In the Civitas survey, two-thirds of  respondents said they’re capturing data on food security, housing, transportation, and to a lesser extent, employment status and interpersonal violence. It surprised me that the number was that high. Has WISHIN gotten involved in collecting that kind of data?

Rottman: We see some of that data coming through already, and our aim is to include that within the community health record or other data assets as appropriate. That is one of the new use cases we have. We had several new use cases approved in late 2025 that are now effective as of January 17. We are explicitly permitted to receive and then re-disclose social driver and health-related social needs data on behalf of patients where we have that data.

We are not yet working with any community-based organizations or directly with community, information exchange vendors like Findhelp or Unite Us. I think those opportunities will present themselves over time. Right now, I would say that there are privacy policies to navigate within various organizations — how, when and for whom that information gets to us for us to re-disclose.

HCI: Are there other services or use cases we haven’t talked about that you’d want to mention?

Rottman: We are working on quality reporting, and this is really related to HEDIS measurement data. WISHIN has for several years had NCQA Data Aggregator Validation (DAV) status. It is an enormously powerful tool that we can use to enable payers to access in bulk format member data on a monthly basis that they can then track. At the end of the year, working with their HEDIS auditor, they can lean on that WISHIN data, which is primary source-verified. The HEDIS auditor essentially looks at that, looks at the accreditation, and says, you’re good to go.

HCI: Thinking back to the way they used to have to do that, it probably involved lots of paperwork and faxes.

Rottman: That’s exactly it. We’ve removed the administrative burden on both sides. The payers don’t have to have all of the paper or faxes going into the provider offices. We’re enabling that digitally in near real time. And on the provider side, now they don’t have to dedicate resources during September and March of each year to accommodate those record requests. “Chart chase” is the term they use, and it is becoming more efficient.

Another use case involves population health and analytics — enabling insights into cohorts of patients that might have chronic diseases and managing those chronic disease gaps in care.

With population health, we are already getting excitement and anticipated value out of this through participant conversations. There’s an appetite for more data that enables for better care. With prior authorization efficiencies, we are looking at how we can move from weeks and months of authorization to a matter of minutes by enabling that data exchange.

HCI: Ae you offering members access to a pop health and data analytics platform? 

Rottman: We see this more as a data warehouse or a data lake that we manage. Organizations have various assets, such as Epic Cosmos or other EMR-related services where they have a very good focus on the data they have. How can we complement that with the data they don’t have?

HCI: One more thing from the Civitas survey is that they mentioned there wasn’t yet a lot of activity reported around the use of FHIR.  But is that something that’s on WISHIN’s roadmap?

Rottman: Yes. One strategic goal for this year is to create and offer FHIR resources. There is a process for enabling that. FHIR has been a huge talking point for a number of years. It is enabling the appropriate infrastructure and the back-end data asset to deliver discrete data, rather than hundreds of pages in a continuity of care document. What does that radiologist need right now for that patient, without all of the noise?

We have had a framework of what this looks like for quite some time, and now we are investing in what that infrastructure will look like, and then the market will let us know what they want. We are using FHIR in a way that enables the single-sign-on I mentioned previously. So there are some lightweight FHIR resources we’re providing, but not yet at the scale that moves the transformation in healthcare.