Overview of Health Information Exchange in the U.S.

1. Overview of Health Information Exchange in the U.S. Kate Berry CEO National eHealth Collaborative (NeHC)

2. Discussion Topics • Introduction to NeHC • Current landscape for HIT and HIE • Examples of leading HIE organizations

3. About NeHC National eHealth Collaborative (NeHC) is a public-private partnership that works collaboratively with healthcare stakeholders to tackle barriers and accelerate progress in achieving secure, interoperable electronic exchange of health information nationwide, to improve American health and healthcare. NeHC is a cooperative agreement partner of the Office of the National Coordinator for Health IT (ONC) in the U.S. Department of Health and Human Services (HHS).

4. NeHC Board of Directors Simon Cohn, MD, MPH Chair, 2011 Board of DirectorsKaiser Permanente Laura AdamsRhode Island Quality Institute Holt AndersonNorth Carolina Health Information and Communications Alliance, Inc. David Baker, MD, MPHNorthwestern University Lori Evans Bernstein, MPHGSI Health Kate Berry National eHealth Collaborative Alice Brown, JD National Partnership for Women and Families Pamela Cipriano, PhD, RN, FAAN Institute of Medicine Janet Corrigan, PhD, MBANational Quality Forum Arthur Davidson, MD, MSPHDenver Health Steven Findlay, MPH Consumers Union Thomas Fritz, MA, MPAInland Northwest Health Services Kevin Hutchinson Former CEO of Prematics Michael Lardiere, LCSWNational Council for Community Behavioral Healthcare Patricia MacTaggart, MBA, MMA George Washington University Chuck ParkerContinua Health Alliance Paul Uhrig, JDSurescripts GOVERNMENT LIAISONS: Mary Jo Deering, PhD Office of the National Coordinator for Health Information Technology Douglas Fridsma, MD, PhD Office of the National Coordinator for Health Information Technology Linda Fischetti, RN, MSU.S. Department of Veterans Affairs Seth Foldy, MD, MPH Centers for Disease Control and Prevention 4

5. NeHC Mission, Vision and Strategy A transformed U.S. healthcare system that ranks #1 worldwide in health and healthcare through innovative access, sharing and use of health information in every community and across the nation. VISION Achieve Sustainability for NeHC to AccomplishOur Goals Engage with Stakeholderson HIE Ensure NeHC’s Vitality and Relevance STRATEGIC GOALS Promote Nationwide HIE Convene Consumer Consortium on eHealth Operate NeHC University Support NwHIN Exchange MAJOR INITIATIVES Develop and Disseminate HIE Leader Profiles Accelerate HIE Progress Through Collaborative Forum and Programs Create Online Communities and Knowledge Base Develop and Communicate a National HIE Roadmap NeHC is a public-private partnership that enables secure and interoperable nationwide health information exchange to advance health and improve healthcare. MISSION

6. Overview of HITECH Program Provider incentives • $34B incentives to providers under Medicare and Medicaid • For physicians and hospitals using certified EHRs and achieving “meaningful use” • Up to $44,000 per physician under Medicare or $60,000 under Medicaid • Beginning in 2011 spread over four years with disincentives beginning in 2015 6

7. Overview of HITECH Program (continued) Infrastructure and support for HIE and other programs • $564M for statewide HIEs ($4M-$40M per state) • $250M for 17 Beacon Community HIEs ($10M-$20M each) • $598M for Regional Extension Centers for implementation support • $1.5B for Federally Qualified Community Health Centers • $112M for training at community colleges and universities for workforce development • $60M for SHARP, research in security, patient-centeredness, new architectures, secondary use • $4.3B for broadband • $2.5B for distance learning/telehealth grants 7

8. National Health Information Exchange Programs • Nationwide Health Information Network Exchange • A group of federal agencies, local, regional and state-level HIEs and integrated delivery networks demonstrating live health information exchange using the Nationwide Health Information Network standards and specifications

9. Current Participants on NwHIN Exchange • Centers for Disease Control and Prevention (CDC) • Department of Defense (DoD) • Social Security Administration (SSA) • Department of Veterans Affairs (VA) • Kaiser Permanente • HealthBridge • MedVirginia • Regenstrief Institute • Inland Northwest Health Services • North Carolina Healthcare Information and Communications Alliance • Many more organizations in the queue…. Including state HIEs, Beacons, health systems 9

10. National Health Information Exchange Programs • The Direct Project • The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet

11. Examples Pilot Projects Using Direct • Hennepin County Medical Center – sending immunization records to MN Department of Health using Direct • MedAllies in Hudson Valley, NY – launching a Direct pilot project to demonstrate the delivery of critical clinical information across transition of care settings in a "push" fashion that supports existing clinical workflows • Rhode Island Quality Institute – using Direct to exchange data between primary care providers and specialists and between EHR users and the state HIE • CareSpark in Tennessee – demonstrating the routing of mammography referrals from the VA to the private sector provider using Direct 11

12. National Health Information Exchange Programs • The Standards & Interoperability Framework • The S&I Framework is a set of integrated functions, processes and tools being guided by the healthcare and technology industry to achieve harmonized interoperability for healthcare.

13. The Standards and Interoperability Framework • Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system. • An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services. • Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

14. Examples of 12 Leading HIEs from a Soon to be Released NeHC Report • Availity • Business and clinical exchange between payers and providers through a national network • Savings include 10-12% fewer calls to health plans, 60% cleaner claims, 10% fewer paper claims • Big Bend RHIO --Physicians and hospitals sharing information on patients in Tallahassee, Florida region • HealthBridge • Hospitals and physicians sharing information on patients in Greater Cincinnati-Northern Kentucky tri-state area • Estimates more than $20 million annual savings • HealthInfoNet – statewide HIE in Maine with 16 hospitals and 2,000 clinicians currently participating, goal is to have all hospitals and 80% of physicians connected by 2015

15. Examples of 12 Leading HIEs from a Soon to be Released NeHC Report (continued) • Inland Northwest Health Services • Diversified healthcare services company connecting 38 hospitals and 450 ambulatory organizations including 4,000 physicians • Provides 47,000 end-users with secure access to community-wide EHR with records for 3.5 million patients in Washington, northeast Oregon, northern Idaho, western Montana • One hospital system estimated $1.3 million in savings • Participating hospitals spend less than 2% on health IT infrastructure compared to national average of 3+% • MedVirginia • Provide system for community-wide clinical information exchange in Central Virginia to improve clinical workflow, achieve meaningful use, create PCMHs • Partners with DoD, SSA, VA via NwHIN Exchange

16. Examples of 12 Leading HIEs from a Soon to be Released NeHC Report (continued) • Quality Health Network • Clinical data exchange collects and distributes data to and from diverse healthcare providers including acute care, urgent care, long-term care, reference labs, surgical centers, behavioral health, public health, pharmacies, physician practices • Colorado west of the Continental Divide and eastern Utah • Organized in “medical neighborhoods” based on referral patterns • Rochester RHIO (Ted will cover) • Sandlot • HIE driving EMR adoption and connectivity and exchange among practices, labs, and hospitals • 12 hospitals, 350 physicians, 2 national labs across 7 counties for 1.7 million patients

17. Examples of 12 Leading HIEs from a Soon to be Released NeHC Report (continued) • SMRTNET • Network of networks in Oklahoma exchanging data between hospitals, Native American tribes, community health centers, labs, universities, practices, first responders, public health, etc. • 3,000 users and 3.1 million individuals in MPI in 2011 • Taconic Health Information Network and Community (THINC) • Community-wide initiative in Hudson Valley, NY to advance HIT, HIE, EHRs • 363 providers 4 (soon to be 8) hospitals using the HIE • U.S. Department of Veterans Affairs • Develop virtual lifetime electronic record (VLER) for every service member and veteran and enable HIE between VA and private sector health systems driving need for HIE • Leverage NwHIN Exchange – 11 regional pilots by September 2011 and nationwide deployment summer 2012

18. Critical Success Factors • Aligning stakeholders with HIE priorities is an ongoing and intensive effort • Establishing a brand in the community that conveys their role as a trusted, neutral entity protecting the interests of participants • Achieving and maintaining alignment requires making difficult strategic choices • Market structure and dynamics, especially in early stages, are important determinants of success • Understanding clinical workflows and managing change are core competencies

19. Ongoing Challenges • Policies and procedures designed to meet complex privacy requirements tend to impede an HIE’s efforts to achieve the critical mass of patient records needed to accelerate adoption • Gaps in interoperability standards and lack of rigor in adhering to existing standards are drains on HIE resources

20. Business Models • All but 3 of the 11 receiving funding from private sector are currently self-sustaining with fees from participants covering operating expenses • A prevalent philosophy is to charge all private sector participants for using the HIE • Despite a minority of the HIEs presently receiving financial support from payers (3), several more believe that this source of revenue is essential to long-term sustainability of the HIE

21. Portfolio of Services • These leading HIEs are incubators of innovation • The role of HIEs in providing healthcare consumers/ patients with access to their data is a work in progress, with most organizations either testing strategies with pilot projects or refraining from making investments in this area • Reduced data distribution costs and increased staff productivity are currently the major reasons why participants are willing to pay for the services offered by these HIEs

22. Strategies to Create Value • Interest in the NwHIN spans the continuum, with HIEs participating in Beacon Community initiatives or motivated to connect to the U.S. Department of Veterans Affairs leading the way • 5 are currently connected to NwHIN Exchange • 3 more plan to connect to NwHIN Exchange • Those same HIEs are also implementing Direct standards and services • Leaders of these HIEs are cautiously optimistic about the emergence of accountable care organizations, seeing potential opportunities but also concerned about their potential impact on market dynamics

23. Future Outlook • Raising capital to steadily grow the HIE organization’s connectivity footprint and portfolio of services is key to long-term sustainability • As the HIE grows, its stakeholder community becomes more heterogeneous, making governance more challenging and complex