IHIN Leadership, Technical Staff, and Services Development in Iowa - November 2018 Update

1. Iowa Health Information Network (IHIN) November, 2018 For Iowa, By Iowans

2. Agenda • Introductions of New IHIN Leadership/Technical Staff • IHIN Hybrid Model • Services Development • Participant Onboarding • HIE Maturity Model and IHIN Recommendations • Questions/Comments • My Journey

3. New President/CEO • Stephen M. Stewart, MBA, CHCIO, FACHE, FCHIME, FHIMSS, CPHIMS, CRISC, CISM, CGEIT, CISA, CHP • Iowa Native with over 30 years of IT experience with a specialty in healthcare • Specialties: Application Software and Interfacing, Purchasing, Policy and Procedures, ICD-10, HIPAA, and Cyber Security • CFO functionality shared between IHIN Controller and one outsourced third-party consultant, Randy Ingram

4. Introduction of New West Des Moines Technical Team Members Jonathan Hills Chief Technology and Security Officer Darren Clark HIE Enterprise Architect Darren Clark joined IHIN in October. Prior to joining the IHIN, Darren worked at UnityPoint Health Corporate Services as an HIE Program Manager where he led the organizations HIE initiatives. Darren held multiple positions at UnityPoint Health, including an Infrastructure Architect and a member of the Design Team responsible for the organizations infrastructure and technology strategies. Prior to joining UnityPoint Health, Darren worked for multiple fortune 500 organizations and as a consultant. Darren is a graduate of Peru State College with a Bachelor in Business Administration. He holds an Associate’s Degree in Communications and Technology from National Institute of Technology. Darren has been active with the Iowa Chapter of HIMSS serving as past president, program chair and lobbying on Capitol Hill advocating for health information technology. A native of Iowa, Darren lives in Des Moines with his wife and four children and enjoys outdoor activities, and traveling. • A native Iowan, Jonathan provides leadership and support for the continued development of an innovative, robust, and secure information technology environment throughout the IHIN ecosystem and its numerous participants. Prior to joining IHIN, Jonathan worked in the healthcare field as a Technology Consultant, Network Administrator, Network Engineer, Systems Engineer, and HIPAA Security Officer. Jonathan is a mini-golf enthusiast and pinball wizard from Eastern-Iowa.

5. IHIN Hybrid Health Information Exchange (HIE) Model • HIE architecture determines where patient data is stored and how it is accessed by HIE participants • The centralized model has a clinical data repository that is maintained by the HIE; Users access and update the system directly • In the federated model, patient data remains in the individual EHRs or clinical data repositories of health systems, hospitals or providers; The HIE provides the connectivity, interoperability and record location services necessary to exchange data, but is not responsible for data storage

6. Foundational Health Information Exchange • Data Storage Options in the Information Exchange Model • ADTs required for EMPI (demographics) • Continuity of Care Documents (CCDs) • Observation Result (ORUs) for Lab and Imaging Push Pull / Query

7. Current Services IHIN Patient Query IHIN Portal Direct Secure Messaging HISP Health Information Service Provider Services Registry Reporting Electronic Lab Reporting Statewide Alert Notification System (SWAN)

8. Registry Statuses as of October 2018 • Newborn Screening • Live with Spencer Hospital/OZ as of 9/5/18; Working with IDPH on continued roll-out plans • Electronic Laboratory Reporting (eLR) • Working on transitioning VPN connections to IHIN VPN; Spencer live; Wheaten Franciscan and Great River in progress • Electronic Initial Case Reporting (eICR) • Draft charter provided and determined DSM is the mechanism for eICR; Spencer Hospital will serve as pilot site • Cancer Registry • We have been contacted by AllScripts regarding registry set up and are following leads from those conversation • EMS/Trauma • Finalized/signed contract with ImageTrend; Worked through business requirements and finalizing VPN set-up; Spencer Hospital will serve as pilot site • Iowa Registry for Congenital and Inherited Disorders (IRCID) • Have agreement to the ICD-10 codes they would like tracked and reported • Iowa Office of the State Medical Examiner (IOSME) • Pending availability of data from IHIN participants to create extractable/searchable data for IOSME • Iowa Immunization Registry Information System (IRIS) • Live in the IHIN test environment • Prescription Drug Monitoring Program (PDMP) • Determining services available to Iowa Pharmacy Board; Working on licensing fees with Vendor Appriss

9. IHIN Provider Onboarding Update • ADT in production • Genesis • Hawarden • Spencer • Dallas County • ADT in process • Burgess Health Center • Clarinda Regional • Community Health Center Davenport • Fort Madison Community Hospital • Pella Regional Hospital • UnityPoint Health • ORU’s in production • Spencer • ORU’s in process • Hawarden • CCD’s in process • Community Health • Dallas County Hospital • Unity Point will begin process Mid-October • Discussions on next steps to begin onboarding have begun with Mercy Health Network (which includes both CHI and Trinity hospitals)

10. HIE Maturity Model – Enabling Health Information Sharing: The HIS Maturity Model • A maturity model will enable Health Information Sharing by: • Providing states with a mechanism to assess the maturity of health information exchange within a state’s healthcare Enterprise • Ensuring the most effective use of scarce resources, leveraging common efforts, both public and private • Ensuring that best practices and lessons learned, such as increased modularity, are incorporated • Improving reuse of solutions across states

11. HIS Maturity Model Benefits • Helps prioritize areas that may require technology supports/enhancements • Reveals the mitigations and workarounds needed to support a program • Helps you understand gaps, where you may need to make more Health Information Technology (HIT) investments • Demonstrates how to mature a capability based on cost/benefit analysis and resource • Helps with overall HIT planning • Helps identify gaps and determine steps to incrementally improve the capability

12. How a Maturity Model is Used to Improve a Capability • A maturity model shows how a capability can be improved “step by step” • Each level lays out critical success factors for the capability – Expectations are made clear • As objectives to improve the capability to get to the next level are clear this enables: • Incremental Improvement: Helps identify gaps and determine steps to incrementally improve the capability • Roadmap Development: Provides the steps one can use to build the roadmap for improving the capability • Identify realistic target: Can determine which level is achievable for the capability based on cost/benefit analysis and resources

13. Proposed HIS Capabilities to Include in Maturity Model

14. IHIN Gap Assessment • IHIN is currently at Level I capability maturity for health information sharing • In addition to the Business Architecture (BA), the Information Architecture (IA) and Technology Architecture (TA) were also assessed. The IA was assessed for the Current-state, the Target-state, and any identified gaps to be addressed specifically in the following areas: • Data Management Strategy (DMS) • Logical Data Model (LDM) • Conceptual Data Model (CDM) • Data Standards

15. HIS Maturity Model Dimensions: Criteria for Assessment

16. IHIN Assessed Maturity Capabilities Included • ADT Events/Encounter Alerting – Medicaid as Primary with Opportunity to Spread to Other Payors/ACOs/etc. • Eligibility and Benefits Information • Patient Consent • Lab Orders/Results (ORUs) • Health Record • Provider Attribution • Provider Directory • DIRECT Messaging • Registry • Redundancy (Enabled by Data Governance and Structure) • Reporting/Analysis Capability

17. Questions / Comments ???

18. West Des Moines, Iowa, IHIN Contacts Stephen Stewart, President/CEO • (319) 269-8560 • stephen.stewart@ihin.org Andi Bryan, VP, Operations • (515) 681-4661 • andrea.bryan@ihin.org Renee Gilley-Gates, Senior Client Director • (515) 778-1376 • renee.gilley-gates@ihin.org Darren Clark, HIE Enterprise Architect • (515) 214-3669 • darren.clark@ihin.org Jonathan Hills, Chief Technology and Security Officer • (319) 217-2175 • jonathan.hills@ihin.org Megan Maher, VP, Program Management Office • (515) 554-7547 • megan.maher@ihin.org Karri Drabik, Director, Project Management Office • (440) 596-2075 • karri.drabik@ihin.org Barbara Saeugling, Controller • (515) 776-6851 • barbara.saeugling@ihin.org Allen Wentland, IT Director • (515) 350-3306 • allen.wentland@ihin.org Diane Welcher, Office Manager • (515) 381-0359 • diane.welcher@ihin.org

19. My Journey

20. So how did I get here? What was the path? • Men's Retail • Chamber of Commerce • Gillette-Oral B • Burroughs Corporation • Became Unisys via merger with Sperry • Foodservice • Transportation-Ryder Systems • Medical Billing-CBE Group • Medical Billing-Avadyne Health • Henry County Health Center • Southeastern Renal Dialysis • CPSI/TruBridge • Schuylkill Health System Pottsville PA • UIHV • IHIN

21. Been A Great Journey • When I was 25, thought I was ready to be Chairman of GM and could not figure out why they did not give me the job • When I was 35 it dawned on me that I may not know everything nor even the stuff that really mattered • When I was 45 I figured out that life long learning was the only answer • When I was 55 I finally discovered that sharing and teaching what I had learned actually produced benefits

22. Arriving at IHIN • Had great advantage: I was part of founding IHIN • Organization was in need of new strategy • Board was actively engaged • 2017 Audit was in process • Cash Flow was tight • Financial stability shaky-but soluable • Participant Relations weak • Staff Morale very low • Came as Interim June 2018 • Got asked to stay

23. Wisest men I have ever known • “Tell the truth, all the time, even when it hurts, and in the end you and they will be far better for it. And you will be able to sleep at night and never have to look over your shoulder. Treating people right and honestly ALWAYS wins.” • M. S. Stewart My father • My first real mentor

24. Wisest men I have ever known • “There are only two functions of any firm, produce a product and sell it. Does not matter what the firm does or the service it provides, only two things really matter. I can’t tell you which one comes first but I can tell you everything else exists to support these two functions. If it does not, it is nothing more than blood sucking, profit draining overhead.” • C.G. Dore-President Oral B Laboratories • My second real mentor

25. Wisest Boss I did not like but actually taught me something • “Don’t be afraid to be wrong, just don’t be wrong long” • Corollary • “Don’t make the wrong mistake” • “Think like I think and you cannot go wrong” • “Think profit first and results will follow” • A Boss I did not like, but learned from, mostly what not to do • Personally: I agree with the first two points, not the second two, and have tried hard not to practice them.

26. So what is new about being a CEO • There really is no where else to turn (except your board) • They expect you to find the answers • Listening is more important than talking • But sometimes you have to talk-The key is knowing when • You cannot do everything yourself • Staff development is critical • Learning and training never ends • You do not have to be right all the time but batting 500 is not good enough

27. So what is new about being a CEO • People expect answers-and deserve them • Intelligent answers that is • It is ok to have to think about things • Everyone is a customer-even real customers • Politics is part of the game and will not change • Until the final responsibility rests with you it is hard to know what it is like to carry it • People want to help you-especially if you are honest

28. Key Lessons • Do not sugar coat bad news: It is not a fine wine, it does not get better with time • Think before you act-you are responsible • Do not fear decisions • Seek counsel wherever you can • Analysis paralysis will destroy the teams will to win • Treat people well-all people • Do what you say you will do

29. Key Lessons • It is OK to admit being wrong • Especially when you are and you will be at times • Lead by example-put in the hours • Encourage the team to make decisions • Celebrate their victories • Accept their defeats • Help pick up the pieces when needed