Health Information Technology Meeting April 28, 2009

1. St. Louis Regional Update Status of Health Information Exchange Initiatives Health Information Technology MeetingApril 28, 2009

2. St. Louis Regional Update • Only 2 major electronic health information exchange projects currently underway in St. Louis region: 1. St. Louis Integrated Health Network – only HIT initiative sharing clinical/patient information from major health care providers, including BJC, SSM, SLU hospitals, all community health centers and health departments in St. Louis region 2. Midwest Health Initiative (led by St. Louis Business Health Coalition)- only HIT initiative aggregating data from major insurers/payors with strong employer support • Both efforts underway for several years, have data sharing agreements in place, have invested several million dollars to date in each initiative, and each “go live” in 2009 • Projects complimentary, fill different market needs

3. ST. LOUIS INTEGRATED HEALTH NETWORKST. LOUS REGIONAL HEALTH INFORMATION EXCHANGE PROJECT Electronically linking hospitals and health centers across the St. Louis region

4. St. Louis Integrated Health Network • Objectives and Desired Outcomes The St. Louis region is implementing a health information exchange project across the major health care providers in St. Louis City and County. The project will improve patient care by enabling exchange of essential electronic patient information across health care providers. Initial goals include: • Reducing non-emergent use of Emergency Services • Enhancing coordination, quality, and efficiency of care through secure electronic exchange of patient health information • Connecting Medicaid and uninsured patients with a primary care home • Expected Impact • Over 350,000 uninsured and Medicaid recipients (phase I), with potential expansion to entire region/population (TBD)

5. CONSTITUENTS Regional priority of St. Louis Regional Health Commission, Mayor of City of St. Louis, St. Louis County Executive Current participants include: • Hospital emergency departments in the St. Louis region’s areas of high need (Phase I): • Barnes-Jewish Hospital • St. Louis Children’s Hospital • Christian Northeast Hospital • St. Louis University Hospital • St. Mary’s Health Center • Cardinal Glennon Children’s Medical Center • DePaul Health Center • All major Community Health Centers (5 FQHCs, St. Louis ConnectCare) • St. Louis City and County Departments of Health • Washington University and St. Louis University Schools of Medicine

6. IHN – Governance Structure of HIE Project

7. Shared Data • Exchange of clinical information between providers – history and physical reports; progress notes; medication orders; allergies; lab and test results; radiology reports • Exchange of registration information between providers – patient demographics, contact information, visit history • Identification and referral of non-emergent Medicaid and uninsured emergency department patients without an identified primary care physician • Use of messaging system to facilitate communication between emergency department physicians, care coordinators, primary care physicians/staff, and specialists (consults, referrals, notifications, etc.)

8. St. Louis Integrated Health Network • Timeline/Project Approach • Community-based decision making • Over three years in planning • “Go live” with Phase I – Summer 2009 • Technical Approach and Reason • Linked EMRs and patient registration systems utilizing Vanderbilt/Memphis model and technology • “Vaulted” model (vs. centralized record) • Determined utilizing extensive community planning and dialogue

9. St. Louis Integrated Health Network • Lessons Learned • Start with process flow redesign and HR alignment – let technology enable, not drive, business goals • Obtaining consensus is difficult – maintaining it requires constant effort • Let organizations participate at own pace – “forced collaboration” models don’t work well • Focus on what you can agree to and get it done – don’t waste energy attempting what’s not yet possible • Secure just enough funding at the right time – don’t be overfunded too early in the process

10. MIDWEST HEALTH INITIATIVE A common table for all interested parties to join together to share information and work to improve the quality, affordability, safety, efficiency, equity, and patient centeredness of health care services across the region.

11. MHI Summary • Objectives and Desired Outcomes • WHY: Urgent need to improve health and health care value • WHAT: Integrated longitudinal data warehouse • Defined mission and initial deliverables; Developed data security and HIPAA procedures; Executed contracts; Secured data vendor; Completed initial data collection; Secured initial funding • WHAT’S NEXT: Fall 2009 Complete Initial Deliverables; • Expected Impact • Purposeful design as a “Community Benefit” rather than a membership organization to be a “tool” to empower others rather than a single solution. • Expect to improve health and health care quality and affordability across the region. • Coverage • Commercial and Medicaid populations in St. Louis MSA and 16 counties west (mid-Missouri) to Columbia/Jeff City

12. MHI Summary • Constituents • Physicians, Consumers, Labor, Health Plans, Business, Public Sector, Community at Large. • Constituents expected to represent the community’s interest first, their constituency group second and not their institutional perspective. • Governance Structure • Acting Board built data asset. In the process of transitioning to a Governing Board and Leadership Team with all stakeholders represented in both. • No plans to change • Data • Eligibility, medical, and pharmacy claims (all data elements) • Began with 4 major health plans; Added Medicaid, labor, • Will continue to add data sources with each refresh

13. MHI Summary • Timeline • Cycle 1 - Primary care physician reports on AQA measures, hospital and community reports—4th quarter 2009; • Cycle 2 - Refresh data; physician quality reporting to include specialists through self-serve website -2010; • Cycle 3 - Refresh data; Continue above with addition of Consumer website reporting on quality and cost – 2011 • Research base will be available to community under direction of Board • Project Approach – steps to accomplish the work • Define scope/deliverables; base funding commitments and contracts on these. Communications, contracting, strict coordination of data standards. • Continue to grow community engagement; prepare physicians for release of quality reports and verification process • Technical Approach and Reason • Technology Solution: Integrated longitudinal data warehouse • Benefit: Creates a tool to respond to a variety of health information needs, now and over time, rather than a single problem. • Disadvantages: Expensive and requires significant trust

14. MHI Summary • Lessons Learned: • Community interest in improving health care is strong and growing. • Stakeholders are interested in cooperative action. • Privacy/security agreements will take as long or longer than the developing the data extracts. • Challenges: • Changes - in your partners’ key leadership and/or financial position, system or data vendor, or the law. • Recommendations: • Reach consensus on your value proposition and initial deliverables early and stay focused. Plan for your evaluation before you begin. • Secure just enough funding-avoid being over funded • Be flexible when able but do not compromise data integrity. • Never, never, never give up.