Janet M. Marchibroda Chief Executive Officer, eHealth Initiative

1. An Overview of Communities in the U.S. Who are Adopting HIT and Mobilizing Information to Support Health and HealthcareNewYork-Presbyterian Industry PresentationMedInfo 2004San Francisco, CA Janet M. MarchibrodaChief Executive Officer, eHealth Initiative And Executive Director of its FoundationExecutive Director, Connecting for HealthSeptember 8, 2004

2. We are Solving Common Problems • Looming Healthcare Crisis • Quality and Safety Challenges • Public Health Threats

3. Pioneers in Health Information Exchange* • Bellingham, WA • Delaware • Florida • Indianapolis, IN • Los Angeles, CA • Maine • Maryland • Massachusetts • Michiana Health Information Network, IN • Michigan *Sample

4. Pioneers in Health Information Exchange* • New York • North Carolina • Ohio • Pennsylvania • Rhode Island • Santa Barbara, CA • Tennessee • Utah Health Information Network • Vermont • Washington, D.C. *Sample

5. Common Issues and Challenges • Organization and governance – engaging stakeholders • Lack of upfront funding and sustainable model despite the fact that standardized coded health information exchange would save U.S. healthcare system $337B over 10 year implementation period and $78B/year thereafter • Competing entities reluctant to share information that would undermine competitive advantage • Technical issues: architecture, accurately linking patient data, applications, standards, security

6. Connecting Communities for Better Health • $6.9 million program conducted by the eHealth Initiative’s Foundation in cooperation with HRSA… additional funding being secured • Providing seed funding to community-based multi-stakeholder collaborations that are mobilizing information across organizations • Mobilizing pioneers and experts to develop and disseminate resources and tools to support health information exchange: technical, financial, clinical, organizational, legal

7. Communities Being Funded • Connecting Colorado (Denver, CO) • Establishing a secure environment and necessary legal framework for sharing clinical data • Interface engine for clinical data acquisition from four data repositories from four healthcare delivery institutions • Secure web server application to display integrated clinical information • Indiana Health Information Exchange (Indianapolis, IN) • Building upon existing infrastructure for electronic community health record developed by Regenstrief • Common, secure electronic infrastructure that is initially supporting clinical messaging • Single IHIE electronic mailbox through which clinicians can access clinical results for their patients

8. Communities Being Funded • MA-SHARE MedsInfo e-Prescribing Initiative (Waltham, MA) • Anchor project of the Massachusetts Health Data Consortium’s MA-SHARE Program • Involves health plans and hospital emergency rooms • Enables clinicians to access prescription history for emergency department patients • Makes available electronic prescribing technology at the point of service • MD/DC Collaborative for Healthcare Information Technology (Baltimore/Washington Metro Area) • Involves private physician practices, community hospitals, three major academic systems • Just getting off the ground…

9. Communities Being Funded • Santa Barbara County Care Data Exchange (Santa Barbara, CA) • Involves hospitals, physician group practices, public health, labs, and clinics • Manages peer to peer technology application whose purpose is to allow community physicians and other providers to securely share patient-specific data without the necessity of a central data repository • Taconic Health Information Network and Community (Fishkill, NY) • Involves 2,300 independent practice association, hospitals, labs, health plans, pharmacies and employers • Clinical, insurance, administrative and demographic information will be available through secure internet infrastructure to support care delivery

10. Communities Being Funded • Tri-Cities TN-VA Care Data Exchange (Kingsport, TN) • Involves hospitals, VA medical center, medical groups, public health, pharmacies, behavioral health care providers, health plans and employers • Providing foundation for health information exchange in a multi-jurisdictional area • Whatcom County e-Prescribing Project (Bellingham, WA) • Involves Whatcom Health Information Network, hospitals, medical groups, three specialty practices, and pharmacies (hospital and retail-based) • Will support electronic prescribing for those who have and do not have an electronic health record • Part of a broader initiative that is facilitating information exchange between providers and patients

11. Communities Being Funded • Wisconsin Health Information Exchange (National Institute for Medical Informatics – Midwest) (Milwaukee, WI) • Involves public health agencies for nine counties, hospitals, business coalition, medical society, and hospital association • Single easy-to-use portal for three existing networks: network for emergency care, state public health information network, and state immunization registry

12. Barriers to Adoption • Upfront Funding and Alignment of Incentives (a Business Model) • Interoperability Which Can be Achieved through Standards • Clinical Process and Work-flow Changes Required • Lack of Perceived “Value” • Lack of Awareness of Safety Benefits • Not Yet a “Standard of Practice”

13. Leveraging U.S. National Efforts • Medicare Modernization Act implementation • Implementation of DHHS Strategic Framework • Emerging incentive programs by large employers and payers • Public-private sector collaborations such as Connecting for Health • Lessons from increasing # of demonstration projects and implementations: AHRQ, CMS, eHI/HRSA • Emerging legislation – will see increase in 2005 • Emerging private sector coalitions and initiatives

14. What We Can Learn from U.K. and Other Nations • Technical Strategies • Use of standards • Methods for accurately linking data while protecting patient privacy • Reducing risk • Security strategies • Procurement strategies

15. What We Can Learn from the U.K.and Other Nations • Engaging Clinicians • Requirements development • Enabling customization while achieving national standards to support rapid, widespread adoption • Addressing organizational and clinical process change issues during migration • Engaging Patients • Understanding Value – Care Delivery, Clinical Research

16. Key Imperatives for Moving Forward • Building public-private sector partnerships…neither the government nor the private sector can do this alone… • Aligning national standards with local efforts…too much emphasis on one or the other will create issues • Employer, purchaser and payer (private sector and CMS) incentives should reward standards-based interoperable applications and electronic connectivity

17. Key Imperatives for Moving Forward • Investments in “dead-ends” should be avoided…incremental approaches should enable movement toward an interoperable, electronic health information infrastructure without “rip and replace” • Reference implementations are needed to help us take standards and policies to the “next level” and learnings should be widely disseminated and supported to accelerate adoption

18. Key Imperatives for Moving Forward • Innovation is needed to provide support to clinicians—particularly small to medium medical practices—as they make the transition

19. What We are Doing to Help • Providing knowledge resources and tools • Financing • Technical aspects • Clinical process change • Organizational and legal • Bringing communities together to learn from experts and each other • Expanding our community beyond the U.S. – Leadership in Global Health Technology Initiative

20. Closing • We are finally building momentum…the “stars and planets are aligning” • The focus has shifted from “whether we should” to “how will we do this?” • This work will create lasting and significant changes in across the world…how clinicians practice…how hospitals operate….how healthcare gets paid for…how patients manage their health and navigate our healthcare system • By cooperating and collaborating, we can learn from each other....help us all move more effectively toward the goal

21. Thank You Janet M. MarchibrodaChief Executive Officer, eHealth Initiative Executive Director, Foundation for eHealth InitiativeExecutive Director, Connecting for Health 1500 K Street, N.W., Suite 900 Washington, D.C. 20039 202.624.3270 Janet.marchibroda@ehealthinitiative.org