“The Connected Healthcare Community: A New Model for Health Care in the U.S.”

1. “The Connected Healthcare Community:A New Model for Health Care in the U.S.” Scott Decker Chief Executive Officer

2. Our Healthcare System in Crisis “...the most remarkable feature of this twenty-first century medicine is that we hold it together with nineteenth-century paperwork” Tommy G. Thompson • Former Secretary, • Department of Health and Human Services

3. Patient-centric design Disparate IT systems are unified through a shared information architecture Collaborative Care Model All providers have access to complete, up-to-date patient information Patient Centric Database The Connected Healthcare Community Diagnostic Labs Pharmacies Hospitals Patients Managed Care Physicians & Staff Technology Infrastructure

4. Federal Policy Solutions:Three Building Block Strategies Regional Health Information Organizations • State or local entities to oversee and support regional health information exchange • Multi-stakeholder governance with public health and quality improvement role • Support of local EHR implementation in addition to technical assessment for NHIN deployment National Health Information Network • A nation-wide utility that allows secure and seamless health information exchange • Certification of EHR compliance with minimal standards set by the private sector • Used by federal agencies to support data collection and health information exchange EHR Adoption Strategy • Reduce loss and risk for physicians investing in EHRs • Implementation support for primary care physicians that leverage specialist and hospital adoption • Incentives through Medicare, consolidate purchasing power, and clarify hospital-physician affiliations Office of the National Coordinator for Health Information Technology, 2005

5. Regional Health Information Organizations (RHIOs) • State or local entities to oversee and support regional health information exchange • Multi-stakeholder governance with public health and quality improvement role • What will a RHIO do? • Oversee business policies for data sharing • Support physician office implementation of EHRs • Every American should be covered by a RHIO that will support information exchange on their behalf Office of the National Coordinator for Health Information Technology, 2005

6. National Health Information Network • A nation-wide utility that allows secure and seamless health information exchange • Capitalized by public and private investment and operated by private organizations • What will NHIN do? • Connect clinicians to allowable data about their patients • Allow federal agencies to collect and share data for public health surveillance, research, and payment administration • Policy options: • Federal recognition of Product Certification Commission • Determine role of government in oversight of NHIN Office of the National Coordinator for Health Information Technology, 2005

7. National Model of interconnected RHIOs

8. Projected Financial Savings of Collaborative Care Deployment: Center for Information Technology Leadership

9. CHC Funding/Sponsor Examples • State-Run Initiatives • Maine • Rhode Island • Nebraska • IPA Initiatives • Taconic • Hospital-Led Consortiums • Houston • Southern California • Stand-Alone RHIOs • Eastern Tennessee • Santa Barbra Initiative • Payer Initiatives • Wellpoint • BC/BS Massachusetts

10. Strategic Readiness Assessment • Strategic Business Planning • Governance Structure • Funding Model Development • Technology Planning and Strategy • Technology Readiness Assessment • Technology Infrastructure • Shared Electronic Record • Security and Access Management • Ubiquitous Access • Connecting Physicians • Connecting Hospitals and Labs • Connecting Pharmacies and PBMs • Connecting Consumers and Patients • Stakeholder Support and Management • Trading Partner Management • Business Development • Office Workflow Optimization • ROI Analysis Evolution of regional networks

11. 200+ Community Initiatives Nationwide State of Maine Portland Wyoming Rhode Island Taconic Nebraska Silicon Valley Regenstrief Mesa County NE Tennessee Santa Barbara W. North Carolina DFW Houston Florida Hawaii

12. Taconic – Health Information Exchange • Hudson Valley, New York • 1000+ current users (400 MD’s) using a shared data exchange • Multi-tiered P4P funding • Connects four hospitals and two reference labs (LabCorp and Quest) • Person Index established • Three EMR vendors sign interoperability agreement with data exchange • System live and users trained within 90 days of kickoff

13. Technology Models • Two basic models • Central Data Repository • Federated Architecture • Central Data Repository • All clinical data together in one place • Concerns about privacy • Federated Architecture/Record Locator Service • Each community member keeps “its” data • Difficult to achieve actionable longitudinal view

14. Clinical Advantages of a Regional CDR • Effective re-use of clinical data • Codified data for reporting, graphing, and clinical decision support • Ongoing surveillance • Hazardous conditions • Missed disease management opportunities • Potential errors • Adverse effects • Automatic alerts to providers • Data from multiple sources combined • Clinical alerting rules run across combined data • Longitudinal, patient-centric view • Multiple providers in multiple locations easily share data from multiple systems

15. Technical Advantages of a Regional CDR • Centralized security model • No need to provision multiple individual systems • Time to market • Common data framework • Common configuration tools • Common implementation process • Reusable interface libraries • System performance and reliability • End user not waiting while multiple systems are queried • Easily scalable with increased number of source systems and users

16. Technical Advantages of a Regional CDR • Not dependent on source system availability • Easy to provide redundancy and eliminate single points of failure • Person resolution complexity • Fully decentralized system requires matching patients across multiple systems in real time • Allows timely human resolution of ambiguous matches • Standard legacy system interfaces • HL7 and now CCR • Takes advantage of built-in interface capabilities already built in to most clinical information systems

17. Standards • In order to deliver interoperability, adherence to standards is key • HL7 for registration and results exchange • CCR for visit snapshot • ICD9 for problems • CPT for procedures • NCPDP for pharmacy • X.12 for eligibility and billing • Problem with standards is definition • HL7 too loose • CCR doesn’t define vocabularies

18. Connected Community Interoperability among physicians with full EMRs; web-based EMRs or paper charts AST IPA Physician Group Imaging Center Orders, Results Reporting, Analysis Secure Messaging Pred. Modeling Imaging studies Reports eRX Meds History, Results, Problems, Notes ADE/ADI/Formulary alerts Secure Messaging Clinical Referral mgmt. End of visit Clinical and Patient Education Transcription sign-off Care Management CCR record sharing Reports Public Health Services Secure Messaging HIE Single Sign-on Rounds info ADT notifications Results, Reports, Images Demographics/insurance updates Critical Alerts Transcription Signing Security, Interoperability, EPI, codification, etc. Hospitals Personal health record, Secure Messaging Health Risk Appraisals Problem Questionnaires Rx Refill Req., Content Results Viewer, On-line Bill Pay Links to other sites Longitudinal Patient Records eRX, Meds history Formularies Real-time Patient Record Alerts, Secure Messaging Care Management Reporting At-risk Popul. Mgmt. Claims-built Patient History, Group-level Formularies, Eligibility./Auths. Clinical/Pharma. information. Alerts Members, patients, consumers PBMs, Retail Rx, (SureScripts, RxHub) Care managers Knowledge, Content, Dec. Support Payers