Presentation for HIT SUMMIT WEST March 8, 2005 Presenter: Mike Skinner

1. Presentation for HIT SUMMIT WEST March 8, 2005 Presenter: Mike Skinner

2. SBCCDE, Inc. a 501c3 company

3. Mike Skinner Executive Director (818) 612-8561 Mike@sbccde.org

4. Initial Funding Support California HealthCare Foundation (www.CHCF.org) Foundation for eHealth Initiative http://ccbh.ehealthinitiative.org/profiles/SBCCDE.mspx This project is funded in part through a contract with the Foundation for eHealth Initiative (“FeHI”) and their cooperative agreement with HRSA, Office for the Advancement for Telehealth (“HRSA/OAT”). The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official view of HRSA/OAT or FeHI.

5. RHIOs • Regional Health Information Organizations (RHIOs) are being formed across the country in response to the “Framework for Strategic Action”, published by Dr. David Brailer, National Coordinator for Health Information Technology, as a guide for national adoption of community-based, interconnected Electronic Health Records (EHRs) within 10 years. • SBCCDE was Dr. Brailer’s vision of what we know today as a RHIO • SBCCDE is oriented around decision-making improvements at the time of care • Current & future RHIOs may also focus on other community health care functions such as post-care analysis, disease management, and disease and immunization registry

6. Governance • 501c3 • Tax Exempt Status • Funding Opportunities • Board of Directors representation • Physician community • Business community • Consumers

7. Board of Directors • Mr. Phillip Greene, COO, Santa Barbara Regional Health Authority Chairman, SBCCDE (805) 685-9525, phil@sbrha.org • Mr. Paul Jaconette, CFO, Sansum-Santa Barbara Medical Foundation Clinic Treasurer, SBCCDE (805) 681-7700 pjaconette@sansumclinic.com • Mr. Dan Herlinger, Consumer & Business Advocate Secretary, SBCCDE (805) 966-7697, herlinger@cox.net • Dr. George Hiester, President, MidCoast IPA, Board Member, SBCCDE (805) 925-2521, ghiester@pol.nt • Mr. Roger Heroux, COO, Santa Barbara Public Health Department Board Member, SBCCDE rheroux@co.santa-barbara.ca.us • Dr. Owen Stormo, Cottage ER Physician Board Member, SBCCDE (805) 886-1326, ostormo@cox.net • Mr. Alberto Kywi, CIO, Cottage Health Systems Board Member, SBCCDE (805) 682-7111, akywi@sbch.org • Mr. Jim Raggio CFO, Lompoc Valley Community Healthcare Organization Board Member, SBCCDE (805) 737-3301, raggioj@lompochospital.org • Ms. Sue Anderson, CFO, Marian Medical Center Board Member, SBCCDE (805) 739-3110, sanderson@chw.edu

8. Financial Sustainability • Benefactors still not well understood or measured • “If you build it, they will come”  it still needs to be built, then see who comes • Public/grant funding for startup costs (need to be a 501c3) • Large stakeholders and/or data contributors • Community hospitals • Reference laboratory • Community medical groups • Large companies with high employee base • Private health plans • State plans • Pharmacy companies • Local tax support

9. Access to Data is the Key “Content is King” • Timely access to data saves lives • Above all, orient your RHIO around access to current and historical data • Keeping data access in mind, fashion your mission statement; then, proceed with RFIs/RFPs and focus on solutions that most closely match your mission • Questions to ask: • Is the goal more ambulatory/point-of-care (as in SBCCDE)? • Is the goal to provide post-encounter functions such as outcomes, disease management? • Is the goal to improve financial operations by automating admin functions? • Or all of the above? • Have a long-term plan, but start small & build to your mission

10. Technology • Peer-to-Peer (P2P) • NO centralized database • Not an EMR; rather, a community EMR broker/switch • Think of as highly secured clinical search engine  CDE-OOGLE.com – query for patient, then follow links (see ILS) • “Look & Leave”

11. Identity Correlation Service (ICS) • Be bathed in demographics, and use all of them • Educate/train providers on improving match data • Be prepared to manually manage mis-matches • Conduct periodic assessments (have a policy & procedure for this) • For SBCCDE, this is the only database in the system

12. Clinical Data Repository (CDR) • Don’t exclude legacy (non-P2P) sources [essential to collect & expose as much data as possible] • But, don’t build centralized databases to overcome • Use separate hosted CDRs to manage HL7-collected data, with links to these databases from ILS • Re-direct the link once the source system is P2P compliant

13. Information Locator Service (ILS) • Maintains the list of “links” • Follow the links most useful for the current condition of the patient • Links are sort able by type of data and date range (MySBCCDE approach depending on role) • Oriented around patient care at the time of care • ILS can be redirected as legacy systems upgrade to P2P

14. Project Status • Testing & Certification • Data Feed Integrity & Verification • Security, HIPAA Compliance • Physician & Staff Testing • Deployment & On-Going Training – Spring 05

15. Measuring Success • Stable and financially-secure operations • Number of users and inquiries increasing steadily • Number of lives covered • Physician & Patient testimonials of real-world impact • Consumer support

16. Consumer • Understand the consumer in your community • Engage the local university to set up consumer focus groups & surveys • Work with local school districts to build interest in high schools • Don’t leave out, but don’t over-engage prematurely • Win the support of the physician first, let the physician be your champion to reach the consumer • Be prepared to respond to serious concerns from consumers and consumer groups – have an informational tri-fold that physicians can hand out to consumers as an educational device (specify Privacy Officer, complaint procedures, etc) • At the right time, build consumer “user groups” and co-opt the consumer advocacy groups in your community

17. Lessons Learned • Invite everyone to the table • Establish governance early, and follow By Laws procedures • If 501c3, apply for federal exemption ASAP – it takes time & energy • Hire an experienced legal firm, and keep them in the loop at all times • Execute agreements early, especially data provider and user agreements • Don’t try to pop all the corn in the field – set achievable goals & march toward them • Don’t let the seemingly impossible list of challenges overwhelm you – block and tackle • Spell out all interface & data specifications in excruciating detail, and hold everyone to them • Hold your vendor to their obligations, but meet your own obligations too

18. CareScience, Inc. CareScience.com A Quovadx Company Contact: Jerry Rankin (415) 546-3009 Jerry.Rankin@Quovadx.com __________________________ https://cde.carescience.com