Pamela Clarke, Senior Director, HSX Daniel Wilt, Senior Director, HSX

1. Pamela Clarke, Senior Director, HSX Daniel Wilt, Senior Director, HSX NJ DVHIMSS October 29, 2015 SEPA Health Information Exchange: How to Get Services Deployed Transforming Healthcare and Improving Patient Care in the Greater Philadelphia Region

2. Who are we? A Non Profit 501(c)(3) Member Owned Entity. Corporation formed in May 2012. Board and Governance formed in January 2013. Staff of 8 FTEs, technology vendors, consultants, several college interns and incredible volunteerism from our members. Geography FocusCity of Philadelphia and surrounding counties: Bucks, Montgomery, Chester, Delaware and Philadelphia counties. Plans to expand coverage as current members become connected.

3. What is HealthShare Exchange of Southeastern Pennsylvania? HSX is a non-profit health information exchange (HIE) organization serving the greater Philadelphia Region. The HSX Missionis to provide secure access to health information that enables preventive and cost effective care; improves the quality of care; and facilitates the transitions of care. TheHSX Visionis to build a trusted community of healthcare stakeholders collaborating to deliver better healthcare to patients.

4. HSX Current Membership Health Systems • 37 Acute Care Hospitals • 93%+ Emergency Department (ED) visits in the region Independent Behavioral Health Facilities • Eagleville Hospital • Elwyn Specialty Hospitals • Physicians Care Surgical Hospital Accountable Care Organizations • Delaware Valley ACO • Noble Health Alliance Health Plans • AmeriHealth Caritas • Health Partners Plans • Independence Blue Cross • 62%+ of the covered lives in the region Independent Ambulatory Practices and FQHCs • 42 New Signed Up

5. New Member Candidates 2015 2016Entities Interested in Joining HSX • Behavioral Health Facilities • Behavioral Health MCOs • Birthing Centers • Large Private Practices • Long-Term Care Organizations • National Health Plans • Other Hospital/Health Systems • Regional-Focused Health Plan • Retail Pharmacy • Urgent Care Centers

6. Enabling Exchange within a Layered Ecosystem

7. Solving Critical Health Problems in the Region Uncoordinated Discharge Process The hand-off to the next provider is not well coordinated. Unknown Primary Care Provider (PCP) or Care Team The discharging facility does not know the name of the patient’s PCP or Care Team or how to contact them. Incomplete and Delayed Information Even if information is transmitted, it is usually incomplete, not timely and sent by handwritten hard-copy or fax. Results in Failed System Leads to medication mix-ups and errors, absence or delay in follow-up care and increased emergency room utilization.

8. HSX Services Roadmap

9. Keys to Success for Deployment and Adoption Social Work Ideal: Begin where the client is. Field of Dreams: If you build it, he/they will come. Problem Solving Approach: What is the problem you want to address? Be Hands On: Engagement and Adoption Works!

10. Provider Directory

11. Challenges with Direct Secure Messaging Solutions that Work • Duplicate Direct Addresses: HSX’s primary Direct address solution! • Principle #1 : Don’t let the perfect get in the way of the good! • Interoperability Challenges: Exchange Partner Testing • Principle #2: If at first you don’t succeed, try, try again! • Clinical Naysayers: The “What Ifs Club” • Principle #2: “Progress always involves risks. You can’t steal second base and keep your foot on first.” Frederick B. Wilcox

12. Direct Secure Messages Sent and Received by HSX HISP Users ACTF and CAH Go Live *Note: Message count shown is for those entities using HSX as their HISP, meaning it is a subset of all message volume that exists within the HSX member/participant community. January 2015 message count is an estimate based on January 14th – January 31st data.

13. Average Daily Direct Secure Messages and Unique Recipients

14. Master Patient Index (MPI) Patient Entities

15. ENS Subscriptions and Notifications

16. Considerations for ENS Roll Out • What are you going to do with the data? • Establish a subscription for data that is meaningful and is actionable. • Who is going to access the data? • Need to think about workflow and resource allocation. • When do you want to receive the data? • Consider the best time frame for receiving the information. • How do you want to receive the data? • Consider the options for data delivery. • Review the Model • ENS is a flexible service. Patient panels and subscriptions can be updated and changed based on need.

17. Emergency Management Preparations • After The Recent Train Incident and Ability to Location Family Members • 200+ Injured Individuals Were Admitted to 5 Different Hospitals in the Philadelphia Area • In Preparation for the Papal Visit in September to Philadelphia • Estimated 1M+ People to be on the Benjamin Franklin Parkway • How Can the HIE Help Support the Region?

18. HIE Emergency Management Urgent Patient Activity Liason (UPAL) • What is UPAL? • A real time look up capability of an individual patient’s emergency healthcare activity across the greater Philadelphia region in the event of a regional situation impacting healthcare services for a large number of citizens. • Why is HSX Establishing UPAL? • HSX members believed that it is critical for HSX to be able to provide a back up in the event of a crisis or emergency circumstance during the Papal visit. • UPAL can be invoked to respond to member hospitals on behalf of inquiring family members in an effort to locate patients who have been admitted, discharged or transferred to one of the region’s hospitals. • What UPAL is NOT? • This service is not a replacement for Knowledge Center. UPAL could be deployed if several HSX member hospitals needed assistance responding to family member inquiries in an emergency circumstance.

19. HIE Emergency Management Urgent Patient Activity Liason (UPAL) • How UPAL works? • If HSX was notified by their members and or a governmental agency that there was an emergency circumstance warranting the initiation of UPAL, HSX would obtain approval from the Executive Committee to begin the UPAL service. • HSX would notify hospital members that the service was available. • HSX Staff will provide 24/7 availability and support when this service is available. • To make patient location requests, contact HSX Support via the phone at 855-479-7372

20. HIE International Exchange • Proof of Concept Exchange • C-CDA Exchange Between HSX and Toronto,Canada and Rome, Italy • Technical Foundation • Prior work from 2014 ONC exploratory project based on EU-USA MOU for HC data exchange • Mutual support for IHE International standards for message transport • Business Foundation • Papal visit and other VIP events in Philadelphia • Europe & Canada considered high-frequency vacation/business destinations for PA residents

21. HIE International Exchange • What Went Well • We were able to demonstrate use of the IHE standard for transport easily • CDACCDA continues to be conduit to International Pt Summary (IPS) content for international exchanges • Challenges • Obviously Languages and Coding Sets • Patient consent differences

22. HIE Promotes Consumer Focused Care

23. HealthShare Exchange of Southeastern Pennsylvania

24. Thank You! Martin Lupinetti Executive Director martin.lupinetti@hsxsepa.org 215-391-4907 Pamela Clarke Senior Director, Member Services and Policy pam.clarke@hsxsepa.org 215-422-4323 Daniel Wilt Senior Director, Information Technology daniel.wilt@hsxsepa.org 215-422-4321 Jennifer Natale Senior Manager, Engagement and Adoption jennifer.natale@hsxsepa.org 215-422-4322 Rakesh Mathew Program Manager rakesh.mathew@hsxsepa.org 215-391-4908 Yolande Greene Project Manager Yolande.greene@hsxsepa.org 215-422-4325 HealthShare Exchange of Southeastern Pennsylvania, Inc. 1801 Market Street, Suite 750 Philadelphia, PA 19103 www.hsxsepa.org