HealthInfoNet Moving to the Next Generation of Value Added Statewide Information Service s

1. HealthInfoNet Moving to the Next Generation of Value Added Statewide Information Services MeHIMA Annual Conference Bar Harbor, ME September 18, 2014 Todd M Rogow, CTO

2. Topics To Be Covered • Update on HealthInfoNet Exchange Operations • Value Added Service Portfolio • Current Major Grant Related Activities • Where HIN is Headed • Evolving Challenges • Resources & Questions 2

3. About HealthInfoNet • A private independent nonprofit HIT organization funded by both private and public sources. • Operates the statewide HIE in Maine – A real time query-based central data repository Health Information Exchange • ONC Statewide Regional Extension Center, Primary technical contractor for ONC HIE Cooperative Grant and ONC Bangor Beacon Grant • SIM Testing Grant Partner 3

4. HealthInfoNet History • 2004 - Maine Health Access Foundation, Maine CDC, Maine Quality Forum and Maine Health Information Center study need and support for an exchange in Maine. • 2005 - Stakeholders begin planning and development. • 2006 - HealthInfoNet incorporated with Devore Culver, formally Chief Information Officer of Eastern Maine Healthcare, as Executive Director. • 2008 - Demonstration phase begins. • Participants included MaineHealth, Central Maine Healthcare, Eastern Maine Healthcare, Maine General Health, Martin’s Point Health Care, Franklin Memorial Hospital and the Maine CDC. • 2010 - Demonstration phase ends and statewide roll-out begins. • Award of HIE, REC, and Beacon Grants 4

5. Data Categories Managed in the HealthInfoNet HIE Today • Patient Identifier and Demographics, including insurer • Encounter History • Laboratory and Microbiology Results • Radiology Reports • Adverse Reactions/Allergies • Prescription Medication History (claim/fill – incomplete!) • Diagnosis/Conditions/Problems (primary and secondary) • Immunizations • Vital Signs • Dictated/Transcribed Documents • Continuity of Care Documents (CCD) 5

6. HIE Connections • 34 of 37 hospitals (all under contract to connect in 2014) • 34 FQHC sites • 400+ ambulatory sites including physician practices behavioral health and long term care facilities www.hinfonet.org 6

7. AchievingBusiness Sustainability

8. HIE Population Statistics As of August 31, 2014 • 1,359,402 lives in the HealthInfoNet database (this includes 90% of Maine’s resident population) • 163,031 Non-Maine residents have clinical data in the exchange • 16,111 individuals have opted out (1.2%) • 2,349 Maine clinicians and support staff are active users of the exchange • 50% of active users accessed the exchange in August, 2014

9. HIE Operating Statistics August 1, 2013 – July 31, 2014 • Incoming Data • Over 15 Million inbound messages are received by HealthInfoNet each month • Portal Use • 185,454 patient records accessed by HIN portal users • Between 810 and 1,173 authorized users per month • Clinical Data Transfer - • Over 2.6 Million patient clinical messages sent in support of ACO organizations • 55,098 real-time email notifications • 30,902Continuity of Care Documents (CCD) sent for discrete data integration into EHR applications • Public Health • 496,719 data transmissions sent to Maine CDC in support of Electronic Lab Reporting and Syndromic Surveillance (Meaningful Use Measures) 3,446,990 Clinical Records Either Accessed or Transferred by HealthInfoNet over the Last 12 Months

10. HealthInfoNet Value Added Services • Meaningful Use Stage 1 & 2 Connection to Public Health for Laboratory Reporting, Syndromic Surveillance, Immunization Reporting • ACO/Value-Based Purchasing Data Source • Real Time Notification Service • Enterprise Master Patient Index Management • Interoperable Secure Messaging • Analytic and Reporting Tools 10

11. Analytic and Reporting Tools • Leverage Transactional Data Flowing Into the Exchange to Support Quality and Population Health Analysis as well as State, Federal, and Health Plan Reporting • Near Real Time Data Set to Support Market Share Analysis, Patient Origin Studies, etc. • Foundation for Community-Wide Health Reform Reporting • Near real-time clinical risk profiling • Readmission • Inpatient Utilization • ER Admission • High Cost 11

12. HIN Analytic and Reporting DashboardViews 12

13. Volume and Market Share Dashboard Where their patients come from This chart shows that the selected hospital has 81% of market share for orthopedic surgery cases w/in County 13 And the highest volume procedures.

14. Volume and Market Share Trending This chart shows that volumes for orthopedic surgery for the sample hospital are declining for both outpatient and inpatients and market share for inpatient orthopedic surgery within their service area is declining. 14

15. Readmission Risk Management Dashboards:Readmission Risk Profile The map shows where these patients originate. These charts show distribution of patients by chronic disease, service line, and diagnostic category This visuals shows the number of inpatient encounters by 30 day readmission risk level. 15

16. Population Risk Management Dashboards:Population Profile This chart shows that for the selected health system there are 81 patients who have >70% chance of an ED visit, inpatient admission, and being high cost within the next 6 months The map shows where these patients originate. The most common Diagnoses for these patients are Hypertension and Diabetes 16

17. Population Risk Management Dashboards:Individual Patient Summary The summary above shows that this 59 year old female had 5 inpatient admissions, 14 ED visits, and 36 outpatient visits in the last 12 month period. The chart shows the timing of each encounter along with the risk scores increasing over time. 17

18. Population Risk Management Dashboards:Individual Patient Summary Provides top 10 reasons driving each risk score. Summarizes key clinical findings. 18

19. Population Risk Management Dashboards:Individual Patient Summary Provides top 10 reasons driving each risk score. Summarizes encounter history. 19

20. HIN State Innovation Model (SIM) Grant Activities • Provide automated notifications to MaineCare care management staff as well as participating provider care managers when MaineCare patients are admitted to Emergency Departments and Inpatient Settings • Continuing HIN’s Behavioral Health HIT efforts: • Paying for HIE subscription fees for participating behavioral health providers • Providing EHR adoption incentives to 20 BH Organizations to support their purchase and implementation of EHRs and connect to HealthInfoNet • Developing and deploying the "blue button" approach to allowing patients who access their medical records through provider-base personal health portals, to access their HealthInfoNet data • Providing Data Services and Analytics for MaineCare – supporting patient care coordination and provider reporting 20

21. HRSA Flex Grant • Make HIE available to all Maine VA clinics and Togus Hospital • Web-based access to the HIE’s “Clinical Portal” • Connect HIE bi-directionally to VA EHR • Focus on National VLER/VISTA onboard via Healtheway’s eHealth Exchange network • Primary function will be CCD exchange in year one • Provide coordinated education and implementation support for VA providers • Future activities: focused on expanding HIE services, discrete data management, and PHR/Veteran access to medical records

22. Where HIN Is Headed • Finalization of 5 Year Strategic Plan (Nov 2014) • Finalization of Business Development/Revenue Priorities -Connection to Social Security Administration -Enhanced Analytics with Inclusion of Claims Data to Compliment the Clinical Data Set -Inclusion of other data sources • Statewide Adoption of HIN Analytic & Reporting Tools • Expanded Adoption of HIE Service Adoption by Specialists and Non-Hospital Sectors • Inclusion of additional data categories, e.g. Advanced Directives • Work Flow Optimization Within Care Coordination Process, e.g. Medical Record data completeness and accuracy check • Expanded reporting capabilities, e.g. Maine Health Data Organization (MHDO) Hospital Encounters Report 22

23. Challenges Impacting HIN • Changes in the Health Delivery System In Maine (and the region) -Corporate Consolidation -Evolving Models of Care -Uncertainties About Payment Reform • Evolving Data Exchange Standards • Meaningful Use Standards and Incentives

24. Resources & Questions HealthInfoNet Website: www.hinfonet.org - Shows connected facilities - Key Clinical Exchange News & Facts - Today’s presentation Thank you! Todd Rogow, Chief Technology Officer