REGIONAL COLLABORATIVES

1. REGIONAL COLLABORATIVES September 14, 2009

2. Company launched September 2004 • Non-profit registered in the State of Massachusetts • CEO on board January 2005 • Backed by broad array of 34 MA health care stakeholders MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE

3. Outcomes analysis MAeHC-level: Analysis • Benchmarking • Negotiated reporting to plans • P4P • Chart review MAeHC-level: QDC Community-level: HIE • Brockton • Newburyport • North Adams Provider-level: EHR MAeHC ARCHITECTURE AND DATA FLOWS

4. QUALITY MEASURES DON’T HAPPEN, THEY GET DONE Illustrative EHR Implementation Value Chain Overall project management Vendor contracting and management Readiness assessment & planning Practice transformation & workflow planning System deployment & Implementation Reporting, decision support, and performance measurement Inter-operating with internal and external systems Post- implementation support • Gaps at any point along the way will undermine adoption

5. Prescription refill request on fax machine (Right behind the joke of the day) “Hey Sally! Where is Mrs. Jones x-ray?” WHY DO SO MANY PHYSICIANS OFFICES LOOK LIKE THIS? Printer with results from one lab Unopened mail Courier just dropped off more envelopes Unsorted results Web portal (from one hospital) About to ring with stat results

6. CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008) % Community 1 Community 2 Community 3

7. BREAKOUT OF CLINICAL USE MEASUREMENT

8. NORTH ADAMS HIE SCREEN SHOT

9. Brockton • Newburyport • North Adams MAeHC ARCHITECTURE AND DATA FLOWS • Benchmarking • Other reporting • P4P • Chart review How to handle consent policy for unanticipated expansion of use, even if it’s legally allowed? • Outcomes analysis Is 5-10% opt-out acceptable for public health and population health? • Encrypted identifiers How to handle physician desire for routine re-identification? • Re-identifiable • Entity-by-entity opt-in consent • (North Adams exception) Are physicians enthusiastically pursuing consent? How to deal with “non-believers” and free-riders?

10. DATA BEING SENT TO THE MAEHC QDC TODAY • Problems • Procedures • Allergies • Medication • Demographics[de-identified] • Social/Family hx if it can be sent in discrete data • Smoking status- if it can be sent over in discrete data • Visits • Diagnosis • Lab results • Rad results • Future[ inpatient data to include surgical history]

11. Records Received By MAeHC QDCThrough May 2009 000 • 437,000 total records since Jul 2008 • 57,000 records received in May 2009 Brockton Newburyport North Adams

12. MAEHC QDC DATA COUNTS (I) Patients Patient visits Brockton Newburyport North Adams Diagnoses Procedures

13. MAEHC QDC DATA COUNTS (II) Problems Lab results Brockton Newburyport North Adams Medications Vaccinations

14. MAEHC QDC LOG-IN SCREENSHOTS

15. MAEHC QDC REPORT SCREENSHOTS Peer comparison report (2) Peer comparison report (1) Benchmark summary report Drill-down report

16. QUALITY DATA CENTER IS BECOMING A “PUBLIC UTILITY” AS WELL AS A COMMERCIAL PLATFORM

17. MEANINGFUL USE INTEROPERABILITY REQUIREMENTS COULD PUSH THE ENTIRE INDUSTRY TOWARD HIE • Lab results delivery • Prescribing • Claims and eligibility checking • Quality & immunization reporting, if available 2011 • Substantially steps up exchange • Provider to lab • Pharmacy to provider • Office to hospital & vice versa • Office to office • Hospital/office to public health & vice versa • Hospital to patient • Office to patient & vice versa • Hospital/office to reporting entities • Registry reporting and reporting to public health • Electronic ordering • Health summaries for continuity of care • Receive public health alerts • Home monitoring • Populate PHRs 2013 • Access comprehensive data from all available sources • Experience of care reporting • Medical device interoperability • Starts to envision routine availability of relatively rich exchange transactions • “Anyone to anyone” • Patient to reporting entities 2015 Meaningful Use objectives requiring health exchange • Increases volume of transactions that are most commonly happening today • Lab to provider • Provider to pharmacy

18. CREATING INFRASTRUCTURE TO FACILITATE MEANINGFUL USE $564 million $598 million Regional Health IT Extension Centers State-level HIE • Non-profit implementation assistance organizations to facilitate meaningful use among “priority primary care providers” • 70 will be set up across the country • 3 cycles of funding • 12/09, 4/10, 9/10 • Awards of $1M to $30M – does NOT pay for hardware, software, or interfaces • Must commit to getting at least 1000 priority PCPs to meaningful use in 2 years • Matching funds required: • Years 1 & 2: 10% • Years 3 & 4: 90% • Each state given planning and implementation grants to implement HIE • 50 awards across the country • Awards announced 12/09 • Awards of $4M to $40M • Managed by States or non-profit state-designated entities (SDEs) • Must implement state plans aligned with federal goals • State-level directories • eligibility and claims • eRX & medication histories • Lab ordering and results • Public health reporting • Quality reporting • Clinical summary exchange • Matching funds required: • FY 2010: 0% • FY 2011: 10% • FY 2012: 25% • FY 2013: 12.5%

19. http://www.maehc.orgMicky Tripathi, PhD MPPPresident & CEOmtripathi@maehc.org781-434-7905