Agenda

1. Interoperability: Progress through Unprecedented CollaborationCharlene Underwood, MBADirector, Government and Industry Affairs, SiemensChairperson, HIMSS Electronic Health Record Vendors AssociationHIMSS Annual ConferenceSan DiegoFebruary 12, 2006

2. Agenda • A Word About EHRVA • Interoperability: A Brief History • Progress Based on Collaboration • A Suggested Roadmap • What We’re Doing

3. HIMSS EHRVABackground • Formed in 2004 • All major EHR suppliers • Large and small companies serving ambulatory and acute care provider organizations of all types • Key initiatives to support accelerated EHR adoption • Certification • Interoperability • Membership is open to HIMSS corporate members who design, develop and market EHRs in the US HIMSS EHRVA collectively serves the majority of healthcare providers in the US

4. * * Acquired by Allscripts January 2006

6. 1970’s Financially-driven HIT with basic clinical function. 1980’s Increasingly complex clinical applications requiring more timely data sharing. HL7 emerges as Standard Development Organization. 1990’s Evolving EHR functionality demands integration among disparate applications. DICOM sets precedent as single standard for diagnostic imaging in Radiology and Cardiology. 2000’s Growing public awareness of HIT importance increases pressure for seamless interoperability. Government drive to interoperable EHRs and IT based healthcare transformation. Interoperability: A brief history

7. Interoperability: A Definition • Interoperability means the ability of health information systems to exchange and use healthcare information within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities. HIMSS 2006

8. Interoperability Goals • Work together to agree on interoperability standards. • Include our customers in the decision making process. • Simplify access to EHR Vendors for government, standard development organizations and other associations. • Move quickly using incremental approaches to improve product availability by using tight execution and reuse of existing standards. • Promote industry collaboration, standards planning, and convergence.

9. Essential Factors to Achieving Goals • Adoption of a single set of interoperability standards. • Ability for standards to support multiple levels of sophistication, now and in the future. • Ability to introduce advancements in standards incrementally, while assuring backward compatibility with current implementations. • Processes for profiling and testing standards must be sustainable over time.

10. Interoperability Strategies • Collaboration • Leadership • Commitment • Community

11. Collaboration • Interoperability Collaborative: HIMSS EHRVA, IHE and HL7 • Promote and demonstrate interoperability • Accelerate work towards a single set of standards • Communicate to all stakeholders • Technical • Non-technical • Policymakers • Vendors: Interoperability Roadmap • Built on available standards and / or promote the need for new / harmonized standards • Specify, test, and demonstrate interoperability in IHE

12. 2014 Goal for National EHR Use 2006 EHR Demonstration Projects Consumer & Population Connectivity Interoperability Roadmap Consensus Incorporates broader NHIN InitiativesVersion 2 – 01.06 2006 Interoperability RoadmapV2 Publication IHE Connectathon RHIOConnectivity Single Standard Harmonization Begin HL7 convergence of CCR into CDALaunch of HL7 Version 3 Interoperability Prototypes Gain Ground 2005 Interoperability Collaboration Formation HHS Award of NHIN Demonstration Project contracts Provider toProvider Connectivity Gulf States RHIO Initiative Reprioritization of National HIT Goals: Interoperability a necessity for emergency response 2005 Hurricane Katrina Interconnect Clinicians to Share Data Inter Enterprise Connectivity 2005 AHIC Formation Launch of Patient Care Coordination Domain 2004 HHS/ ONC Strategic Framework Interoperability Roadmap Launch Incremental interoperability approach established Version 1- 01.05

13. HL CDACRS, CCD HL CDARad Report HL CDAAnest., Pediat. HL V2, V3Pub. Health Rep. HL V2, V3Patient Admin HL ConsentDocs HL CDALab & Path HL CDA+PDF, TIFF HL V3Meds, Pt Care HL V3 Meds,Orders, Lab HL7 Reference Information Model IHE LabRT WF CDC. Impl. Guide IHEXDS-Sc IHEXDS-MS IHE PIX, PDQ IHE DynQ Med-All-Pb IHEXDS-Lab IHE Axs Consent ePrec. NPRM IHEXDS-I IHEXDS-zz IHE CT,ATNA, XUA IHETransact IHE XDS EHRVA Interoperability RoadmapFully specified Interoperability Roadmap with Integration Profiles and Standards Security and Identity Persistent Info Documents Dynamic Information Access Workflow Quality Clinical Content Quality & Public Health Reporting Notifications (ePrescribing, Lab Ordering etc.) HIT to HIT Systems Clinical Specialties Radiology Scanned Document Medical Summaries Patient and Provider ID Mgmt Access Control Medications Lab Results Problems Allergies EHRVA Roadmap Dynamic Information Document Sharing Transactions Management Resource LocatorServices HIT Systems to NHIN Internet EHRVA Interoperability Roadmap at : www.ehrva.org

14. Leadership • Responded to NHIN RFI with EHRVA Interoperability Roadmap V1 • Presented vendor consensus and commitment to achieve V1 roadmap to Dr. Brailer at HIMSS 2005 • Included as part of response to ONC RFP for NHIN demo projects • Used in EHRVA response to ONC after Katrina disaster • Updated and expanded in January 2006 • Broadening collaborative input

15. Commitment • Increased member leadership and involvement in standards processes • HL7 (EHR TC, Board, Advisory Groups) • ASTM, HL7 balloting • Health Information Technology Standard Panel (HITSP) • Supported launch and leadership of IHE Patient Care Coordination Domain • ACP, AEP, AAFP, nursing, vendors • Planning and Technical Chairs • Close coordination with HL7 to develop Care Record Summary implementation guide • Member Education

16. Commitment • Leadership and participation in HIMSS Interoperability Showcase • Planning Chairs • Nearly half EHRVA members implemented the IHE cross-enterprise sharing of medical summaries • Structured data for meds, allergies and problems • Sponsorships and other support

17. Community • Hurricane Katrina Response • Accelerated roadmap to support providers and evacuees • Offered free software and discounted support to affected practices • Ongoing evaluation of roadmap based on experience and NHIN input • Support of AHIC and ONC initiatives • Through contribution to the success of HITSP, CCHIT and NHIN prototypes

18. 2014 Goal for National EHR Use • Five Years from Now…Transformation! • Personal Health Records • Physician-to-Patient communications • Peer-to-Peer interaction • Quality measures & Pay-for-Performance • Population health management • Biosurveillance • Two Years from Now… • Interoperable EHRs: practices, hospitals, labs, imaging & pharmacies • Interactive patient information exchange • 2006 • EHRVA • Interoperability RoadmapV.2 • HIMSS • IHE RHIO Demo • NHIN Demo • Projects • Now… • EHR upswing • Lack of connectivity: hospitals, labs & pharmacies • Reliance on paper-based information • 2004-2005 • HHS/ ONC • Strategic • Framework • AHIC • Hurricane Katrina • Interoperability • Collaborative

19. The Future: Delivering on the Value Promise • Outreach and education • AHIC and legislators • Physician organizations • Provider IT executives • Support national interoperability efforts • Community (AHIC) breakthrough areas • HITSP harmonization efforts and use cases • Global standards planning and harmonization efforts • Deliver interoperable EHR components for the NHIN demo projects • Real-world implementation of interoperability • Work with RHIO projects to leverage EHRVA Interoperability Roadmap