Health Information Technology Meeting April 28, 2009

1. Health Information Technology MeetingApril 28, 2009 KANSASCITY BI-STATE HEALTH INFORMATION EXCHANGE (KC-BHIE)

2. Objectives and Desired Outcomes Why did this project/organization begin? • KC-BHIE is the outcome of discussions between HIE organizations for several years • Founding organizations include: • CareEntrust • KC CareLink • Kansas City Quality Improvement Consortium • Meetings began with MARC regularly last September when local HIEs were ready to pursue a holistic view of health information exchange • The above HIEs currently operate in complementary areas • Minimize the number, cost, and complexity of connections among health care entities • All entities expressed a desire to leverage our highly successful HIE assets in a collaborative manner to benefit our region

3. Objectives and Desired Outcomes • What has this project accomplished to date? • Discussions regarding goals, experiences and lessons learned • Researched national and regional HIE activities • Drafted a Roadmap for the development of a Regional HIE to become a community network focused on improving patient health • Information sharing and understanding • Created matrix which details current scope and breadth of founding organizations • Individual entities have accomplished much for the region

4. CareEntrust • Have provisioned 100K of the 107K+ covered lives to date • 17 HIPAA business associate contracts generating 43 data sources and 66 data interfaces • System contains clinical, claims (procedure and medications) and consumer/patient-entered information • Over 4M transactions processed and available within the system today • Is an operational not-for-profit and the first employer-sponsored health information exchange (HIE) in the country • Charter: the delivery of an electronic health record system to providers and consumers to improve the safety, quality and efficiency of care • Went production-live in May 2007:

5. KC CareLink KC CareLink is a non-profit electronic health information exchange linking health care providers in our bi-state community • Hospitals, clinics, FQHCs, Health Departments and Specialty Referral Networks use KC CareLink to exchange clinical data in the Kansas City community. • Within the 190,000 patient records, our database reflects that over 25% of the patients sought care at multiple locations. • Our referral software is relied upon to coordinate patient care within and across provider organizations. • The community relies on our available, secure services to make thousands of referrals each year. • KC CareLink has proven that it eliminates duplicate efforts and services while improving care quality and reducing cost. • Our technology foundation can support significant continued growth.

6. Kansas City Quality Improvement Consortium • Formed in 2000 to Build a Forum for Health Practitioners to: • Encourage an Opportunity for Best Practice and Community Health Status Improvement • Participate in Creating a Process for Broadly Inclusive Best Practice Implementation • Recognized by: • HHS as the Missouri/Kansas Chartered Value Exchange • Robert Wood Johnson as an Aligning Forces for Quality Grantee • What KCQIC has done: • Provide Quality Data Reporting to PCPs in the KC Bi-State Region • Performed Patient Satisfaction Surveys for over 700 PCPs • Provided Patient Advocacy Leadership Summit Focused on Faith Based Community • Sponsored Bi-State Kid’s Congress for Health • Developed Kansas City Clinical Guidelines for Asthma, Hyperlipidemia, & others

7. Recent KC-BHIE Participants • Missouri Primary Care Association represents twenty-one Federally Qualified Health Centers in Missouri • Organized association-wide quality and performance improvement requires expedited data collection and reporting • Data Warehouse project is a tool to enable collection, reporting, and limited research and benchmarking for better/best practices • Community Care Link • Access and Coordination of Services for 12 Agencies serving more than 3,000 clients • MAACLINK • The Mid America Assistance Coalition (MAAC) has developed MAACLink, an innovative software system, as a tool for more effective community collaboration and improved client services across many social service agencies

8. Objectives and Desired Outcomes • What is planned for the future? • Expand stakeholder participation • Complete the Roadmap, which is the comprehensive development Plan for KC-BHIE • Host an Educational Conference for all Kansas City stakeholders • Support ARRA related initiatives including enabling physician EMR selection, implementation and connectivity • $300M for Health Information Exchanges shared across all states

9. American Recovery and Reinvestment Act (ARRA)Carrots, Sticks and the Rules • KC area provider incentive potential (starting in 2010) • Hospitals: up to $11M over 3 years • Physicians: up to $44K over 3 years • Medicare Reimbursement Penalties • Starts in 2015 • Payments reduced by: • 1% for 2015 • 2% for 2016 • 3% for 2017 and beyond (could increase up to 5%) • Rules: Must meet all three requirements to get ANY incentive payments: • “Meaningful use” of certified EHR technology • Information exchange to improve the quality of care • Reporting on clinical measures

10. Coverage • What is the scope of the project? • KC-BHIE is a shared services infrastructure with a modularized deployment of services - a technology network to connect HIEs • Examples include: • Physician portals with clinical and claims based information • Patient portals – patient health record • Referrals • Quality and disease reporting • Research • Public health • Administrative services (Each of the above examples are available today by one or more HIEs) • What is out of scope? • As a community collaborative, there are no services out of scope.

11. Constituents • MAACLink • Community CareLink • CareScope What entities including type are involved in the scope of this project? • Additional operational HIEs have joined the discussions since we began meeting last year and now have the following active data exchange organizations participating: • KC CareLink • CareEntrust • KC QIC • MO PCA • Include public advocacy groups, providers, hospitals, payers, etc. Other groups expressing interest in attending weekly meetings include: • Saint Luke’s Health System, Truman Medical Centers, National Council on Alcohol and Drug Dependence, Kansas University Hospital, Medical Society of Johnson and Wyandotte Counties • KC-BHIE is a logical choice to create a seamless connection to further health information exchange in the Kansas City region due to the breadth of existing relationships

12. Governance Structure What is your governance structure? • To be finalized based on experiences of other successful HIE organizations across the country What areas/entities are represented? • Hospitals, Medical groups, Local HIEs, Social Service and Behavioral Health Organizations • Seeking other key stakeholders and content experts to lead the organization Do you have plans to change this structure in the future? • Expand participants • Formalize roadmap

13. Data What data elements are currently being captured and exchanged across the facilities? • In the Kansas City metropolitan area, HIE networks including CareEntrust, KCQIC, KC CareLink, MAACLink, MO PCA and Community CareLink are internally exchanging health information such as:

14. Data Did you start with a subset of data and facilities? • Each organization focused on a set of data and facilities that met the requirements of the organizations that participate in their network What data elements are you planning to exchange next? • Our goal is to link together our current networks so that we are exchanging patient data between each network • This will create a metropolitan area Health Information Exchange • The participation of more provider organizations can provide an even greater reach across the Kansas City metropolitan area

15. Time Line What are the future milestones and schedule for the project? • Complete roadmap • Mission and Vision Statement • Key Principles • Governance • Legal • Finance • Technology • Host a local educational conference • Identify and apply for national and local grants

16. Time Line • What are specific dates for milestone completion? • Complete Layout of Roadmap – 6/30/09 • Mission and Vision Statement – 6/30/09 • Key Principles – 6/30/09 • Complete Other Components of Road Map • Technology – 9/30/09 • Governance – 11/30/09 • Finance – 1/31/10 • Legal – 3/31/10 • Host a local educational conference by 6/30/09 • Identify and apply for national and local grants - on going

17. Project Approach What steps are being taken to accomplish the work effort (i.e. planning, analysis, etc.)? • Participate in KC-BHIE weekly meetings • Create subgroups to develop specific roadmap components • Leverage skills of participating groups to complete tasks

18. Technical Approach & Reason • What technology solution is being planned/implemented? • The anticipated solution is a standards-based platform with inter-operable plug-and-play components • This solution will facilitate the participation of multiple vendors How did the team determine this technology solution? • We are in the process of forming the sub-group team that will identify the appropriate technology solution

19. Technical Approach & Reason • What are the benefits to this technology solution? • Flexibility is our core technical architecture goal • New capabilities need to be easily added in an incremental manner as needs evolve • Standards-based: maximize connectivity and financial incentive compliance under federal program requirements What are the disadvantages to this technology solution? • We will better understand the disadvantages once we have agreed upon a technology solution

20. Lessons Learned What lessons did the project team discover? • HIEs are stronger together- Connecting existing assets is a strong foundation on which to build • Cooperation leads to leveraging our experiences and strengths in understanding policy, process and operational issues • Clinical adoption is challenging • Buy-in comes at different speeds • Understanding stakeholder needs is essential • Process change and organization/user adoption are much harder than technology design

21. Lessons Learned What things has the team done well that the team would recommend to others who are starting or are already on this path? • Leveraged our experiences and individual expertise • Openness and frank understanding of participants business goals What challenges has the team faced? • Each HIE has faced their own challenges and overcome them in order to be operational What advice does the team have for others who are starting or are already on this path? • There are no shortcuts