Colleen Woods Health IT Coordinator State of New Jersey June 8, 2012

1. Connecting Patients to a Greater State of Health New Jersey Health Information Technology Colleen Woods Health IT Coordinator State of New Jersey June 8, 2012

2. The Condition of Healthcare • The Population is Aging (Baby Boomers) • Nursing, Physician and Other Clinical Shortages • More than 51% of the US Population’s healthcare is financed in some way by tax dollars (Medicare, Medicaid, Charity Care, Government Employees, Armed Services, Firefighters, Police, Teachers, Etc…) • Healthcare IT adoption is 12 years behind other industries • Today’s healthcare information network for sharing clinical information is connect via phones and fax • In New Jersey 60 – 70% of providers are still using paper-based medical records (NJHA Estimate)

3. “Where Wisdom Lives” David Brooks New York Times Columnist “The average 56-year-old couple pays about $140,000 into the Medicare system over a lifetime and receives about $430,000 in benefits back. The program is also completely unaffordable. Medicare has unfinanced liabilities of more than $30 trillion. The Medicare trustees say the program is about a decade from insolvency. “ – New York Times, Monday June 6, 2011

4. Healthcare Transformation Payment Transformation Delivery of Care Transformation Health Information Technology Transformation Electronic Health Records (EHRs) Health Information Organizations (HIOs) Health Information Network (HIN)

5. Seeing Results Primary Care Practices of Better Health Greater Cleveland Practices that use electronic health records saw significantly higher achievement and improvement in meeting standards of care and outcomes in diabetes than practices using paper records. --NEJM, September 1, 2011 • Nearly 51% of patients in EHR practices received care that met all of the endorsed standards. • Only 7% of patients at paper-based practices received this same level of care– a difference of 44%. • After accounting for differences in patient characteristics between EHR and paper-based practices, EHR patients still received 35% more of the care standards.

6. Primary Care Practices with Advanced Electronic Health Information Capacity by Country Adoption of health information technology (IT) among primary care practices is highly variable across countries, with the United States lagging well behind other nations Percent reporting at least 9 of 14 clinical IT functions* * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 1. 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians

7. Percentage of Office-Based Physicians planning to apply for Meaningful Use Incentives* New Jersey (31%) has a lower percentage of physicians potentially able to meet meaningful use core criteria when compared with national average New Jersey (16%) has the lowest percent of physicians in the country using any EMR/EHR system *Also includes office-based physicians who have EHR system capabilities to support eight Stage 1 Core Set meaningful use objectives • Source: • CDC/NCHS, National Ambulatory Medical Care Survey • Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2010, and Preliminary 2011 State Estimates

8. Jersey Health Connect (McKesson RelayHealth) • Hospitals: • CentraState Medical Center • Children's Specialized Hospital • Clara Maass Medical Center • Hackensack University Medical Center • Holy Name Medical Center • Hunterdon Medical Center • JFK Medical Center • Morristown Memorial Hospital • Newton Memorial Hospital • Overlook Hospital • Robert Wood Johnson University Hospital (New Brunswick, Hamilton, Rahway) • Saint Barnabas Medical Center • Saint Clare's Hospital (Denville Campus, Dover General, Sussex) • Saint Peter's University Hospital • Somerset Medical Center • Trinitas Regional Medical Center • Physicians • Summit Medical Group • Central Jersey HIE Project (CHIEP) • Long Term Care • PARKER • Health-e-cITi-NJ (IGI Health / ORBIT) • Hospitals: • Christ Hospital • East Orange General Hospital • Jersey City Medical Center • Meadowlands Hospital Medical Center • Newark Beth Israel Medical Center • Saint Michael's Medical Center • St. Joseph's Hospital (Paterson, Wayne) • UMDNJ-University Hospital • Federally Qualified Health Centers: • Newark Community Health Centers, Inc. • Newark Homeless Health Care • Horizon Health Center • North Hudson Community Action Corporation Health Center • Metropolitan Family Health Network • Home Health • Visiting Nurse Association of Central Jersey HIOs/IDNs Sussex Passaic Bergen Hudson Essex Morris Union Somerset Warren Hunterdon Middlesex Monmouth Mercer • Trenton Health Team (Covisint) • Public Health Department • City of Trenton • Hospitals: • Capital Health Regional Medical Center • Capital Health Medical Center – Hopewell • St. Francis Medical Center • Federally Qualified Health Center: • Henry J. Austin Health Center, Inc. Ocean • MOHIE (ICA) • Hospitals: • Bayshore Community Hospital • Community Medical Center • Jersey Shore University Medical Center • Kimball Medical Center • Monmouth Medical Center • Ocean Medical Center • Riverview Medical Center • Southern Ocean Medical Center • Federally Qualified Health Center: • Monmouth Family Health Center Burlington Camden • Camden (Noteworthy) • Hospitals: • Cooper University Hospital • Kennedy University Hospital (Turnersville, Cherry Hill, Stratford) • Lourdes Medical Center of Burlington County • Our Lady of Lourdes Medical Center • Underwood Memorial Hospital • Virtua Hospital (Berlin, Marlton, Memorial, Voorhees) • Federally Qualified Health Centers: • CAMcare Health Corporation • Project Hope, Inc. Gloucester Salem Atlantic Salem Cumberland Cape • Integrated Delivery Networks • Hospitals: • AtlantiCare Regional Medical Center (Atlantic City, Mainland Campus) • South Jersey Healthcare (Regional Medical Center, Elmer Hospital) May www.nj.gov/njhit

9. NwHIN, Health Plans Conceptual Technical Architecture Full Operation • NJHIN • Onboarding • Security Compliance State Gov’t HIO • State Data Sources: • Immunizations • Medicaid • Blood Screening • Bio surveillance • DMV Demographics • Other registries GATEWAY • Health Entity Directory • Web Services Registry • Provider Directory • (supporting DIRECT) • Provider Credentialing • State Gateway Services • Relay Service (External Queries) • Patient Discovery & Document Exchange • Statewide Data Aggregation NJHIN Core Services Certificate Authority Health-e-cITi Camden Trenton Health Team MOHIE Jersey Health Connect Surescripts & Labs Physician Office IDN Hospital Nursing Home EMS EMS Home Health • NJHIO Nodes • Pt Discovery & Document Exchange Gateways • HIO-level MPI • HIO-level Record Locator • Consent Mgmt (interim) • DIRECT Services • Security Compliance Hospital Nursing Home Health System Physician Office

10. Participants and HIO Activity * * Physicians in these hospitals access data within their own hospitals only www.nj.gov/njhit

11. Clinical Data Exchange

12. Hospital EHR Adoption www.nj.gov/njhit Source: EHR Incentive Program Registrations and NJHA survey

13. NJ Primary Care Physicians by County County Health Rankings 2011

14. Physician EHR Adoption BME: New Jersey Board of Medical Examiners AAMC: Association of American Medical Colleges, Estimate SK&A: Research Vendor County Health Rankings, NJ-HITEC www.nj.gov/njhit

15. $130.4+ mil. in EHR Incentives Paid in NJ • Total EHR Incentive Program Registrants: • Eligible Professionals = 5,884 • Eligible Hospitals = 57 www.nj.gov/njhit CMS, June 5, 2012

16. Benefits to PCP Lessons Learned • Highest utilizers of HIOs – office staff, medical records staff, nurse practitioners • Real cost savings seen in the administrative processes – referrals, prior authorization • Communication with the patient • Point of care reminders • PCP’s who have EHR’s now want HIE www.nj.gov/njhit

17. Lessons We're Learning • HIE to HIE and the NJHIN – slow • Trust agreements – difficult • Implementation – climb the wall, reenergize • Moving closer to the “tipping point” • New focus on accuracy • Consent – a bear • Integration/Interoperability – hard • Collaboration is vital! www.nj.gov/njhit

18. Questions? Reference: www.nj.gov/njhit