Welcome to the RHIO Revolution The Latest Scoop on the National Discussion OK HIMSS

1. Welcome to theRHIO Revolution! The Latest Scoop onthe National DiscussionOK � HIMSS Jeff DavidDirector of Industry Development, HIMSS

2. Presentation Highlights RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward Welcome to the RHIO Revolution! The Latest Scoop on the National Discussion. As a cornerstone of the government�s plan to modernize the healthcare system, RHIOs are intended to oversee the business processes and policies for healthcare information exchange. Topics Include: What are the underlying dynamics driving the national vision for EHRs, RHIOs and the NHIN (National Health Information Network)? What every RHIO needs to know about the latest Federal initiatives�From ONCHIT and HHS to the unprecedented level of current Congressional activity. HIMSS�s expanding role, both nationally and locally � The HIMSS RHIO Federation. Getting Involved and Moving Ahead. You can�t talk about RHIOs just by themselves � Its how they fit into the larger equation � The Driving Forces The national agenda � the exec branch HHS sec Leavitt Dr Brailer and the Office of�. Because the RHIOs have flowed out of their strategic framework �sepcicaly the second Goal Congress then HIMSS and the RHIO fed -- then some deep thoughts.Welcome to the RHIO Revolution! The Latest Scoop on the National Discussion. As a cornerstone of the government�s plan to modernize the healthcare system, RHIOs are intended to oversee the business processes and policies for healthcare information exchange. Topics Include: What are the underlying dynamics driving the national vision for EHRs, RHIOs and the NHIN (National Health Information Network)? What every RHIO needs to know about the latest Federal initiatives�From ONCHIT and HHS to the unprecedented level of current Congressional activity. HIMSS�s expanding role, both nationally and locally � The HIMSS RHIO Federation. Getting Involved and Moving Ahead. You can�t talk about RHIOs just by themselves � Its how they fit into the larger equation � The Driving Forces The national agenda � the exec branch HHS sec Leavitt Dr Brailer and the Office of�. Because the RHIOs have flowed out of their strategic framework �sepcicaly the second Goal Congress then HIMSS and the RHIO fed -- then some deep thoughts.

3. Presentation Roadmap RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward

4. All Roads lead to�R H I O EHRs no longer stop at the hospital walls. The HIT industry and HIMSS are investing unprecedented time, money and resources into the primary-care E.H.R revolution. The Future is Here, its just not evenly distributed: Davies???!!!! Slide later �You�ve seen one RHIO; You�ve seen one RHIO�EHRs no longer stop at the hospital walls. The HIT industry and HIMSS are investing unprecedented time, money and resources into the primary-care E.H.R revolution.

8. Healthcare is Information Over 90% of the activities that go into the delivery of healthcare are centered around information and information exchange. The CONSUMER is the central object within this Information System. Therefore, clinically-derived �Consumer-Centric, Information-Rich� Electronic Health Records will become the common Nexus of Information for ALL players in the 21st century health system. RHIOs as catalyst for helping the info to flow. Brailer�s Offfice Comes into existence at a time when all of the other pieces are aligned (The Underlying dynamics of the wave ) (Coopetition � the game is changing) (RHIOs are really the new game).RHIOs as catalyst for helping the info to flow. Brailer�s Offfice Comes into existence at a time when all of the other pieces are aligned (The Underlying dynamics of the wave ) (Coopetition � the game is changing) (RHIOs are really the new game).

9. Covering the full spectrum of Careand capturing nearly all transactions At the screen � capturing, for the first time the majority of EVENTS that make up a conusmers HC experience -- because to have a real consumer-centric, information-rich E.H.R you need to capture all of those transactions to create a true moving picture.At the screen � capturing, for the first time the majority of EVENTS that make up a conusmers HC experience -- because to have a real consumer-centric, information-rich E.H.R you need to capture all of those transactions to create a true moving picture.

10. Macroeconomic View:U.S. Healthcare IT Investment However, investment in technology is very different In the ambulatory sector, technology investment is equal to less than 1% of gross revenues while in the acute care sector the level of technology investment is about 5% of revenues�overall healthcare is spending about 2.5% of revenues on IT compared to nearly 4% across all industries.However, investment in technology is very different In the ambulatory sector, technology investment is equal to less than 1% of gross revenues while in the acute care sector the level of technology investment is about 5% of revenues�overall healthcare is spending about 2.5% of revenues on IT compared to nearly 4% across all industries.

11. State of EHR Adoption

12. baskcally the AAFP members are saying they�r either doing E.H.R. or on there way in 12 or 24 � only 11% said �NO, not interested� � GRAIN or Salt: Forrester went deeper and asked them � what do you mean by HER and they go back things like �word-perfect� etc� So obviously there�s confusion --- So I�m giving you this big Grain but at the same time this really is striking because what its really saying is �. Couple years ago �What do I need that for��.now �I know I need to know about this, I�m not really sure what this is, and I�ve heard these a lot going on�baskcally the AAFP members are saying they�r either doing E.H.R. or on there way in 12 or 24 � only 11% said �NO, not interested� � GRAIN or Salt: Forrester went deeper and asked them � what do you mean by HER and they go back things like �word-perfect� etc� So obviously there�s confusion --- So I�m giving you this big Grain but at the same time this really is striking because what its really saying is �. Couple years ago �What do I need that for��.now �I know I need to know about this, I�m not really sure what this is, and I�ve heard these a lot going on�

13. The Value of Interoperability and Electronic Health Records 1/05 C!TL Study1: Standardized, encoded, electronic healthcare information exchange would: Save $337B over a 10-yr implementation period. Plus $78B per year thereafter 9/05 RAND Study2: Widespread adoption and effective use of EMRs and other HIT improvements would: Save $162B annually Potential health and safety benefits could double this. Improve quality and efficiency of the healthcare system.

14. What�s Driving Action? Quality Patient Safety Excess Costs Bio-preparedness Disaster Management HIPAA was also a response to these excess costs � part of the simplification � take costs out Because using computers provide for privacy and security � This was a necessary preamble. President G.W. Bush Just marked Anniversary of Executive Order 13555 HIT mentioned in State of the Union � Two Years Running!! Requested $50M reprogramming for FY2005 and $125M for FY2006 Federal Landscape: Anniversary of Dr. Brailer as National Coordinator for Health IT Secretary of Health and Human Services big proponent Agencies meeting Executive Order requirements HIPAA was also a response to these excess costs � part of the simplification � take costs out Because using computers provide for privacy and security � This was a necessary preamble. President G.W. Bush Just marked Anniversary of Executive Order 13555 HIT mentioned in State of the Union � Two Years Running!! Requested $50M reprogramming for FY2005 and $125M for FY2006 Federal Landscape: Anniversary of Dr. Brailer as National Coordinator for Health IT Secretary of Health and Human Services big proponent Agencies meeting Executive Order requirements

15. Presentation Road Map RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward

16. The Dot.Gov Boom Arrives What Has Happened. The Medicare Reform bill of 2003 was signed into law and included unprecedented HIT legislative provisions.particularly for e-prescriptions from physicians and pharmacy Appropriations for Health IT included $50 million for AHRQ and additional amounts at HRSA, CDC, and TATRC Developed as part of the Consolidated Health Informatics Initiative (CHI), the Department of Health and Human Services (DHHS), Department of Defense (DoD), and the Veteran�s Administration (VA) announced the adoption of uniform standards for the electronic exchange of clinical information across the federal government. HHS purchased a permanent license to the standard terminology �SNOMED Clinical Terms� that will be available free to health care providers and systems nationwide to broadly promote and support dissemination of common clinical data standards. The Federal government sponsored its first ever-national conference on developing and advancing a National Health Information Infrastructure (NHII). U.S. Dept. of Health and Human Services commissioned the Institute of Medicine and Health Level 7 to design a standard EHR functional model that will be broadly diffused across the US health care system at no cost to providers or delivery systems. Healthcare IT and MS: Year Two of A National Priority ----- Everybody Getting Involved President George W. Bush Just marked 1st Anniversary of Executive Order 13555 HIT mentioned in State of the Union � Two Years Running! Requested $50M reprogramming for FY2005 and $125M for FY2006 Federal Landscape: Anniversary of Dr. Brailer as National Coordinator for Health IT Secretary of Health and Human Services -- Big HIT Proponent Agencies Meeting Executive Order RequirementWhat Has Happened. The Medicare Reform bill of 2003 was signed into law and included unprecedented HIT legislative provisions.particularly for e-prescriptions from physicians and pharmacy Appropriations for Health IT included $50 million for AHRQ and additional amounts at HRSA, CDC, and TATRC Developed as part of the Consolidated Health Informatics Initiative (CHI), the Department of Health and Human Services (DHHS), Department of Defense (DoD), and the Veteran�s Administration (VA) announced the adoption of uniform standards for the electronic exchange of clinical information across the federal government. HHS purchased a permanent license to the standard terminology �SNOMED Clinical Terms� that will be available free to health care providers and systems nationwide to broadly promote and support dissemination of common clinical data standards. The Federal government sponsored its first ever-national conference on developing and advancing a National Health Information Infrastructure (NHII). U.S. Dept. of Health and Human Services commissioned the Institute of Medicine and Health Level 7 to design a standard EHR functional model that will be broadly diffused across the US health care system at no cost to providers or delivery systems. Healthcare IT and MS: Year Two of A National Priority ----- Everybody Getting Involved President George W. Bush Just marked 1st Anniversary of Executive Order 13555 HIT mentioned in State of the Union � Two Years Running! Requested $50M reprogramming for FY2005 and $125M for FY2006 Federal Landscape: Anniversary of Dr. Brailer as National Coordinator for Health IT Secretary of Health and Human Services -- Big HIT Proponent Agencies Meeting Executive Order Requirement

17. President Bush Gets IT �Medicine ought to be using modern technologies in order to better share information, in order to reduce medical errors, in order to reduce cost to our health care system by billions of dollars...Within ten years, every American must have a personal electronic medical record. The federal government has got to take the lead in order to make this happen by developing what's called technical standards.� April 26, 2004 Whether you like him or not, I�ll say this He gets IT. We all know the state of the UWhether you like him or not, I�ll say this He gets IT. We all know the state of the U

18. Office of the National Coordinatorfor Health IT (ONCHIT)� David Brailer, of course, gets IT Dr. Brailer�s Priorities Address Standards Achieve Interoperability Initiate Certification Close Adoption Gap Engage Incentives Coordinate Federal Initiatives Encourage Private Sector Leadership Bush Administration FY2006 Budget Request $125M proposed for utilizing technology to improve healthcare $75M for ONCHIT $50M for year 3 of AHRQ grants Bush Administration FY2006 Budget Request $125M proposed for utilizing technology to improve healthcare $75M for ONCHIT $50M for year 3 of AHRQ grants

19. CMS�Mark McClellan gets IT �How do we get the most benefits to the most people for a particular treatment?�Through widespread adoption of Modern HIT�through EMRs with direct links to Federal Agencies, through e-prescribing, through interoperability and standards, through robust data sharing between systems in order to collect Information regarding a Drug�s use in clinical practice and to monitor patient safety� Pres requested $34B decrease in MC Congress said no. MMA stabilization dries up on Sep 30. � so a 30% decrease in reimbursement rates are possible. P4P: demo project underway � preliminary data shows improvement in quality based on electronic submission on Q data. CMS webiste prss release www.cms.hhs.gov Pharm benefit goes live in January E rx Jan 1 also. Doctor�s Office Quality � Information Technology (DOQ-IT) Substantial improvement in quality cannot be achieved without HIT and process redesign Increase adoption and utilization of HIT Assist providers IT adoption decision Implementation and workflow Currently CA, MA, UT, AR Pres requested $34B decrease in MC Congress said no. MMA stabilization dries up on Sep 30. � so a 30% decrease in reimbursement rates are possible. P4P: demo project underway � preliminary data shows improvement in quality based on electronic submission on Q data. CMS webiste prss release www.cms.hhs.gov Pharm benefit goes live in January E rx Jan 1 also. Doctor�s Office Quality � Information Technology (DOQ-IT) Substantial improvement in quality cannot be achieved without HIT and process redesign Increase adoption and utilization of HIT Assist providers IT adoption decision Implementation and workflow Currently CA, MA, UT, AR

20. Agency for Health Research and Quality (AHRQ) $139 million in contracts and grants 5 State-based contracts to develop state-wide networks - $25 million � CO, IN, RI, TN, UT 100 grants to help implement and demonstrate value of IT � Planning, Implementation and Demonstration - $96 million HIT RC � Joy Keeler is exec Driector.HIT RC � Joy Keeler is exec Driector.

21. Secretary Leavitt Gets IT HHS - 60,000 personnel and $503B budget New Visionary leader who is driven! EHR (Electronic Health Record) and NHIN (National Health Information Netword) CHI (Consolidated Health Informatics) Initiative becomes part of Federal Health Architecture Industry Involvement Funding Department of Health and Human Services Secretary Leavitt �Big Proponent of HIT Secretary�s 3 Main Initiatives: Impacting a Cultural Change Toward Wellness Realigning the Incentives Landscape for Patients, Providers,and Payers Healthcare IT drives the numbers 1 and 2 Current Issues of Interest BioSurveillance and BioPreparedness Medicare Pay-for-Performance pilots Medicare E-Prescribing Proposed Regulations Commission on Systemic Interoperability Report (October 2005) ONCHIT Organization Hurricane Relief American Health Information Community Department of Health and Human Services Secretary Leavitt �Big Proponent of HIT Secretary�s 3 Main Initiatives: Impacting a Cultural Change Toward Wellness Realigning the Incentives Landscape for Patients, Providers,and Payers Healthcare IT drives the numbers 1 and 2 Current Issues of Interest BioSurveillance and BioPreparedness Medicare Pay-for-Performance pilots Medicare E-Prescribing Proposed Regulations Commission on Systemic Interoperability Report (October 2005) ONCHIT Organization Hurricane Relief American Health Information Community

22. Response to Hurricane Katrina: The ONCHIT has established KATRINA HEALTH (www.katrinahealth.org) a multi-organization response team that is addressing legal and technical aspects of evacuee registration/information access, field medical records development and deployment, dissemination and communications, as well as privacy, security and authentication components.

23. New York Times � A Good Idea From the Odd Couple Published: May 16, 2005, Editorial �The last thing that's likely to get noticed, amid all this potential for dish, is that the cause this odd couple was promoting in the press conference heard round the world is actually a very good one - the need to drag the health care industry out of the dark ages of scribbled notes and into the modern world of electronic record keeping. It's a position that has strong support among academic experts, business leaders and members of both political parties. Shifting to electronic records that can be viewed by doctors, patients and health insurers not only will make the health care system more efficient, but also should reduce medical errors caused by sloppy records or the failure to communicate effectively.� New York Times � A Good Idea From the Odd Couple Published: May 16, 2005, Editorial The sight of Hillary Clinton and Newt Gingrich locked in political embrace has political Washington swooning. Mr. Gingrich - whom Mrs. Clinton once surely regarded as part of that "vast right-wing conspiracy" - helped orchestrate the defeat of her ambitious health care reform and led the charge to impeach her husband. But lately, he's made flattering remarks about Mrs. Clinton's strength as a potential presidential candidate, and the two have been chummy on a Pentagon advisory panel. Last week, the senator and the former House speaker were standing together to boost passage of a bill to increase electronic record keeping in the health care industry. Trust us, political junkies are going to be chewing on this one forever. Is this part of Hillary's presidential strategy? Newt's yearning to shed his image as a fire-breathing conservative and become a temperate elder statesman? The last thing that's likely to get noticed, amid all this potential for dish, is that the cause this odd couple was promoting in the press conference heard round the world is actually a very good one - the need to drag the health care industry out of the dark ages of scribbled notes and into the modern world of electronic record keeping. It's a position that has strong support among academic experts, business leaders and members of both political parties. Shifting to electronic records that can be viewed by doctors, patients and health insurers not only will make the health care system more efficient, but also should reduce medical errors caused by sloppy records or the failure to communicate effectively. Both Senator Clinton and Mr. Gingrich have a genuine and longstanding interest in health care reform. We hope that they go on to tackle much tougher issues, such as how to finance or restructure the government's major health care programs or how to cover more of the uninsured without bankrupting the federal government. If they can agree on bipartisan solutions there, it really would be the beginning of a beautiful - if peculiar - political relationship.New York Times � A Good Idea From the Odd Couple Published: May 16, 2005, Editorial The sight of Hillary Clinton and Newt Gingrich locked in political embrace has political Washington swooning. Mr. Gingrich - whom Mrs. Clinton once surely regarded as part of that "vast right-wing conspiracy" - helped orchestrate the defeat of her ambitious health care reform and led the charge to impeach her husband. But lately, he's made flattering remarks about Mrs. Clinton's strength as a potential presidential candidate, and the two have been chummy on a Pentagon advisory panel. Last week, the senator and the former House speaker were standing together to boost passage of a bill to increase electronic record keeping in the health care industry. Trust us, political junkies are going to be chewing on this one forever. Is this part of Hillary's presidential strategy? Newt's yearning to shed his image as a fire-breathing conservative and become a temperate elder statesman? The last thing that's likely to get noticed, amid all this potential for dish, is that the cause this odd couple was promoting in the press conference heard round the world is actually a very good one - the need to drag the health care industry out of the dark ages of scribbled notes and into the modern world of electronic record keeping. It's a position that has strong support among academic experts, business leaders and members of both political parties. Shifting to electronic records that can be viewed by doctors, patients and health insurers not only will make the health care system more efficient, but also should reduce medical errors caused by sloppy records or the failure to communicate effectively. Both Senator Clinton and Mr. Gingrich have a genuine and longstanding interest in health care reform. We hope that they go on to tackle much tougher issues, such as how to finance or restructure the government's major health care programs or how to cover more of the uninsured without bankrupting the federal government. If they can agree on bipartisan solutions there, it really would be the beginning of a beautiful - if peculiar - political relationship.

24. Congress too! Frist-Clinton (S. 1262) Murphy-Kennedy (H.R. 2234) McHugh-Gonzalez (HR 747) Stabenow-Snowe (S. 1227) Grassley-Baucus (S. 1356) Jeffords (S. 544) HELP Legislation (S.1356)

25. Presentation Road Map RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward

26. Legislation S. 1355 Better Healthcare through IT Act S. 1262 Health Technology to Enhance Quality Act of 2005 S. 1227 The HIT Act of 2005 S. 1223 IT for Health Quality Act S. 544 Patient Safety and Quality Improvement Act S. 16 Affordable Health Care Act S. 1356 Medicare Value Purchasing Act of 2005 S.1418 The Wired for Healthcare Quality Act H.R. 2234 21st Century Health Information Act H.R. 747 National Health Information Incentive Act of 2005

27. New Caucuses and Coalitions 21st Century Health Care Caucus � 34 members Senate Health Quality Improvement and Information Technology Caucus � 2 members Senate Centrist Coalition � 20 members New Democrats Coalition � 42 members

28. Urge Your Elected Officials to Join Visit http://capwiz.com/himss/home/ 21st Century Caucus (House) � contact Mike Zamore (Rep Kennedy D-RI) or Mike Baxter (Rep Murphy R-PA) Health Quality Caucus � contact Lisa Layman (Sen Stabenow D-MI) or Bill Pewen (Sen Snowe R-ME)

29. The States Currently Tracking 150 HIT Bills Across the Nation in State Legislatures Wisconsin - $10M for HIT loans and grants Connecticut � SB 6557 � Mandatory eRX and EMRs Indiana � SB 566 � Establish Medical Informatics Commission Minnesota � HB 1162 � Establishes HIT Advisory Committee New Mexico � HB 780 � Electronic Health Data Study ARIZONA: HB 2701 (Feb): Medical Error Reporting Governor�s are organizing state initiatives to support HIT adoption AZ HB 2701 Feb introduced: Mandate that Medical errors be reported. AZ HB 2701 Feb introduced: Mandate that Medical errors be reported.

30. ONCHIT and the Four GoalsGoal 1: Inform Clinical Practice Strategy 1: Incentivize EHR adoption Strategy 2: Reduce risk of EHR investment Strategy 3: Promote EHR diffusion in rural & underserved

31. RHIOs = Regional Health Information Organizations NHIN � National Health Information Network CHI = The federal Consolidated Health Infromatics initiativeRHIOs = Regional Health Information Organizations NHIN � National Health Information Network CHI = The federal Consolidated Health Infromatics initiative

33. RFI Responses overwhelmingRFI Responses overwhelming

34. ONCHIT RHIO Comments The definition of RHIOs is "murky to date" Hope to define publish RHIO characteristics this year "Needs to be some official recognition of RHIOs" There may be a need to "accredit" RHIOs so that there is not competing RHIO structures Primary purpose: "harmonize differences in state laws" �Main objective of RHIOs will be to build public trust in health care IT, as well as protect privacy, integrate security techniques and align financial incentives.� While no dominant design for RHIO has yet emerged, �mature proto-types� would be: Regenstrief - Massachusetts -North Carolina And AHRQ�s five-state initiative (CO, UT, RI, IN, TN)

35. June 2005 � New York CityHIMSS SummitSecretary Leavitt announces AHIC To help nationwide transition to EHRs -- including common standards and interoperability Provides input and recommendations to HHS on making health records digital and interoperable, and assuring private and secure records Secretary Leavitt to personally serve as Chairperson. He will appoint up to 17 members Scott P. Serota, President and CEO, Blue Cross Blue Shield Association Douglas E. Henley, M.D., Executive Vice President, American Academy of Family Physicians Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc. Charles N. Kahn III, President, Federation of American Hospitals Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation Steven S Reinemund, CEO and Chairman, PepsiCo Kevin D. Hutchinson, CEO, SureScripts Craig R. Barrett, Chairman, Computer Systems Policy Project E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration Mark B. McClellan, M.D., Administrator, Centers for Medicare & Medicaid Services Julie Louise Gerberding, M.D., Director, Centers for Disease Control and Prevention Jonathan B. Perlin, M.D., Under Secretary for Health, Department of Veterans Affairs William Winkenwerder Jr., M.D., Assistant Secretary of Defense, Department of Defense Mark J. Warshawsky, Assistant Secretary for Economic Policy, Department of Treasury Linda M. Springer, Director, Office of Personnel Management Michelle O�Neill, Acting Under Secretary for Technology, Department of Commerce Scott P. Serota, President and CEO, Blue Cross Blue Shield Association Douglas E. Henley, M.D., Executive Vice President, American Academy of Family Physicians Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc. Charles N. Kahn III, President, Federation of American Hospitals Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation Steven S Reinemund, CEO and Chairman, PepsiCo Kevin D. Hutchinson, CEO, SureScripts Craig R. Barrett, Chairman, Computer Systems Policy Project E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration Mark B. McClellan, M.D., Administrator, Centers for Medicare & Medicaid Services Julie Louise Gerberding, M.D., Director, Centers for Disease Control and Prevention Jonathan B. Perlin, M.D., Under Secretary for Health, Department of Veterans Affairs William Winkenwerder Jr., M.D., Assistant Secretary of Defense, Department of Defense Mark J. Warshawsky, Assistant Secretary for Economic Policy, Department of Treasury Linda M. Springer, Director, Office of Personnel Management Michelle O�Neill, Acting Under Secretary for Technology, Department of Commerce

36. FOR IMMEDIATE RELEASE Contact: HHS Press Office Tuesday, Sept. 8, 2005 COMMISSIONERS SELECTED FOR AMERICAN HEALTH INFORMATION COMMUNITY The Community Will Help Shape the Future of Health Care for Generations HHS Secretary Mike Leavitt today selected 16 commissioners to serve on the American Health Information Community (the Community), a federally-chartered commission charged with advising the Secretary on how to make health information digital and interoperable. The work of the Community will help the country achieve the President�s goal of having most Americans using interoperable electronic health records within 10 years. Patients, doctors, hospitals and insurance companies will have access to vital and confidentiality-protected medical information immediately and efficiently, helping to reduce medical errors, improve quality, lower costs and eliminate paperwork hassle. �The President has set a national goal to move health care from the paper age to the information age, and the American Health Information Community will help guide this transformation.� Secretary Leavitt said. �My aspiration is for the Community to provide stakeholders with a meaningful voice in a federal process that will ultimately shape health care for generations.� Interoperability of health information is a shared goal among health care payers, providers, vendors and consumers. Myriad competitive interests have prevented a unified effort to achieve common standards and interoperability. As a result, health care has lagged behind other industries -- like the banking, transportation, and retail trade -- in realizing the benefits of modern information technology (IT). �From nearly anywhere in the world, we can withdraw money from our bank accounts, pay bills, apply for a mortgage, book airline tickets and even order groceries online,� Secretary Leavitt said. �But, more often than not, we can�t share a X-ray digitally, from one hospital to another, even if they are on opposing street corners. Even worse, if a loved one is involved in a life-threatening accident, paramedics and emergency room doctors cannot quickly check their medical histories for even the most basic things � like blood type or allergies. We can and must do better than this.� The national strategy to confront this problem calls for federal agencies -- that pay more than one third of all health care costs -- to collaborate with private payers in developing and adopting an architecture, standards, certification process and a method of governance for ongoing implementation of health IT. Once the market has structure, patients, providers, medical professionals and vendors will innovate, create efficiencies and improve care. Secretary Leavitt will chair the Community.

37. American Health Information Community (The Community or AHIC): A public-private entity that will advise HHS on specific actions necessary to achieve a common interoperable framework; will serve as a constituent forum First meeting was October 7, 2005: Breakthroughs Identified Consumer Empowerment My PHR, My medication history, My health record locator, and My registration info Health Improvement eRx; Quality Monitoring & Reporting; Chronic Disease Monitoring; Immunization Records; and, an Employee Empowerment Tool Public Health Protection ER Info Network; Bio-Surveillance & Pandemic Surveillance; Adverse Drug Event Reporting & Notification Breakthrough Actions Consumer Empowerment Breakthrough Work Group established Briefings called for on: E-Prescribing Quality Monitoring & Reporting Additional Work Groups TBD

38. ONCHIT RFPs ONCHIT I: �Standards Harmonization� -- Harmonize industry-wide health IT standards� development ONCHIT II: Certification � Evaluate/launch a conformance certification process for HIT ONCHIT III: NHIN Prototypes -- Create six prototypes of a national health information network (NHIN) ONCHIT IV: Privacy and Security -- Assess and develop plans to assess business policy and state laws that affect privacy and security practices

39. HHS Health IT Strategy

40. ******

43. ******

44. **********

45. Compliance Certification(ONCHIT-2) Update

47. Privacy and Security(AHRQ 05-0015) Update

49. Subject Matter Experts National Governor�s AssocSubject Matter Experts National Governor�s Assoc

50. Contacts for ONCHIT RFPs: General: Carla Smith at csmith@himss.org HITSP: Michelle Maas Deane at mmaasdeane@ansi.org CCHIT: Mark Leavitt, MD mleavitt@himss.org Privacy & Security: Holt Anderson at holt@nchica.org

51. Industry Transformation The �tipping point� has arrived! Why?

52. The Tipping Points President Bush Secretary Leavitt Dr. Brailer ONCHIT/AHRQ RFPs 13 (and counting) pieces of legislation New Congressional Caucuses & Coalitions Increased federal funding Significant State Activity

53. Presentation Highlights RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward

54. Getting involved:The RHIOs and HIMSS ROLE�ROLE�

55. HIMSS role� We�re not the wave itself. We�re not a Healthcare Provider. We�re not a technology Vendor. We�re not a government agency. Yeah, we have this huge conference, but that�s not what we really are. We are a collaborative national association in the midst of this wave -- and for the involved members of this Society we are,more than anything else�

56. "Americans of all ages, all conditions, and all dispositions constantly form associations. They have not only commercial and manufacturing associations, in which all partake, but associations of a thousand other kinds--religions, moral, serious, futile, general or restricted, enormous or diminutive� �Where at the head of some new undertaking you see the government of France, or a man of rank in England, in the United States you will be sure to find an association.� Alexis de Tocqueville , 1835 Applies to both HIMSS and RHIOs To really �get� HIMSS�s unique role as the HIT industry�s not-for-profit national Association (and the role that payers can assume as new stake-holders in this vertical) please allow me just 120 seconds to take you through a quick history of HIMSS and how we got the unique industry position we hold today. 1831 Alexis de Tocqueville scholar, statesman, philosopher: travels to the US and later writes in �Democracy in America� One of the most quoted, to this day, psychoanalysis of America, American Life, and the Soul and spirit of the people here..To really �get� HIMSS�s unique role as the HIT industry�s not-for-profit national Association (and the role that payers can assume as new stake-holders in this vertical) please allow me just 120 seconds to take you through a quick history of HIMSS and how we got the unique industry position we hold today. 1831 Alexis de Tocqueville scholar, statesman, philosopher: travels to the US and later writes in �Democracy in America� One of the most quoted, to this day, psychoanalysis of America, American Life, and the Soul and spirit of the people here..

57. History of HIMSS � in 90 Seconds: Cleveland, 1899: Eight Hospital superintendents convene to discus healthcare management and the �economy and efficiency� of the underlying processes and systems. They form an association that eventually becomes the AHA (American Hospital Association). 1961 � 1966, H M S S: �Hospital Management Systems Society� formed within AHA by a subgroup concerned with refocusing AHA efforts on its original vision of advancing the underlying systems and processes to improve healthcare. 1986 � 1993, The �i�s have it: Healthcare IT emerges as an industry vertical � HIT community finds it home in HMSS. The �I� is added, and the �H� is changed from �hospital� to �healthcare� -- the name is officially changed to �HIMSS�. HIMSS separates from AHA. HIMSS�s membership and activities, including the Annual Conference, �explode� in size. Stage is set for today�s HIMSS and its role in transformation of Healthcare through HIT�

58. We, in fact, collaborate so well that the other organizations wind up joining us. We, in fact, collaborate so well that the other organizations wind up joining us.

59. Finally, one single, unified national society

60. HIMSS = 15,000 individuals, 45 chapters, & 260 corporations You�ll see this slide is a graphical representation of the organization. It will take all of HIMSS to achieve this End State. Just to use a few examples, our website has to be robust, our publications providing very timely knowledge, research being at the forefront; HIMSS needs to represent all the communities that will make the End State possible; and, we need to advocate a number of issues to realize the End State. Once we began discussing an End State, we began thinking about the components necessary to achieve the End State. Think of them as sort of Key Agendas that must be completed before the End State can be realized. To take us through that discussion, we�ve created a graphic to help.You�ll see this slide is a graphical representation of the organization. It will take all of HIMSS to achieve this End State. Just to use a few examples, our website has to be robust, our publications providing very timely knowledge, research being at the forefront; HIMSS needs to represent all the communities that will make the End State possible; and, we need to advocate a number of issues to realize the End State. Once we began discussing an End State, we began thinking about the components necessary to achieve the End State. Think of them as sort of Key Agendas that must be completed before the End State can be realized. To take us through that discussion, we�ve created a graphic to help.

61. RHIO Federation Overview Launched October 21, 2005

62. RHIO Federation Objectives Set realistic expectations for interoperable health information in the United States Create and disseminate tools to foster successful exchange of health information Conduct research that identifies best-of-breed, emerging themes and documents outcomes of RHIO execution Connect the people who are tasked with executing RHIOs, as well as connecting the RHIOs themselves with payers, life sciences, vendors, consultants, policy-makers, and clinicians � everyone has a stake in the game

63. RHIO Federation Membership Any RHIO or HIE effort can join for free HIMSS members can participate in the task force to develop deliverables Organizational Membership being developed for organizations that want to join the HIMSS RHIO Federation and are not HIMSS Members

64. RHIO Federation Key Focus Business Rules Chain of Trust Harmonization

65. Top-Down/Bottoms-Up Clear fit with HIMSS strategic plan Recommendation developed by HIMSS volunteers Unanimous support from HIMSS Board of Directors and Executive Management HIMSS recognized as practical guide for HIT issues & voice for HIT community Strong Alignment with Chapters Leverage HIMSS�s unique position as a national leader with grass-roots membership in all 50 states�

66. Current HIT Interoperability Efforts:Its time for a Federation!

67. The federal health IT strategy envisions creating a secure and standards-based �network of networks�

68. RHIO Development Challenges RHIOs require local cooperation Without RHIOs, local competition restricts interoperability Lack of Local Visionaries and Evangelists

69. RHIO Development Leadership Encourage Local Chapters to Develop RHIOs Train and Certify  - RHIO Coordinators - Interoperability Technicians - Security Professionals Provide Support for Development Efforts - Develop �How To� Documents  - Provide Involvement of National Experts

70. RHIO Definition A Regional Health Information Organization (RHIO) is a multi-stakeholder organization that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. At its heart, RHIOs are about INFORMATION SHARING

71. Presentation Highlights RHIO Revolution Overview: What are the underlying forces driving this new national vision? The Latest on the National Agenda: Who�s involved and why? The President, HHS, ONCHIT, CMS, and Congress The HHS and Congressional initiatives: What every RHIO needs to know HIMSS�s Important Role Announcing the HIMSS RHIO Federation! Getting Involved Moving Ahead: Leadership, ROI, and The Way Forward

75. �I'm Not Bad,I'm Just Drawn that Way�

76. The EHR Adoption Deadlock

77. Getting the Wheels Turning

79. Finally, a lesson from the 1930�s NY World�s Fair� The city of tomorrow will be designed and flourish under the theme of� �UNITY Not UNIFORMITY� We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction. - Bill Gates We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction. - Bill Gates

80. Questions?Contact Jeff DavidHIMSS Director ofIndustry Development(734) 973-6116 x104jdavid@himss.organd visit www.himss.org

81. Questions