Advanced Health Information Exchange : Ready for Meaningful Use and Beyond Keith Hepp, CFO and VPO of Business Developme

1. Advanced Health Information Exchange :Ready for Meaningful Use and BeyondKeith Hepp, CFO and VPO of Business Developmentkhepp@healthbridge.org

2. HealthBridge HIE • One of the nation’s largest and most successful community health information exchanges (HIE) • In operation since 1997 • Secure, electronic health information exchange for Greater Cincinnati-Northern Kentucky tri-state area + business and technical operations for 4 other HIEs • Combined Network includes 50+ local hospitals, 7500+ physicians in Kentucky, Ohio and Indiana • Delivers more than 3.2 million clinical messages PER MONTH; nearly 30 million messages for 2010

3. Collaborative HIE Network

5. Meaningful Use & HIE What do you need to know to get paid? What is required?

6. MU Definition Meaningful use (MU) is defined as: • Use of a certified Electronic Health Record (EHR) • Electronic exchange of health information • Quality reporting

7. MU = Health Care Transformation Technology Quality reporting Clinical Decision Support Improving care coordination Engaging patients Managing Population Health Meaningful Use Quality Improvement Practice Redesign Exchange

8. HIE Best Practices Phases

9. New Projects & New Capabilities

10. Greater Cincinnati Beacon Collaboration • Goal: Provide funding to communities to strengthen health IT infrastructure and exchange capabilities and achieve measurable improvements in health care quality, safety, efficiency, and population health. • Funding: $13.75 million award to Cincinnati • Awarded: Sept 1, 2010 • Length of Initiative: 30 month initiative • 60 Days for Planning; Implementation over 28 mos.

11. Beacon Community Programs – 17 nationwide

12. Greater Cincinnati Beacon Collaboration • Two Demonstration Projects • Pediatric Asthma – led by Cincinnati Children’s • Adult Chronic Disease – led by Health Improvement Collaborative & Greater Cincinnati Health Council • Six (6) Health IT & Exchange Enhancements • Led and implemented by HealthBridge • Core Infrastructure - New MPI and Repository • ER-Inpatient Alerts, Disease Registry, Summary Record Exchange, REL Data • Rigorous Evaluation and Performance Measurement • Performedby UC, CCHMC • Evidence of improvement to drive payment reform GCBC support is provided under cooperative agreement 90BC0016-01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services .

13. Opportunity to Address • Incomplete Knowledge of Diabetes and Asthma Care Quality • Data exists in silos – need more complete data for improvement • No single health system, hospital or practice has complete view of patient care • Many gaps in information, data sharing only partially electronic • Preventable ER visits: • Patients need appropriate primary care rather than emergency care • Hospital Readmissions: • Hospitals will be challenged on reimbursement for readmissions – big financial impact • Patients need appropriate primary care to prevent readmission • Transitions in Care: • PCP lacks information from patient’s hospital visit • Specialists lack most current information from PCP • Hospitals need updated list of patient meds for medication reconciliation

14. Diabetes Data Flow HealthBridge Longitudinal Registry Enhancement WellCentive Practice Registry Some EHR/EMR (e.g. EPIC, Centricity) Nightly Data Flow ETL 21 Sites Hospital lab and clinical data Manual Data Entry Some Paper Based ETL Data from OHA Clinical Data Repository HealthBridge Monthly Snapshots 6-8-12 month lag to validate accuracy Monthly Reports Ad Hoc Alerts

15. Future Plans – 2011-12 • REC - Expanded Meaningful Use Assistance for Stages 1-3 • Beacon - Enhanced Suite of Quality Improvement, Care Transformation and Accountable Care Services and Tools (Registries, Data Analytics, Summary Patient Records, etc.) • PHRs - Connectivity to Personal Health Records and Other Patient Engagement Technologies (IN Challenge Grant) • HIE Expansion – • Assist new providers to connect for continuity of care (home health, AAA, etc.) • Spread of Advanced Technologies to Other Communities • Connect with other HIEs and Provider Networks (IN, KY) • Use Nationwide Health Information Network (Nw-HIN) Direct and Connect platforms •

16. Nw-HIN Connectivity Bidirectional Connectivity EHRs HB Nw-HIN HUB Mirth Direct Connect Gateway Mirth Connect Mirth Match Summary Record Exchange (C-32) Community Use Cases Nw-HIN Use Cases Emergency Dept Lookup Transitions in Care SSA Disability Eligibility CMS C-HIEP CDC Public Health Lab Project State HIE Connectivity PHR Connectivity

17. Data Protections • Data exchange for “physician of record” easy • Data use conforms with applicable laws on privacy and security and BAAs already in place with HIE participants. • Data is NOT be released to the public. • Data exchange primarily for improving patient treatment. • Limited data sets for improvement work (diabetes, asthma related data) and limited time frame (for next 28 months) • For practices participating in a Beacon improvement cohort, only aggregated, de-identified data will be reported quarterly to the Office of the National Coordinator • No provider or patient level detail available reports that come from data warehouse and analytics engine.

18. Dr. Stanley Fortson, EVP Oncology Hematology Care Marty Larson, Founder CCHIE, Executive Director, GDAHIN