Overview 2017 Updated: July 18, 2017

Table of Contents Slides 3 – 13: About Healthix Slides 14 – 26: Healthix Services Slides 27 – 32: Healthix Integration Models Slides 33 - 35: Uses of Healthix Data Slides: 36 – 39: Patient Consent Slides that need updating monthly with latest stats: 5,9,12,15,37 (7,13,39)

About Healthix Statistics SHIN-NY Role of Healthix Solutions Sources of data & Types of data Timeline Participants

Largest Public HIE in the Nation More than 16,000,000 patients Healthix contains data from healthcare organizations throughout New York City and Long Island. Healthix uses sophisticated software to reconcile data of over 58 million provider Medical Record Numbers (MRNs) to create composite profiles of over 16 million patients.

Healthix Monthly Statistics (June 2017) About Us 46 Million inbound clinical messages 206,000 Real-time clinical alerts 121,000 Patient Summary Documents Shared (CCDs) Healthix Monthly Statistics (June 2017) Healthix is the largest public Health Information Exchange (HIE) in the United States Supplies secure data to improve healthcare quality, efficiency and effectiveness Provides a range of clinical information in real-time Facilitates care coordination Hundreds of healthcare organizations at more than 1,500 facilities across New York City and Long Island participate in Healthix.

Healthix and the SHIN-NY The SHIN-NY is composed of 8 HIEs or Qualified Entities (QEs). The NYS DOH establishes common services, privacy and security policies, and technical standards for interoperability. When a user queries for patient data, Healthix automatically returns data from both Healthix and the SHIN-NY.

Role of Healthix in Exchanging Information SHIN-NY PRIVATE HIEs PRIVATE HIEs INCLUDE: Health Plans Large Provider Systems PPS Pharmacies More eHealth exchange and SHIEC 450 Participants ~ 1,500 Facilities HEALTHIX

Providing Solutions, Adding Value Coordinated Care: Complete View of Patient Real-time Intervention at the Point of Care Determine Risk and Provide Actionable Data 1 2 Opportunity for a Richer Patient Portal 3 4 BETTER OUTCOMES COST EFFICIENCY HIGHER SATIS-FACTION

Sources of Data In development The breadth of data in Healthix is expanding in the number and type of contributors In development Hospitals Independent Physician Practices of All sizes Long-term Care, Nursing Facilities Behavioral Health Facilities Federally Qualified Health Centers (FQHCs) Community Based Organizations Home Care EMS 63 213 123 57 35 30 21 Medicaid Claims Health Plans PPS Leads Medicaid Health Homes Independent Pharmacies Independent Labs & Radiology Centers NYC Correctional Health Services All Other Public HIEs in New York State Veterans Administration 13 9 3 5 2 1 7

Types of Data Demographics (Name, Gender, DOB, Race, Ethnicity, Language) Allergies Medications Medication Allergies Smoking Status Immunizations Encounters Observations Vital Signs (Hgt, Wgt, BP, BMI) Pharmacy Fill Data Lab Tests, Values / Results Radiology Reports / Images Other Diagnostic Results Diagnoses Problem Lists Procedures Functional / Cognitive Status Care Plans / Team Members Discharge Instructions /Clinical Summaries Advanced Directives In development Care Plans eMOLST EMS Run Sheets Image Exchange Medicaid Claims Data Social Determinants of Health

Timeline: Growth & Milestones 2007 ALL RHIOS certified as QEs . All receive funding from HCRA to cover increase participation, utilization, provide core services and connect through SHIN-NY NYCLIX merges with LIPIX to form HEALTHIX and other RHIOS outsource their IT operations to NYeC 6 different RHIOS establishe d in NYC and Long Island NYS DOH AWARDS HEAL NY GRANTS: $28M to 13 organization s in NYC and Long Island HEALTHIX Receives Grant to form RHIO named NYCLIX PATIENT DATA PATIENT DATA HEALTHIX insources its IT resources HEALTHIX merges with BHIX 2005 2006 New York State starts SHIN-NY 2012 2013 2014 2015 2016 PATIENT DATA 2008

Healthix Participating Organizations More than 1,500 facilities across New York City and Long Island To see list of participants and what data they http://healthix.org/directory

Over 450 Geographic Coverage Healthcare Organizations with more than 1,500 facilities Across New York City and Long Island

Healthix Services Healthix Portal Delivery of Clinical Summaries Clinical Event Notification Direct Messaging Predictive Analytics

Healthix core services JUNE 2017 USAGE Patient Record Search: Access to a more comprehensive patient profile Statewide Delivery of Clinical Summaries: Ability to push clinical summaries (CCD, C-CDA) and lab results Clinical Event Notifications (CENs): 24/7 Custom alerts provide real-time updates for patients in care Direct Messaging: Secure HIPAA-compliant messaging Predictive Analytics: Assessing risk and managing patients to optimize care PATIENT RECORDS SEARCHED VIA PORTAL NA CLINICAL SUMMARIES DELIVERED 121,524 CENs SENT TO: ALL CLINICAL PROGRAMS 125,900 CENS SENT TO: PUBLIC HEALTH (NYSDOH) 80,188 DIRECT MESSAGES SENT 12,226

Patient Search HEALTHIX PORTAL Search by Demographics Search by MRN Patient Summary Screen

Patient Search

Patient Search by Demographics Name plus 2 other fields then hit search

Patient Search by MRN

Patient Summary Screen Side Menu Shows Data Available

Clinical Event Notifications Workflow Current Offerings Future Offerings

Clinical Event Notification Workflow

Clinical Event Notifications: NOW Current Functionality Subscription file All patients Rule-based IP admission/discharge ED admission/discharge SNF admission/discharge Incarceration/release from NYC jail Patient expiration (death) Frequent ED notifications at time of encounter Healthix Clinical Message Center (Portal) HL7 v2 MDM interface Method of Subscription Trigger Method of Notification

Clinical Event Notifications: FUTURE Future Functionality Subscription file All patients Rule-based Method of Subscription Trigger Method of Notification Complex CEN, change in patient condition Real-time notification of readmission (configurable) Frequent ED Visits – Detect at time of encounter Detect receipt of clinical notes and notify PCP Detect duplicate CT scans real-time Detect when prescription is filled or not Augment information in notification: diagnosis, recent encounters CEN digests – summary Detect receipt of clinical notes and notify PCP

Predictive Analytics Population Health Management Acute Patient Care Management Market Share & Volume Analysis DEMO/TRAINING: http://healthix.org/analytics/

Predictive Risk Scores Population Risk Models Patient History Patient Risk of Event or Outcome Risk Model Development Multivariate Statistical Modeling – Decision Tree Analysis Machine Learning (predicts future 12 months) Predicted future cost Risk of inpatient admission Risk of emergency department (ED) visit Risk of acute myocardial infarction (AMI) Risk of asthma Risk of cerebrovascular accident (CVA) Risk of congestive heart failure (CHF) Risk of COPD Risk of diabetes Risk of hypertension Risk of mortality Event Based Risk Models (predicts future 30 days) Risk of 30 day readmission Risk of 30 day ED re-visit 1000s of Patient Features Age Gender Geography Income Education Race Diagnoses Procedures Chronic conditions Visit and admission history Outpatient medications Vital signs Lab orders and results Radiology orders Social characteristics Behavioral characteristics

Healthix Integration Methods Standard Integration Single Sign On EHR Integration Flags Hub Models HIE to HIE

Integration methods Standard Integration Single Sign-On EHR Integration Flags Hub Model Integrations HIE to HIE

EHR Integration Flags FLAG Green Yellow Red Consent YES NOT GIVEN N/A Data NO New Data

Patient data : Green Message on Mouse Over Consent Status: Yes External Data: Yes New Data: : Yes Message on Mouse Over

Patient data: Yellow Message on Mouse Over Consent Status: Not Given External Data: Yes New Data: : N/A

Patient data: Red Message on Mouse Over Consent Status: N/A External Data: No New Data: N/A Message on Mouse Over

Uses of Healthix Data

to facilitate care management uses of Healthix data to facilitate care management Accessing Patient Data in an Emergency Situation Managing Patients with Serious Medical Conditions using Clinical Event Notifications Providing Transition of Care Documents for Physicians Supporting Secure Direct Messaging Between Providers Providing Alerts for Frequent Users of ED (3+ visits in 30 days) Facilitating Research using De-identified Data Connecting PPS Leads and Partners IN DEVELOPMENT Delivering Alerts from Health Plans to Providers re: Gaps in Care

to improve public health uses of Healthix data to improve public health Supporting Persons with HIV/AIDS Providing Data for Emergency Patient Search (NYCEPS) Helping in Public Health Outbreaks (e.g. Zika, Legionella) Improving Health of Uninsured - Action Health NYC

Patient Consent

patient consent & engagement 3,854,060 HEALTHIX UNIQUE PATIENT CONSENTS GRANTED 18,553 PROVIDERS WITH ACCESS TO PATIENT DATA AS OF MAY 2017 Consent to a Single Participant Organization Healthix Community Consent One-to-One Exchange Supporting Patients’ Access to their Health Data IN DEVELOPMENT Working with Employers to Increase Access and Consent for Employees

State Policies Healthix and State Policy governs how providers and patients engage in health information exchange, and how they access patient information Compliance with policy facilitates data sharing across RHIOs Obtaining Consent Consent Audit, User Audit Password Strength / Failed Attempts User Roles, Patient Notices SAMHSA / Sensitive Data Re-disclosures http://healthix.org/who-we-are/healthix-policies/

Patient Gives “Provider Consent” data 450 Participants ~ 1,500 Facilities data Provider queries data from all sources Patient Gives Consent HEALTHIX Provider receives CENs of events at all sources Patient

Contact Us If you have questions, would like to see a demonstration or are interested in connecting with Healthix Your Name 646.000.0000 yourname@healthix.org