Presented By LeRoy Jones – Chief Executive January,

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3 GSI’s Primary Area of Focus GSI Health is a healthcare solution provider and system integrator, focused on healthcare information technology (HIT)  Enabling provider-to-provider data exchange and delivery  Enabling public-health reporting by provider entities  Facilitating analytic reporting on healthcare data  Delivering composite solutions from complementary vendor application offering

About GSI/Core Competencies Healthcare Information Exchange (HIE) National healthcare IT standards development leadership System Integration of heterogeneous partner solutions Software Architecture & Development Focused on Interoperability Standards-based Solutions Data-Driven Quality Assurance Experts Federal, State, Regional, and Private Clientele 4

GSI’s Approach to the HIE Market GSI Health has a multi-pronged approach to the HIE market based on enablement, operation, and meta- knowledge. Products – We have HIE infrastructure components that we are able to layer into other pre- existing solutions, or use as a self- contained platform for data exchange. Services – We are a full-service consulting company that assists organizations, and the industry at large, effectively implement health information exchange. We have an emphasis on standards-based systems integration. Partnering – We have been very successful in transitioning our clients into partners, and finding synergies among even competing organizations that lead to strong solutions. Partnering Products Services True Interoperability is Multi-Pronged 5

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What is Meaningful Use? The Department of Health & Human Services defined a multi- stage, expanding definition of what constitutes a “meaningful user” of electronic health record (EHR) technology 7

What is Meaningful Use? Stage 1 The Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information. For Stage 1, which begins in 2011, there will be 25 objectives / measures for Eligible Providers and 24 objectives/measures for eligible hospitals. In 2011, EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to submit aggregate clinical quality measure numerator, denominator, and exclusion data to CMS or the States by attestation. Stage 2 Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. These changes will be reflected by a larger number of core objective requirements for Stage 2. 8

What is Meaningful Use? Stage 3 Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes. Determination for these criteria are still TBD, based on progress of previous stages.

Meaningful Use Core Set Eligible Providers – 15 Core Objectives Computerized physician order entry (CPOE) E-Prescribing (eRx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information

Meaningful Use Core Set Eligible Hospitals –14 Core Objectives CPOE Drug-drug and drug-allergy interaction checks Record demographics Implement one clinical decision support rule Maintain up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Report hospital clinical quality measures to CMS or States Provide patients with an electronic copy of their health information, upon request Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request Capability to exchange key clinical information among providers of care and patient-authorized entities electronically Protect electronic health information

Standards for Interoperability Meaningful use regulations stipulate a raft of standards and corresponding sources for implementation guidance, which is likely to dominate all discussions of standards for some time to come The standards expressed generally cover Content (HL7 CDA R2 CCD, ASTM CCR, NCPDP Script v8.1, HL [PH Labs], HL /2.5.1 [PH Surveillance/Immunizations], CMS PQRI XML) Vocabulary (ICD9-CM, CPT4, SNOMED CT 2009, LOINC v2.27, RxNORM, HL7 CVX – Vaccines Administered, OMB Race/Ethnicity codes) Privacy / Security (NIST FIPS Pub for encryption, FIPS Pub hashing SHA-1, audit trail items) Transport standards (SOAP, REST) were expunged in Final Rule 12

MU Sucked the Air Out of the Room …Phase 2 will, hopefully, be more controlled Phase 1 created frenzy… Providers rushed to learn how they could get their share of the Federal $$ Vendors rushed to pledge MU allegiance so they could get their share of the providers’ $$ Vendors rushed to release the MU versions of their software HIEs bolted it on as an organizing principle 13

Meaningful Use Stakeholder Interplay 14

Meaningful Use Federal Government Activities 15 Federal Government Primarily through the efforts of CMS and the Office of the National Coordinator, regulation and programs launched to spur both industry and government to adopt standards for interoperability, to define functionality floors for EHRs, and to deploy functional connected clinical systems

The Direct Project vs. NHIN Exchange 16

Certification Programs HHS has released rules for both temporary and permanent product certification, detailing how organizations may become certifiers or certifiers of certifiers 17

NIST Testing Infrastructure NIST has a number of test profiles published to demonstrate compliance with MU standards 18

Many Tangential Gov’t Initiatives Launched… 19

Meaningful Use State Government Activities 20 Many States have already explored statewide information exchanges, either through support of regional projects, or supplying centralized infrastructure for connecting clinical systems, though financial sustainability is elusive, but now have embraced the ONC State HIE efforts

Statewide HIE Accomplish State HIEs in five easy steps: 1. Write and submit State Strategic and Operational Plans for HIE 2. Release RFI/RFP for technology partner selection 3. Convene governance and oversight groups for rollout 4. Design Statewide system 5. Build out and rollout 21

Meaningful Use Vendor Activities 22 Vendors had been participating in the various programs from ONC as demonstrations, but now have gotten serious about incorporating the tenets of meaningful use into released products

Where Do I Fit in the Health Information Exchange Ecosystem? 23 Provider / HIE Directory Message Routing RLS / MPI Consent Mgmt. Centralized Shared Service Provider Event Notify Portal Regionally-Sponsored Services Lab Order & Result transactions eRx transactions ID Mgmt. / Auth. Lab Order & Result transactions eRx transactions Point of care solution (e.g. – EHR, HIS) Point of care solution (e.g. – EHR, HIS) Multi-Transport (SOAP, SMTP, etc.) Bi-Directional Initiation (Push, Pull) Secure transport over public internet (e.g. TLS) Multi-Transport (SOAP, SMTP, etc.) Bi-Directional Initiation (Push, Pull) Secure transport over public internet (e.g. TLS) Leverage of established national networked services (e.g. – connection with national labs) Leverage of established national networked services (e.g. – connection with SureScripts) Other National or Regional Services Federated Core Service Med Mgmt PH Reporting Centralized Core ServicesValue-Added Services Federated Core Service

Meaningful Use Provider Activities 24 Providers as a group have largely been recipients of the current wave of industry changes, and now are evaluating technology adoption as the critical players in the clinical transformation

Meaningful Use Payer Activities 25 Payers have not been strongly at the interoperability table with the meaningful use government activities, except in various payment reform initiatives, such as pay for performance pilots, and patient centered medical homes. CMS as the largest payer serves as a model for the private payers, and will be the vehicle for EHR incentive payments

My Conclusion… Because of the work of the previous administration, this administration has been able to move more quickly toward realizing production interoperability There is still some “wait and see” sentiment in the vendor community which should dissipate as the standards and certification picture gets clearer 2011 can be a breakout year if we see vendor product releases that support widespread interoperability 26

Questions/Discussion Welcomed… LeRoy E. Jones 27