Colleen Woods Health IT Coordinator State of New Jersey March 7, 2012 Connecting Patients to a Greater State of Health

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) 2

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,

1.Electronic Health Records (EHRs) 2.Health Information Organizations (HIOs) 3.Health Information Network (HIN) Payment Transformation Delivery of Care Transformation Health Information Technology Transformation 4

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. 5

* 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: Commonwealth Fund International Health Policy Survey of Primary Care Physicians Percent reporting at least 9 of 14 clinical IT functions* Adoption of health information technology (IT) among primary care practices is highly variable across countries, with the United States lagging well behind other nations 6

Source: 1.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 New Jersey (31%) has a lower percentage of physicians potentially able to meet meaningful use core criteria when compared with national average *Also includes office-based physicians who have EHR system capabilities to support eight Stage 1 Core Set meaningful use objectives New Jersey (16%) has the lowest percent of physicians in the country using any EMR/EHR system 7

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State Data Sources: Immunizations Medicaid Blood Screening Bio surveillance DMV Demographics Other registries Health Entity Directory Web Services Registry Provider Directory (supporting DIRECT) Provider Credentialing Certificate Authority NJHIN Core Services State Gateway Services Relay Service (External Queries) Patient Discovery & Document Exchange Statewide Data Aggregation GATEWAY NJHIO Nodes Pt Discovery & Document Exchange Gateways HIO-level MPI HIO-level Record Locator Consent Mgmt (interim) DIRECT Services Security Compliance Surescripts & Labs NJHIN Onboarding Security Compliance 9

MOHIE Bayshore Community Hospital Community Medical Center Jersey Shore University Medical Center Kimball Medical Center K. Hovnanian Children’s Hospital Monmouth Medical Center Ocean Medical Center Riverview Medical Center Southern Ocean Medical Center FQHC - Monmouth Family Health Center Hudson Health-e-cITi-NJ Newark Beth Israel Medical Center St. Michael’s Medical Center East Orange General Hospital Meadowlands Hospital Christ Hospital University Hospital St. Joseph’s Healthcare System Jersey City Regional Medical Center FQHC - Newark Community Health Center Jersey Health Connect Atlantic Health Morristown Memorial, Overlook, Newton CentraState Children's Specialized Hospital CJHIEP (Physician Organization) Hackensack University Medical Holy Name Medical Center Hunterdon Healthcare JFK Health System Parker Memorial Home (LTC) Robert Wood Johnson University Hospital Robert Wood Johnson – Hamilton Robert Wood Johnson- Rahway Saint Barnabas Medical Center Saint Clare’s Health Services Saint Peter’s Healthcare System Somerset Medical Center Trinitas Regional Medical Center Camden Cooper Lourdes Virtua Underwood Kennedy FQHC – Camcare / Project Hope Trenton Health Team Capital Health System St. Francis Medical Center City of Trenton FQHC - Henry J. Austin Health Center IDNs AtlantiCare Regional Medical Center Barnabas Healthcare System South Jersey Health System Virtua Health Atlantic Bergen Burlington Camden May Cumberland Essex Gloucester Hunterdon Middlesex Morris Ocean Passaic Salem Somerset Sussex Warren Cape Union Monmouth Mercer 10

Use Case NameDescription 1. Medication History Patient medication histories are made available for Emergency Room admissions only. This Use Case will include the Cross Community Patient Discovery (XCPD) Profile to support accurate patient identification. 2. Public Health Data (Immunization Data) To provide patient immunization history directly to the physician EHR. The State registry connection will be direct to the physician EHR. 3. Diagnostic Results Available to All HIO Customers To provide patient laboratory test and radiology images results (later Use Case will address the Order side as well as open order/pending result). This Use Case will include the radiology report and not the image. 4. ED/Acute Discharge Summary The transfer of patient information in the form of discharge notes to the PCP or specialists at the time of discharge. Near term – ED/Acute Hospital discharge information only. 5. Transition of Care- Referral Information This Use Case is to enhance communications between PCP and specialist with an opportunity to use “Direct” as a near-term way to conduct secure exchange of health information. 11

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2014: EHRs for All New Jerseyans We envision a New Jersey Health IT environment by 2014 where all NJ consumers have a secure electronic health record that includes all health related information and services (including behavioral health & addiction services)!

EHR Adoption MetricActualTargetVariance% Physicians (MDs and DOs) Using an EHR system at Any Practice Location 8,33026,81918, % Total Hospitals Adopting EHRs % 14

Medicare EHR Incentive Payments Provider Type Provider Count Medicare Incentive Payment Amount Eligible Professionals 87215,696,000 Eligible Hospitals925,835,214 Total: $41,531,214 NJ Medicaid EHR Incentive Payments Provider Type Provider Count Medicaid Incentive Payment Amount Eligible Professionals 1202,542,917 Eligible Hospitals3137,277,985 Total: $39,820,902 As of 2/18/

Health-e-cITi Camden Jersey Health Connect Trenton MOHIE Stages of Health Information Organization Development Stage 1Stage 2Stage 3Stage 4Stage 5Stage 6Stage 7 StartingOrganizingPlanningPilotingOperatingSustainingInnovating Stage 4: Well under way with implementation - technical, financial and legal. (Pilot project or implementation with multiyear budget identified and tagged for a specific need) Stage 5: Fully operational health information organization; transmitting data that is being used by healthcare stakeholders.

Almost 2,000 Physicians Sharing/Exchanging Data within a NJ HIO or IDN 48 Hospitals Members 16 Hospitals Exchanging Data within a NJ HIO or IDN

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Camden Coalition Catholic Charities of Trenton Behavioral Health Information Collaborative Bergen Regional Medical Center/CAMCare The Nicholson Foundation NJAMAA Subcommittee Participation 19

Medicaid Waiver Programs are providing a combination of both traditional medical services as well as non-medical services to those who meet both the established clinical and financial criteria EMR system being purchased for State Institutions Administrative Service Organization for the Management Behavioral Health Care Organization (ASO/MBHO Model) 20

HIPAA Consent for Sensitive Data For Example: All patients are auto-connected to the hospital via a Personal Health Record Initial consent is either “all in” or “all out” Once in the PHR, the patient can: Manage granularity of sensitive data Assign relationships to physicians See who has looked at their record 21

2012: Moving from Local to Statewide HIOs Continue Implementing Connect HIO to HIO Integration of BH and CH New Jersey SHARE State Health Access and Records Exchange

Phase 4: Framework Design Financial Sustainability Medicaid Incentive Program and Meaningful Use Stage 1 NJHIN Planning Use Case Development #1-5 Legislation and Regulation = Completed Phase 7: Personal and National Disease Management Syndromic Surveillance Full EHR Adoption Connect NHIN Interstate Exchange Meaningful Use Phase 3 Phase 1: Strategy Planning Funding Request Strategic Planning Organizational Structure Phase 5: Implementation Implement Financial Sustainability HIO Trust Agreements Establish NJHIN HIO Connection Research pilots PHR Focus SHARE (State HIO) Phase 6: Focus on Exchange Data Exchange and Analytics State HIO State Health Registries Long term Care Integration Behavioral Health Integration Meaningful Use Stage Q2-Q Q4 – 2012 Q4 Phase 2: Planning Funding Governance HIO Initial Build Policies Initial Stakeholder Outreach Operational Plan State Medicaid HIT Plan Consumer & Stakeholder Outreach EHR Adoption Enabling New Jersey Health Information Exchange Enabling New Jersey Health Information Exchange Phase 3: Foundation Standing Up Regional HIOs Architecture & Standards Quality Measures Legal Framework Use Cases for Care Coordination 2011 Q1 Q Q2 –Q4 23

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