MASSACHUSETTS eHEALTH COLLABORATIVE December 2008

- 1 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MASSACHUSETTS SPENDS MORE ON HEALTH PER CAPITA THAN ALMOST EVERYONE IN THE UNIVERSE… Average spending on health per capita ($US PPP) Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.

- 2 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved....AND WE GET GENERALLY HIGHER QUALITY AS A RESULT, BUT THE COSTS ARE UNSUSTAINABLE

- 3 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO CREATING A DIGITAL DIVIDE IN THE PROCESS 1-9 physicians CAGR = 8.2% % 50+ physicians CAGR = 8.6% 801 million 110 million 911 million visits in 2004 % 50+ physicians 1-9 physicians Growing at about 1.5 percentage points per year Source: CDC; Center for Health Systems Change; National Ambulatory Care Survey

- 4 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE Company launched September 2004 –Non-profit registered in the State of Massachusetts CEO on board January 2005 Backed by broad array of 34 MA health care stakeholders

- 5 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC BOARD OF DIRECTORS Health plans and payer organizations Blue Cross Blue Shield of Massachusetts Fallon Community Health Plan Harvard Pilgrim Health Care Massachusetts Association of Health Plans Tufts Associated Health Maintenance Organization Healthcare purchaser organizations Associated Industries of Massachusetts Massachusetts Business Roundtable Massachusetts Group Insurance Commission Non-voting members Center for Medicare & Medicaid Services Hospitals and hospital associations Baystate Health System Beth Israel Deaconess Medical Center Boston Medical Center Caritas Christi Fallon Clinic, Inc. Lahey Clinic Medical Center Massachusetts Hospital Association Massachusetts Council of Community Hospitals Partners Healthcare Tufts-New England Medical Center University of Massachusetts Memorial Medical Center Governmental agencies Executive Office of Health and Human Services Healthcare professional associations American College of Physicians Massachusetts League of Community Health Centers Massachusetts Medical Society Massachusetts Nurses Association Consumer, public interest, and at-large Health Care for All Massachusetts Coalition for the Prevention of Medical Errors Massachusetts Health Data Consortium Massachusetts Taxpayers Foundation Massachusetts Technology Collaborative MassPRO, Inc. New England Healthcare Institute Massachusetts Health Quality Partners Tufts University Medical School UMass Medical School

- 6 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CEO Operations Contract admin & HR Evaluation coordinator Project Mgmt Data manager Communication MAeHC ORGANIZATION DESIGNED TO SCALE UP FOR STATEWIDE PROGRAM Practice Services Practice consultants Other Legal Evaluation Technology & Vendor Mgt Health information exchange Support Shared services Design, deployment, & support Community coordination Project management Program integrity Program Leader Brockton Program Leader Newburyport Program Leader North Adams More communities

- 7 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. PILOT PROJECT COORDINATION Community Physician Council Privacy & Security Work Group Community Consumer Council Co-Chairs: Senior Pilot Exec & Community Advocate Members: Physicians, Hospital, Consumers Pilot Steering Committee

- 8 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC SELECTED THREE PILOT SITES FROM 35 APPLICANTS: BROCKTON, NEWBURYPORT, NORTH ADAMS

- 9 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC PILOT PROJECT EXPENDITURES $M MAeHC G&A1.73% Professional fees2.96% CPOE readiness4.08% Evaluation5.912% HIE5.912% MAeHC business services 9.819% EHR20.240% $50.4 $M%

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. ACTUAL COST PER PHYSICIAN FOR EHR $K Support (6 mos)2.87% MAeHC support 9.322% EHR software7.918% EHR hardware22.853% $42.8K $K%

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ARCHITECTURE AND DATA FLOWS BrocktonNewburyportNorth Adams Community-level: HIE Outcomes analysis Benchmarking MAeHC-level: Analysis Negotiated reporting to plans P4P Chart review Provider-level: EHR MAeHC-level: QDC

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. FIRST PRACTICE LAUNCHED IN MARCH 2006 Docs link up to new record style By Jennifer Heldt Powell Tuesday, March 14, 2006 The end of the paper trail By Ulrika G. Gerth/ Friday, March 17, 2006 Setting a new record: Local doctors pilot electronic patient history system By Stephanie Chelf Staff Writer

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. OVER 550 CLINICIANS LIVE IN 18 MONTHS # practices North Adams (15) Newburyport (37) Brockton (89)

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CLINICAL USE OF DEPLOYED EHRs % of Encounters Documented Clinically in EHRs (Q – Q2 2008) Community 1Community 2Community 3 %

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CLINICIAN ATTITUDE TOWARD EHRs The EHR system has helped streamline our processes AgreeDisagree Already has Will in the future Our patients are benefiting from new processes Already has Will in the future We are already able to provide higher quality care Already has Will in the future Overall I have already adopted the EHR I would recommend EHRs to other practices n = 195, 2/08 61% % agree 80% 70% 87% 65% 87% 80% 81% 91% 93% The HIE will help streamline our processes Our quality will improve from the HIE

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. STAFF ATTITUDE TOWARD EHRs The EHR system has helped streamline our processes AgreeDisagree Already has Will in the future Our patients are benefiting from new processes Already has Will in the future Overall I have already adopted the EHR I would recommend EHRs to other practices 86% % agree 95% 96% 83% 94% 96% 91% 88% n = 524, 2/08 The HIE will help streamline our processes Our quality will improve from the HIE

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. PILOT COMMUNITIES WILL BE THE FIRST IN THE COUNTRY TO BE COMPLETELY “WIRED” FOR HEALTHCARE Ethel Roy, 81, visited earlier this month with Dr. Stephen St. Clair, her urologist, at his office in North Adams. (Stephen Rose for the Boston Globe)

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC HEALTH INFORMATION EXCHANGE ARCHITECTURE AND STATUS Community Indexes Terminology Entity Clinician Patient Clinical repository Community record Automated delivery services Lab/rad results Hospital reports EHR data Public health On-demand portal services View/download records Secure messaging Electronic referrals Patient communication Forms routing View/download records Physician communication Appointment request Forms routing Physician portal Patient portal Infrastructure Communities Three stand-alone HIEs Over 500K patients ~600 clinicians, 200+ clinical sites 4 hospitals, 1 community health center Systems connected Ambulatory EHRs (eCW, NextGen, GE, Allscripts) Hospital systems (Meditech), including EHR, lab systems, rad systems, transcription systems Data exchanged Problems, procedures, allergies, medications, demographics, smoking status, diagnosis, lab results, rad reports Standards used: HL7, CCR/CCD, NCPDP Script 8.1, LOINC, CPT4, ICD9, RxNorm Transactions to date (as of Nov 2008) Over 60K patients opted-in to date (91% opt-in rate) 300K+ clinical records exchanged to date 20K+ matched patient records in HIE

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. The eHealth Summary: Medication List Problem List Procedures Social History Allergies Past Medical History Family History Lab Results Radiology Results Immunizations Doctor’s Office Record: Private Office Notes Consultation Letters Scanned Reports Non-consented items

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. OPT-IN PERMISSION MODEL Jane Jones Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity 1 Visit YY YY N 2 Patient chooses which entity’s records to make available to network Consent Jane Jones 3 Pre-defined data sent to central server Send Physician views data prior to or during patient visit 4 Retrieve Community Network Jane Jones eCommunity Record June 9, 2006 Visit history xxx Active problem list xxxDr. Jane Brody Current medications xxxSeacoast Cardio Current allergies xxxDr. Jane Brody Recent laboratory results xxxAJ Hospital Recent radiology results xxxAJ Hospital Other xxxXXX

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. NORTH ADAMS HIE SCREEN SHOT

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. NEWBURYPORT & BROCKTON HIE SCREEN SHOT

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. Reason for Access Required:

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. DATA BEING SENT TO THE MAEHC QDC TODAY Problems Procedures Allergies Medication Demographics[de-identified] Social/Family hx if it can be sent in discrete data Smoking status- if it can be sent over in discrete data Visits Diagnosis Lab results Rad results Future[ inpatient data to include surgical history]

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC QDC MEASURES CAD -1- LDL-C test ordered -2- LDL-C level < Lipid-lowering therapy prescribed -4- Antiplatelet therapy prescribed Diabetes -5- HbA1c test ordered -6- HbA1c level <9 -7- BP level <140/ LDL-C test ordered -9- LDL-C level < Eye exam performed 11- Asthma (appropriate Rx prescribed) 12- Hypertension (BP controlled) Common pediatric conditions 13- Appropriate testing for pharyngitis 14- Appropriate treatment for URI 15- Prenatal care (screening for HIV) Prevention 16- Flu vax 17- Pneumovax 18- Colorectal cancer screening 19- Breast cancer screening 20- Tobacco use Phase 1 Measures Phase 2 Measures

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC QDC LOG-IN SCREENSHOTS

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC QDC REPORT SCREENSHOTS Peer comparison report (1) Drill-down reportBenchmark summary report Peer comparison report (2)

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. THE GRID AND THE LAST MILE Inter-community connectivity MA-SHARE Intra-community connectivity

Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. Micky Tripathi, PhD MPP President & CEO