Beacon Community Program Build and Strengthen – Improve – Test innovation Beacon-EHR Vendor Full Affinity Group July 19, 2013

Full AG Roll call – Lynda Rowe Update on Beacon Transport Pilot Progress – Chuck Tryon/Lynda Rowe/Bruce Wiegand/ Lou Della Posta/Daniel Thomas/Kim Chaundy HeatheWay Presentation Discussion/Questions – Greg Dengler Wrap up/Next Steps – Chuck Tryon Today’s Goals 1

Beacon Pilot Progress Tulsa – In Progress Working on developing pilot option 9+ as well as the details behind numerator denominator calculations Mississippi – In Progress Discussions in progress with Allscripts around pilot options, call scheduled for 10:00am Monday 7/22 South East Michigan – In Progress Went online with one Allscripts practice this week using XDS.b as the transport mechanism in an effort to work toward eHealth exchange – Looking to add an additional Allscripts practice in the next week as well In reference to User Story 2b, SE Michigan is working with Success EHS to pilot PIX and XDS.b Query & Retrieve, with automatic triggers to query our MPI and XDS.b repository to retrieve a longitudinal CDA Keystone – Not Able to Run Pilots at This Time RIQI – In Progress Pilot: ToC: CEHRT to an HIO/HIE/HISP - Query by Provider B – Currently: data is being sent from Provider A, Blackstone Valley, and it is being stored within the HIE (discrete data and the document itself). – To be completed as soon as next week: Quantifying view of the data by Provider B. WNY – In Progress Direct accounts have been established for Elmwood and staff training has commenced on the use of Direct . Mirth is working on the automation process, in the meantime Neva will send files to Elmwood. Go live is planned for 07/23 with Direct function to be implemented shortly there after. 2

Possible Pilot Scenarios Pilot # Query OR Push Provider A Transport Method Certified Transport Entity Transport Method To Provider B C-CDA Generation MU 2 Metric Reporting Description Pilot 1 PushDirect (SMTP + S/MIME) EHR TechnologyTransport is directly from provider A Provider A EHR EHR Supports all aspects of DIRECT Transport Pilot 2 PushAny Edge Protocol HISP /HIE/HIODirect (SMTP + S/MIME) HISP/HIE/H IO HISP/HIO/ HIE HISP/HIE/HIO must be certified to the TOC objective, i.e. support The Direct Applicability statement/produce a C-CDA Pilot 3 PushAny Edge Protocol EHR module Certified with Associated HISP/HIO (relied upon software) Direct (SMTP + S/MIME) EHR Vendor and relied upon software EHR vendor + relied upon software must meet MU2 criteria Pilot 4 PushDirect (SMTP + S/MIME)+ XDR/XDM EHRTransport is directly from provider A Provider A EHR Same as Pilot 1, except adding the optional XDR/XDM transport Pilot 5 PushAny Edge Protocol HISP /HIE/HIODirect (SMTP + S/MIME)+ XDR/XDM HISP/HIE/H IO HISP/HIO/ HIE HISP/HIE/HIO must be certified to the TOC objective, i.e. support The Direct Applicability statement/produce a C-CDA

Possible Pilot Scenarios Pilot # Quer y OR Push Provider A Transport Method Certified Transport Entity Transport Method To Provider B C-CDA Generation MU 2 Metric Reporting Description Pilot 6 PushAny Edge Protocol EHR module Certified with Associated HISP/HIO (relied upon software) Direct (SMTP + S/MIME)+ XDR/XDM EHR Vendor and relied upon software EHR vendor + relied upon software must meet MU2 TOC criteria Pilot 7 PushSOAP + XDR/XDM EHR – Must be certified for optional SOAP transport Transport Directly From Provider A Provider A EHR EHR Hosted SOAP + XDR/XDM Pilot 8 QuerySOAP + XDR/XDM EHR – Must be certified for optional SOAP transport Any Transport via an HIE/HIO/HISP Provider A EHR HISP/HIO/H IE Content may be repackaged by HISP/HIO for provider B Pilot 9 Push OR Query Any TransportHIO as an eHealth Exchange participant Query or push to provider via eHealth Exchange certified protocol Provider A EHR HIO eHealth exchange participant HIO must be a certified eHealth Exchange participant Pilot 10 QueryAny Certified Transport CEHRT natively or with relied upon software None- Query basedProvider A EHR HIO/HIE/HI SP Provider A must be using CEHRT

Vendor Pilot Options 5 PilotSendReceive BeaconVendorBeaconVendor 1: Direct - EHR vendor complete certification Crescent City, Tulsa,SE MISuccess EHS (not yet in production) Cincinnati, Inland NW, RIQI, Tulsa, UtahNextGen UtahVitera Crescent City, SE MI, TulsaSuccess EHS 2: Direct - HIE/HIO/HISP modular certification Inland NW, ? Tulsa & KeystoneGreenwayCincinnati, Inland NW, RIQI, Tulsa, UtahNextGen Cincinnati, Inland NW, RIQI, Tulsa, Utah NExtGenUtahVitera UtahViteraCrescent City, SE MI, TulsaSuccess EHS Crescent City, SE MI, TulsaSuccess EHS Keystone, Southeast MI, WNY, Utah (Pro Only) AllScripts (Pro & Ent.) To HIO Keystone, Southeast MI, WNY, Utah (Pro Only) AllScripts (Pro & Ent.) Need HISP 3: Direct - EHR vendor + relied upon software Cincinnati, Inland NW, RIQI, Tulsa, Utah NExtGenCincinnati, Inland NW, RIQI, Tulsa, UtahNExtGen UtahVitera UtahVitera Crescent City, SE MI, TulsaSuccess EHS Keystone, Southeast MI, WNY, Utah (Pro Only) AllScripts (Pro & Ent.) Need HISP Keystone, Southeast MI, WNY, Utah (Pro Only) AllScripts (Pro & Ent.) Need HISP 4: Direct + XDR/XDM - EHR vendor complete certification Not Technologically Feasible at This Time 5: Direct + XDR/XDM - HIE/HIO/HISP modular certification Inland NW, ? Tulsa & KeystoneGreenwayCincinnati, Inland NW, RIQI, Tulsa, UtahNextGen Cincinnati, Inland NW, RIQI, Tulsa, Utah NExtGen UtahVitera Crescent City, SE MI, TulsaSuccess EHS Keystone, Southeast MI, WNY, Utah (Pro Only) AllScripts (Pro & Ent.) To HIO Keystone, Southeast MI, WNY, Utah (Pro Only)AllScripts (Pro & Ent.) Need HISP

Vendor Pilot Options 6 PilotSendReceive BeaconVendorBeaconVendor 6: Direct + XDR/XDM - EHR vendor + relied upon software Cincinnati, Inland NW, RIQI, Tulsa, Utah NextGenCincinnati, Inland NW, RIQI, Tulsa, UtahNExtGen Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) Need HISP Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) Need HISP 7: SOAP + XDR/XDM - Push from EHR to EHR Inland NW, ? Tulsa & KeystoneGreenway (XDS & XDR) Inland NW, ? Tulsa & KeystoneGreenway (XDS & XDR) Cincinnati, Inland NW, RIQI, Tulsa, Utah NExtGenCincinnati, Inland NW, RIQI, Tulsa, UtahNExtGen Crescent City, SE MI, TulsaSuccess EHS (XDS & XDR) Crescent City, SE MI, TulsaSuccess EHS (XDS & XDR) Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) 8: SOAP + XDR/XDM - Push to HIO/HISP/HIE who forwards to Provider B Inland NW, ? Tulsa & KeystoneGreenway (XDS & XDR) Inland NW, ? Tulsa & KeystoneGreenway (XDS & XDR) Cincinnati, Inland NW, RIQI, Tulsa, Utah NextGenCincinnati, Inland NW, RIQI, Tulsa, UtahNextGen Crescent City, SE MI, TulsaSuccess EHS (XDS & XDR) Crescent City, SE MI, TulsaSuccess EHS (XDS & XDR) Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) Keystone, Southeast MI, WNY, Utah (Pro Only) Allscripts (Pro & Ent.) 9: EHR to an eHealth Exchange push to or query from Provider B Possible in All Environments as Long as Transport From eHealth Exchange Participant is Supported. 10: CEHRT to an HIO/HIE/HISP - Query by Provider B Possible in All Environments With Differences in the Types of Transport Supported. EHR sending vendor must support one CEHRT transport

HealtheWay Presentation Important Points HealtheWay is looking for continued collaboration with Beacon Communities Benefits of eHealth Exchange Membership Standardized exchange structure One “trust community” to join allows trust relationships across many systems MU 2 ToC Support Standardized on-boarding process with testing using CCHIT Management of digital certificates by the eHealth Exchange Annual cost is variable depending on an organizations annual revenue < $1M = $4,750/year $1 - $10M = $9,950/year More than $10M = $19,900/year 7

HealtheWay Interoperability What do the eHealth Exchange HIE Certified Stamps Mean Framework for tightly specified implementation- level requirements for production level interoperability built on the national standards set forth by ONC/CMS which are able to be tested 3 Seals able to be obtained by Vendors (HIE/EHR) to show plug and play capability with eHealth Exchange members 8

eHealth Exchange HIE Certified – Community Geared toward a “Gateway” and the organizations behind a “Gateway” – A “Gateway” is simply the ability of an HIE to take records from their internal community and transpose them if needed into the exchange standards needed to be part of the eHealth Exchange, or vice versa EMRs to an “ eHealth Exchange Gateway” or “Gateway “to “Gateway” Superset of the Network exchange and encompasses HIE to HIE exchange as well as exchange inside an HIE Allows information to be shared within your own “HIE community” as well as HIE communities outside your own (ie Beacon to Beacon Tulsa to Detroit) 9

eHealth Exchange HIE Certified – Direct Interoperability standards and security for the Direct project Allows organizations without a full established HIE community to have trust relationships with any other eHealth Exchange member, therefore a Direct message could be sent to any participating eHealth Exchange member 10

eHealth Exchange HIE Certified – Network Maps 1:1 with the eHealth Exchange specifications: – Patient discovery – Query for Documents – Aligns to eHealth Exchange message platform and underlying framework which allow for the transport to be secure and ensures patient consent An HIE whose sole purpose is to exchange information between eHealth Exchange members (No underlying community of health systems and practices the HIE facilitates exchange between) 11

Wrap Up/Next Steps 12 Final comments All attendees Co-Chairs: Chuck Tryon Next steps Conclusion