Kno2 1 October 22, 2015

Agenda Introduction Goal of Pilot Tier Piloting Activity to Pilot Role of Kno2 in the pilot Standards and Technologies Under Consideration Logistics Ecosystem Defining Success Resources/References

Introduction: Pilot Team NameRole Dane Meuler Other IT system (EHR, HIE, legal etc.) Kno2 Activation Team Surescripts Activation Team As needed by Kno2

Introduction: Organization Kno2 is a cloud platform that is standards based for Interoperability using elements of Direct messaging for transport and clinical document and information exchange We connect communities through Hospital, Health system, ACO and HIE outreach for better care coordination and requests for information and through our partnerships with technology vendors including EMR’s, medical devices, lab and radiology systems. Now nearly 3,000 customers Currently, we Improve care coordination through exchange of important clinical documentation to complete any and every system of record and actor in the use cases; and replace fax workflows for referrals, request for and release of information. Exchange of clinical information and documents, electronically, both structured and unstructured. C-CDA, PDF, Word, HL7, etc. Data driven and narratives to improve care coordination. eLTSS Plan Physical Therapist PAPER Internist EMR/PAPER Hospital EMR Skilled Nursing-Rehab PORTAL Cardiologist EMR Nephrologist EMR Behavioral Health EMR/PAPER PHR eLTSS Record HIE Beneficiary - Estella Family POA EMR Direct Messaging MU2 Home Health/Care PAPER CHARTS Payers/CMS

Pilot Introduction: Business Drivers Instantly Ubiquitous - Connection to any actor with any technology Affordable Easy to Use 5

Goal of the Pilot Kno2 We are the ARROWS!

User Story 2 7 Kno2 We are the ARROWS!

Pilot Workflow 8 eLTSS Plan Physical Therapist PAPER Internist EMR/PAPER Hospital EMR Skilled Nursing-Rehab PORTAL Cardiologist EMR Nephrologist EMR Behavioral Health EMR/PAPER PHR eLTSS Record HIE Beneficiary - Estella Family POA EMR Direct Messaging MU2 Home Health/Care PAPER CHARTS Payers/CMS Direct message Message Header To From Patient Information Message Header To From Patient Information Payload Message Text Attachment Encrypted Payload Message Text Attachment Encrypted CDA XML HL7 HISP to HISP trusts Activation Services Directory Exchange Native EMR’s Kno2 Kno2 enabled EMR’s Identity proofing

Piloting all tiers Standards Under Consideration: Tier 1 – PDF files via efax or Direct Tier 2 – Direct – C-CDA (Structured and unstructured documents), HL7 (2.x) events, PDF files Tier 3: – C-CDA (content and transport) API’s for integration, OAUTH (security), FHIR Standards Across Tiers Direct HL7 CCDA Equifax Level 3 Assurance Two-Factor Authentication SSL Hybrid AES/RSA, encryption for data at rest IETF W3 Microsoft (MS) NIST Microsoft Azure HTML5 CSS3 Standards Across Tiers Direct HL7 CCDA Equifax Level 3 Assurance Two-Factor Authentication SSL Hybrid AES/RSA, encryption for data at rest IETF W3 Microsoft (MS) NIST Microsoft Azure HTML5 CSS3

What are you intending to pilot What role do we play Applicability – Create Plan – Approve/Authorize Plan/Services (Kno2 transports data and documents) – Access, View, Review Plan (Kno2 transports data and documents) – Update Plan (Kno2 transports data and documents) – Connect the community of providers including: Work, Community, Choice & Decision Making, Relationships, Self-Direction, Demographics, Person-Centered Profile, Medication, ADLs/IADLs, Safety, Behavioral Needs, Restrictions, Service, Financial/Payer Information, Service Information, Family Information, Community Connections, Access & Support Delivery, Information & Planning, Health and all others.

What role do you play in the pilot Beneficiary/Advocate Beneficiary System CB-LTSS Provider Clinical and Institutional based provider EHR system Eligibility Determination Form Submitter eLTSS plan developer eLTSS plan facilitator/steward LTSS/case management info LTSS/Service Provider System Payer, Payer System, Other Kno2 We are the ARROWS! We are transport and transformation services for documents and data For the systems, roles and organizations listed above

Pilot Logistics: Timeline – (April 2016 is end date for round one pilots) TODAY Sign up for Kno2 – 10 minutes to get your own Direct address, Partnerships available with TEFT states for Community Connect program and technology organizations as technology partner

Pilot Ecosystem Kno2iQ Partner map - Partial Hospitals nationwide for community outreach Approximately 3,000 Kno2 locations nationwide – Oct new Kno2 subscribers each month

How do you define success VA, Indian Health Services earn Direct 'milestone' accreditation - October 19, Healthcare IT News accreditation Nearly 80% of eligible hospitals attested to MU2 in January 15, 2015 – Becker’s Hospital Review eligible-hospitals-attested-to-mu2-in-2014.html Direct messaging trends – June % of participants support Direct as method of exchange Top Challenges High cost Changing workflows Other providers not ready to interface