1. New Jersey Health Information Exchanges Current State and Potential Strategy June 17,2010 Daniel Morreale

2. from The London Times in 1834 Commenting on... the “stethoscope” Is HealthCare ready to change.. “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.”

3. Although Healthcare is not a field which has historically embraced change there is a growing need for fully integrated health information solutions. Providers, payers and customers struggle to deal with a delivery system that is disjointed and incremental. Health information is not easily shared among providers and is unavailable to patients in a form that is useful. It is often presented without context making it hard is not impossible for providers to make clinical judgments without leafing through many pages of non salient data. The result is a cost of care that is unsustainable and quality that is less than optimal. Background

4. The Industry is working hard to solve problems related to patient safety, clinical quality, customer service, and operational efficiency within an environment of higher regulation and decreasing revenue. Our Primary focus over the past 2 decades has been on capturing data and installing electronic medical records but little effort has been afforded to exchanging data and making it meaningful. Background

5. Reform, Recovery and Meaningful Use HealthCare Reform, ARRA, and Meaningful Use criteria have effectively triggered a shift in thought about information technology. Health reform goals of higher-quality, and more affordable care will not be met without broader and deeper information exchange across the entire health delivery system both within a organization and across the nation.

6. Health Information Exchange Pharmacies Hospitals Clinics Health Centers Work Place Communities Doctors Quality Safety Outcom es Families Pharma Payers Employers Unions FQHC Behavioral Health Nursing Homes Get connected with HIE. The Health Information Exchange is a solution that is both workable in terms of scope and expenditure; and carries with it a potential value proposition that makes the investment of time, money, and resources effective. It is an avenue towards closer physician alignment, reduced cost, more carefully coordinated care, better outcomes and improved patient safety. It is not without challenges …

7. Challenges The current state of health information exchanges nationally are spotty. –A majority of exchanges exist in narrow set of transaction silos, such as labs and medication prescriptions. –There is a less 15% penetration in physician offices –Governance Models tend to be complicated –Privacy Rules even within a state are often inconsistent and may vary by cohort, type of provider and even patient disease states –Sustainability continue to be a challenge for most exchanges unless the state or local government has imposed funding criteria. –Electronic reporting for public and population health measurement and improvement is very limited and stymied often by archaic technologies or antiquated process. Once we work through these issues…

8. Sharing information will get easier. HEALTH INFORMATION EXCHANGE Hospital Payor Employers Provider Public Health Community Patient Tomorrow’s View Integrated and dynamic data flow Hospital Payor Provider Public Health Community Patient Today’s View Point to point and fragmented Employers

9. Tomorrow’s view Creates Electronic Health System that facilitates data collection, integration and aggregation Reduce “Friction” between providers patients and payers Establish the Trustee of the PHR and includes the patient Create “Executable Knowledge” at the point of care improving quality and safety Enhances system performance by reducing cost and normalizing data Create Competitive Advantage with a comprehensive picture of the patient population and status

10. The Unique New Jersey Plan The four out of ten regional initiatives were selected and are expected to be the “centerpieces for North, Central, and South Jersey in a state wide health information exchange. Regional HIE Highlights: 1. Camden HIE The Camden Coalition of Healthcare Providers has built a Citywide Health Database with 8 years of claims data from the three main hospitals within the city: Cooper, Lourdes, and Virtua. 2. Health-e-cITI-NJ The Health Systems Workgroup of Newark comprised of the University of Medicine and Dentistry of New Jersey, Newark Beth Israel, St. Michael’s and the regional FQHC have adopted the HIE effort of Newark Beth Israel. This will be opened up to include East Orange, Elizabeth and Jersey City. 3. Northern and Central New Jersey HIE Collaborative( New Jersey Health Connect The effort is a collaboration of many hospital systems provider organizations, and long term care facilities, and has come together to leverage existing Health Information Exchange capabilities used by Atlantic Health System. Members represent 29 facilities within health systems which include Atlantic Health, Saint Barnabas, Robert Wood Johnson, Hunterdon, Solaris, St. Clare’s, Somerset, VISTA IPA, Summit Medical Group, Trinitas. 4. South Jersey HIE (EMRX-SJ) The South Jersey HIE is the collaboration of four hospitals intent on leveraging the existing AtlantiCare connected community HIE and is composed of AtlantiCare, Shore Memorial, Cape Regional and South Jersey Health System hospitals, and Crestview and Seashore Gardens Nursing Homes.

11. Jersey Health Connect Atlantic Health Hackensack University Medical Center Hunterdon Healthcare Newton Memorial Hospital Robert Wood Johnson Health System Saint Barnabas Health Care System Saint Clare’s Health Services Saint Peter’s Healthcare System Solaris Health System Somerset Medical Center Trinitas Regional Medical Center Summit Medical Group (physician group) VISTA Health System, IPA (physician group) Health-e-cITi-NJ Newark Beth Israel Medical center East Orange General Hospital Trinitas Medical Center Clara Maass Medical Center St. Michael’s Medical center UMDNJ Camden Health Information Exchange Lourdes Health System. Cooper University Hospital Virtua Camden EMRX-SJ AtlantiCare South Jersey Health System Shore Memorial Hospital Cape Regional Medical Center SeaShore Gardens (nursing Home) New Jersey ONC Funded Regional Exchanges

12. Innovative Model Provides for the regional nature of health care delivery by decentralizing HIE’s Unifies the state through a state provided a record locator service and backbone for secure transmission of data. Is inclusive by Inviting non federally funded efforts to participate Celebrates the identity of individual health systems by empowering each to connect to their physician and providers Formed early in the process a task force to integrate the very different technologies in use by all HIE efforts Suggest the appropriate model for the state is that of a utility where the exchanges are privately held but regulated by the state. Integrates the effort of Medicaid without endangering their specific deliverables Created a road map forward in conjunction with NJHIT, State Medicaid and HSS…

13. Roadmap for Statewide HIE Implementation Stage 1 2010 All funded HIE ’ s create their HIE “ environment ” : establish operational procedures, purchase hardware and software, install regional governance, and publish project plans. Commence the build-out of regional exchanges among providers/facilities Common data elements available to providers in all the funded exchanges include but are not limited to: Demographics, Medications, Allergies, problem list, Diagnostic codes/treatment codes, Date of last service, Lab results, Radiology reports, and ability to electronically transmit a Universal Transfer Form (UTF) for LTC patients Technological specifications to require interoperability and data-exchange according to current HL7-hybrid standards, HITSP/C32 Continuity of Care Document (CCD), and emerging IHE connectivity standards. State finalizes policies and procedures on privacy, governance, and sustainability Metrics addressing all five ONC ‘ domains ’ be required State finalizes Governance requirement Finalize Care coordination measurements Exchange-related Privacy & Security recommendations from NJ Health IT Commission be finalized, sent to Governor ’ s Office, Legislature Trust agreements/data-sharing agreements for each regional HIE to be signed by all participants All NJ HIT governance and policy-planning bodies to be centralized under Governor ’ s-office function Governor ’ s office approval of dedicated revenue source for statewide broker/backbone as described below Along with all participants the State develops the Request for Proposal for a statewide broker/backbone that will integrate all HIEs: and a Statewide Record Locator Service Finalized Provider Authentication,Security & Encryption, Help desk, Audit Trail and User agreements based on ONC/national best-practices Medicaid submission of implementation plan that includes build-out of a Master Patient Index Regional HIE’S State of NJ

14. Roadmap for Statewide HIE Implementation Stage 2 2011 Regional HIE’S State of NJ Contract with a company to operate and maintain State backbone resulting from RFP selection process Start install of State backbone and Record Locator Service Connect Medicaid to State backbone by using the Medicaid Master Patient Index to share Medicaid patient records Link in non-federally-funded HIE’s that also adhere to IHE/NHIN standards as described above State operational procedures and governance in place Trust/participation agreements by all participating facilities Amended consents at all participating facilities Baseline of privacy, security, and data elements assured by all participating HIEs and by State backbone All HIE ’ s connect to state backbone and RLS service, making data available in a federated/node model through the backbone.  Phase-in of connectivity to ensure reliability, security, which would involve testing, assuring network standards  Each look-up by an authorized provider would trigger a query of both the regional HIE and the State backbone to return matches  Regional HIE’s continue to connect-in physician offices, leveraging Regional Extension Center  Investigate the connectivity and potential of interfacing with reference laboratories and SureScripts  Lab results and medications available through participating providers in each HIE and the Medicaid MPI will already be available, but this stage will expand to include data feeds from to national lab companies and SureScripts

15. Roadmap for Statewide HIE Implementation Stage 3 2012 Regional HIE’S State of NJ Expand Medicaid MPI/RLS to other payer populations in NJ Develop plan for connecting State backbone to significant health registries for reporting, public-health planning purposes  Immunization Registry  Communicable Disease Registry  Hippocrates emergency-preparedness system Expand backbone to national reference labs and pharmaceutical clearing houses (SureScripts). Backbone will then contain Lab results, medication histories to a much fuller extent than just the regional HIEs can provide Develop plan for integrating and connecting HIE data and state-based departmental program data for Personal Health Record Development Connect Nursing home, behavioral health entities, ancillarie agencies, home health ect

16. Roadmap for Statewide HIE Implementation Stage 4 2013 Regional HIE’S State of NJ DHSS starts analytics on aggregated community- level data (including bio-surveillance) DHSS starts analytics on disease management by community Connect to the national framework Deploy Personal health records to individuals Involving integration of HIE data, Medicaid/payer data, and registry/public-health-reporting data Connect to the national framework This innovative approach is consistent With meaningful use criteria…

17. Lab results delivery Prescribing Claims and eligibility checking Quality & immunization reporting, if available 2011 Increases volume of transactions that are most commonly happening today – Lab to provider – Provider to pharmacy Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Receive public health alerts Home monitoring Populate PHRs 2013 Substantially steps up exchange – Provider to lab – Pharmacy to provider – Office to hospital & vice versa – Office to office – Hospital/office to public health & vice versa – Hospital to patient – Office to patient & vice versa – Hospital/office to reporting entities Access comprehensive data from all available sources Experience of care reporting Medical device interoperability 2015 Starts to envision routine availability of relatively rich exchange transactions – “Anyone to anyone” – Patient to reporting entities Meaningful use and the Health Exchange

18. And it not just strapping on new technology to an old dog, but Re-thinks Healthcare and

19. Creates a “New Value Proposition” Get Connected Get Smart Get Healthy Models of care for a HIE

20. Get Connected Join providers into one network Info can be easily gathered, shared maintained and managed. Automate processes- capture data electronically Patient portal ties to customer and makes mobile Create more attractive network for contracting Electronic Connection to physicians Improves efficiency Opportunity for quality improvement. Insurers Providers Hospitals Consumers Get Smart Use the HIE to attract business Reduce "friction" Improve cycle time and efficiency Gain knowledge about practice and disease states of patients Data availability for MU and outcome measures Improve quality – outcomes Reduce cost – eliminate waste Improve access Negotiate better rates with payers Providers Employers Health Systems Consumers Get Healthy Use info in the exchange to manage care Use the network to reward Physician outcomes with volume Contract with employers/insurers to manage disease state via VMH-as new model of care Lower cost, better outcomes Improved chronic disease Management lowers cost Opportunities to partner with insurers/employers Retail opportunities Insurers Health Systems Employers Consumers Value proposition There are three stages to the development of an HIE Value Proposition Beneficiaries

21. And Prepares to deliver care to the next generation” By managing the care which is chronic, costly, and complex The consumer can not start driving their own care Is mobile, and electronic Encourage development of an informed consumer via internet searches Potentially provides care when and where the consumer wants care Supports medical tourism Lifestyle drugs and neutraceuticals bought through the internet can be tracked via PHR.

22. Thank You