1. What Are We Going to Do Now? SMRTNET Secure Medical Records Transfer Network

2. Todays Connectivity World

3. Foot Surgery Bone Spur removal 1-15-02 Diagnosed Asthma 5-27-99 Diagnosed With Arthritis 2-9-05 Diagnosed With Arthritis 4-29-06 Diagnosed with IBS 9-30-02 Prescribed medication for Cholesterol 12-22-05 SMRTNET brings them together

4. What is an HIE Network? Members only Share data on common patients for treatment Various EHRs and data sources Common governance (policies and rules) Common data sharing agreement Common privacy policies

5. Rural Hospital Benefits Meaningful Use Retention of physicians Recruitment of physicians Encourages use of local hospital Improve key reportable quality indicators Efficiency and friction reduction Communication with specialists and urban areas Decrease drug seeking Reduce cost of uninsured No EHR required Makes a small office big

6. Public HIE Utility Company Non profit operated by members Multiple self-governed networks that can share data Comprehensive member agreement (3 years and $ 125,000) Planning Process Privacy policies Data and connections (51 institutions) Proven technology that fits with Oklahoma Economic stability without grant funds Open access incubator network for all

7. Development Network HospitalTahlequah City Hospital UniversityNortheastern State University Public HealthOSDH/Cherokee County FederalHastings Medical Center TribalCherokee Nation Mental HealthBill Willis Community MHC Community Health CtrNEO Community Health Centers

8. Networks in Oklahoma NetworkSMRTNET Planning Process SponsorStatus SMRTNET statewide incubator YesSMRTNETOperational Oklahoma CityYesGOCHCOperational SMRTNET Northeast YesSMRTNETOperational Norman PHOYesNorman PHOOperational Health Alliance Uninsured YesHAU/OSMAOperational GTHAN-TulsaYesGTHANAssessing bids SoonerVerseYesOKPCAAwaiting Funding OSMAYesOklahoma State Medical Association Planning

9. 2011 Meaningful Use Policy Objectives CPOE Drug interaction checks Problem lists ePrescribing Maintain medication lists Maintain allergy lists Record demographics Record advance directives* Record vital signs Record smoking status Lab test results Generate patient lists Reporting on measures Patient reminders Decision support rules Progress notes* Eligibility checks Electronic claims Electronic copy of record Electronic access to health information Patient-specific education resources Clinical summaries at each encounter Exchange key clinical information Medication reconciliation Electronically submit data immunization data Electronically submit reportable lab results Electronic syndromic surveillance data Compliance with HIPAA privacy and security rules Compliance with fair data sharing practices -Improve quality, safety, efficiency and health disparities -Engage patients and families -Improve care coordination -Improve population and public health -Ensure adequate privacy and security protections Health Outcomes Policy Priorities SMRTNET HIE Billing ePrescribe Secure Messaging Alerts & Reminders Clinical Hub SMRTNET Hub Services Consumer Services Scheduling EMR View Personal Health Record SMRTNET Meaningful Use

11. Data set Demographics Allergies and reactions Diagnosis Procedure code Provider Medications Laboratory results Immunizations History and physical Reports Discharge summary

12. SMRTNET Clinical Encounters in Oklahoma

13. SMRTNET Distribution

14. Current Data Over 37 million encounters Over 11,500 contributing providers Over 3 million patients 16 million diagnoses

15. Hospital ED Cost Reductions for OKC CategoryCost reduction ED uninsured costs (5%)$ 1,714,047 Uninsured lab costs (5%)$ 351,001 Uninsured inpatient (5%)$ 7,439,713 Increase in ED efficiency ($ 10.00 per visit) $ 4,870,000 Total$ 14, 374, 751

16. SMRTNET Community The Experience No Historical Data in EMR SMRTNET Community SMRTNET Community Data

17. SMRTNET Community The Experience SMRTNET HIE View Who Prescribed these? What was Observed? SMRTNET Community Data

18. SMRTNET Community The Experience SMRTNET Community Data

19. SMRTNET Community The Experience Details from Encounter SMRTNET Community Data

20. Security William Braithwaite, MD, PH.D, author of HIPAA Regenstrief Institute and Chris Sears Over 20 Oklahoma attorneys Over 15 privacy officers 27 privacy policies Operational for four years without any incidents

21. Northeast Oklahoma Adair County Health Dept (Stilwell) AMO Health Center (Salina) Bartlesville Health Center (Bartlesville) Tahlequah City Hospital (Tahlequah) Northeastern Oklahoma University (Tahlequah) Three Rivers Health Center (Muskogee) Vinita Health Center (Vinita) NEO Community Health Center (Tahlequah-Hulbert-Westville) WW Hastings Hospital (Tahlequah) Baptist Memorial (Miami) Grove General (Grove) Wilma Mankiller Health Center (Stilwell) Mayes County Medical Center (Pryor) Mayes County Health Department (Pryor) Redbird Smith Health Center (Sallisaw) Sam Hider Health Center (Jay) Will Rogers Health Center (Nowata

22. SMRTNET-OKC (GOCHC) Greater Oklahoma City Hospital Council OU Medical Center Unity Health Center Cancer Institute of Oklahoma Deaconess Hospital (pending) Edmond Medical Center Oklahoma Heart Hospital North Oklahoma Heart Hospital South INTEGRIS Baptist Medical Center INTEGRIS Canadian Valley Regional Hospital INTEGRIS Southwest Medical Center Mercy Health Center Midwest Regional Medical Center Norman Regional Hospital Norman HealthPlex OU Medical Center (Edmond) St. Anthonys Hospital Oklahoma Heart Hospital Moore Medical Center Oklahoma City-County Health Dept (pending)

23. Rural Hospitals Baptist Regional (Miami) Bass Baptist (Enid) Blackwell Regional (Blackwell) Clinton Regional (Clinton) Grove General (Grove) Marshall Memorial (Madill) Mayes County Medical (Pryor) Spencer Behavioral Health (Spencer) Tahlequah City Hospital (Tahlequah) Hastings Indian Hospital (Tahlequah)

24. Norman PHO Very unique group of 300 physicians all using the same electronic record system NPHO will develop their own network Integrate to SMRTNET network Object of AHRQ research contract and Beacon grant Leverage OKPRN Prevention Science Algorithms

25. Ambulatory Interfaces Underway eClinicalWorks Allscripts Cerner Greenway NextGen Carescope

26. OKC Uninsured Clinics Baptist Community Clinic Baptist Mission Center City Rescue Mission and Dental Clinic Cross and Crown Clinic Community Charity Eye Clinic Crossings Community Clinic Good Samaritan Free Clinic of Edmond Good Shepherd Ministries In Gods Care King's Klinic Lighthouse Medical Clinic Little Flower Clinic Manus Juntas Clinic Mid-Del Community Clinic Ministries of Jesus Open Arms Clinic Reaching Our City Medical Center St. Charles Clinic

27. Native American Services Cherokee Nation possibly the only truly interoperable tribe in the country SMRTNET member agreement used as national template for Indian Health Service Active discussions with other tribes

28. Physician Roll-out 1,400 physicians with medical privileges at 24 hospitals at no charge Do not have to have an EHR 1,500 Oklahoma Medical Association (in planning) Norman Physician Hospital Organization 300 physicians All other providers through incubator network and do not need to be in a network

29. Contacts Mark Jones Chief Operating Officer and Principal Investigator markjones@smrtnet.org 918 931 9410