1. Collaborative Opportunities Open Health Tools & Clinical Groupware Collaborative September 2011 Presented by Vince Kuraitis, Better Health Technologies, LLC Dr. Adrian Gropper, HealthURL

3. A Decade of Opening Up Platforms to 3 rd Party App Developers

4. Agenda CGC Background CGC Initiatives OHT/CGC Collaboration Specific Collaboration Opportunity – P4 (Dr. Adrian Gropper)

5. Market Openness Model (MOM) for Collaborative Care CGC Goal: Enable Market Competition Between Walled Garden and Open Platforms 1 Closed 1 Closed 2 Walled Garden 2 Walled Garden 3 Open Platform & Apps 3 Open Platform & Apps Technology Architecture Collaborative Healthcare Business Ecosystem (Value Network) Closed Open Cohesive / Collaborative Fragmented

6. Members/Board of Directors Members Alere Amedisys American Medical Association Christus Health Coto Partners Covington Associates Covisint Epocrates Intel McKesson Medseek Microlife Corporation NaviNet PointClear Solutions Resilient Networks VisionTree + individual members Board Steve Adams, SVP, Alere Mark Blatt MD, MBA, Intel Hank Fanberg, Christus Health Michael Fleming, MD, CMO, Amedisys Vince Kuraitis JD, Better Health Technologies Tom Morrison JD, SVP & Co-founder, Navinet Martin Pellinat, CEO, VisionTree Advisory Board Chair – David Kibbe MD, MBA, American Academy of Family Physicians

7. Simple Open Trusted Modular Innovative Disruptive Platforms/apps Internet/web Affordable User-centric

8. “Platform” has many connotations.

9. Platforms for Collaborative Care Unified definition of platform elements Core components Complementary components Interface Unified domain focus Technological architecture Business ecosystem Clinical accountable care

10. “Platform” used by vendors to describe current offerings For details see: http://bit.ly/pggz98http://bit.ly/pggz98

11. Long standing debate Standards are created (cats) 1.Create (complex) technical standards 2.Market adopts (hopefully) Standards are adopted (dogs) 1.Market adopts (simple) standards 2.Technical standards evolve

12. Synthesis Planning for creation and adoption of standards should occur simultaneously, not sequentially Significant implications, e.g., “Come to the table planning to implement and/or contribute code Rethink nature of process Technical AND Business ecosystem development Need for product launch planning Role for CGC

13. Health IT Vendors that Want to Bring Disruptive Innovations to the Health IT Market Technology Infrastructure Vendors Application developers EHR vendor community Healthcare Stakeholders that Want to Enable Health IT Disruptive Innovation Patients Payers Health plans Employers Government Population Health Consumer Health Industry Financial Industry Providers Others CGC As A Big Tent CGC Initiatives

14. CGC “Initiatives” Advocacy Direct Project support Friday Pilots/Collaboration Workgroup webinars. Sign up at http://www.clinicalgroupwarecollaborative.org/events.aspx http://www.clinicalgroupwarecollaborative.org/events.aspx HIMSS/CGC conference --February 23, 2012 P4 (Participatory Patient-Provider Portal)

15. OHTCGC Open Source Software Modular Software Privacy Security System integrity Functional completeness Composite licensing Versioning Code repositories Support Integration with NwHIN Internationalization

16. P4 -- A Project for Persistent Connectivity Between Systems Problem and Opportunity How do software vendors work together toward the “Triple Aim” of better health, better care, and lower costs for the overall population? Persistent Connectivity Clinical adoption Within an institution Across institutions Technical adoption Software Developers Clinician Innovators

17. Wanted Adoption of connectible systems Lower developer costs Practical adoption model Keep it Simple Rapid impact Stick to existing standards and accepted policies Don’t wait for or presume HIE adoption

18. P4 Project Scope Capture connection authorization by individual users (doctors, patients, staff) Benefits from Single Sign-On (but SSO itself is out of scope) Agnostic to API and to document formats Useful to both payer and provider institutions Accessible to patients and professionals Open Source Reference Implementation Support for Stage 2 Meaningful Use Next Steps Identify sponsors of P4 Software vendors Provider Institutions Payers Formalize Governance

19. Website: www.clinicalgroupwarecollaborative.orgwww.clinicalgroupwarecollaborative.org Contact Info: Vince Kuraitis 208-395-1197 vincek@bhtinfo.com Adrian Gropper 617-571-3857 agropper@gmail.com

20. BACKUP SLIDES

21. Market Openness Model (MOM) for Collaborative Care 1 Closed 1 Closed 2 Walled Garden 2 Walled Garden 3 Open Platform & Apps 3 Open Platform & Apps Technology Architecture New Business Ecosystem (Value Network) Closed Open Cohesive / Collaborative Fragmented

23. Illustrative CGC Principles Mapped to Evolution of HIT Data portability Minimize switching costs Avoid lock-in based on proprietary, non-interoperable technology Importance of app developers Opening API necessary but not sufficient Low barriers to entry Indirect network effects Affordable Value to patients and payers Collaborative business model etc. Use of Internet and web technologies Modular/component architecture: platforms + apps Open standards Data portability Open source Application portability Private and secure etc. Technology Architecture Closed Open New Business Ecosystem (Value Network) Collaborative Fragmented

24. Defining Moments in Platform Evolution Technology Architecture New Business Ecosystem (Value Network) Closed Open Cohesive / Collaborative Fragmented Opened API & Shared Data Shared Workflow

25. Health IT Examples Technology Architecture New Business Ecosystem (Value Network) Closed Open Cohesive / Collaborative Fragmented Epic Cerner Allscripts Helios Medicity Covisint Alere Many EMRs others Practice Fusion Kaiser

26. Value Creation vs. Value Capture Technology Architecture New Business Ecosystem (Value Network) Closed Open Cohesive / Collaborative Fragmented Maximum Value Creation Maximum Value Capture

27. CGC Industry Shaping Vision Break vicious cycle of “closed/monolithic” HIT Providers haven’t demanded open, standardized, interoperable EHRs Vendors build proprietary, non-standardized, non-interoperable EMRs Enable sharing of Health records across providers and with patients Workflow across care providers and with patients Accountability for improved patient outcomes, lower costs, improved quality Identify and/or enable high value use cases for health information exchange and clinical workflow enhancement Enable competition between walled garden and open HIT platforms CGC is a catalyst in shaping the technical and business environment Identify and promote implementation of high value initiatives

28. Conference Theme Options 1) Technology and Business Ecosystems for Collaborative Care 2) Unified Platforms for Collaborative Care, Technology, and Business Ecosystems (not yet to the point of suggesting a specific title; needs wordsmithing):