1. Approaches to Implementation Session 2 April 12, 2011

2. Agenda What is the emerging ecosystem of Direct players? What approaches can States take to enable Direct in their communities? In what situation is each approach appropriate? –When is an approach sufficient to meet HIE needs? –How does the approach fit into the State’s HIE strategy? –What are examples of pilots and States who have adopted a similar approach? Panelist Presentations –Gary Christensen, CIO/COO, Rhode Island Quality Institute –Christopher M. Henkenius, Program Director, NeHII, Inc. –Carol Robinson, Oregon State Coordinator for HIT, Oregon Health Authority Q&A Poll 2

3. What is the emerging ecosystem of Direct players? 50+ vendors have committed to roll-out Direct-enabled functionality, and ~20 states include Direct in their approved State HIE plans* EHRs 4Medica Aprima Allscripts Care360 Cerner eClinicalWorks e-MDs Epic GE Healthcare Greenway Med3000 MEDgle NextGen OpenEMR Polaris RelayHealth Sage Healthcare Siemens Sunquest WorldVistA PHRs Dossia Microsoft HealthVault NoMoreClipboard.com RelayHealth HIEs & HIOs AAFP Ability Akira Technologies ApeniMed Atlas Development Axolotl CareEvolution Covisint Garden State Health Systems Inc. GSI Health Harris HINSTx HIO Shared Services/NeHII Ingenix Inpriva IVANS Kryptiq Corporation Lifepoint Informatics max.md MedAllies MedCommons MEDfx Medicity MedPlus Mirth MobileMD National Health Svcs NetDirector Orion Health ProviderDirect RedwoodMedNet Secure Exchange Solutions Surescripts Techsant Technologies Thomson Reuters Verizon Wellogic States Alabama California Florida Illinois Iowa Kentucky Minnesota Missouri Montana New Hampshire New Jersey North Carolina Ohio Oregon Rhode Island South Carolina Texas Vermont West Virginia Wisconsin * Source: http://directproject.org/content.php?key=getstarted&sub=vendorsupport (as of April 2, 2011)http://directproject.org/content.php?key=getstarted&sub=vendorsupport 3

4. What approaches can States take to enable Direct in their communities? 1.Encourage market-based solutions by establishing parameters for trust –Create a conducive environment for market-driven solutions through enabling policies, certification criteria, etc. –Leverage other State HIE services, e.g., directories 2.Offer complete set of services to all community members –Can buy, build or contract HISP services to vendors to set up HISPs and CAs –Need to think through how market-driven solutions can participate, e.g., Establish HISP functionality at State level, or do match-making with nationwide providers? Provider value proposition and benefits to State HIE from setting up a HISP in light of national services? 3.Fill in the gaps by providing services to under-served participants, e.g., rural and remote providers and labs –Identify target participants –Work through similar set of considerations as in Options 1 & 2 above 4

5. HIE strategy should drive the approach to implementing Direct OrchestratorElevatorPublic UtilityCapacity-Builder $ $ Rapid facilitation of directed exchange capabilities to support Stage 1 MU Develops and bolsters local exchange capabilities Connects local exchange activities with thin layer of statewide infrastructure Directly connects providers into centralized HIE solution Direct Approach #1: Market-based solns Direct Approach #3: Fill in the gaps Individual States may adopt multiple strategies Direct Approach #2: Offer complete svcs 5

6. Panelists and the approaches they adopted Panelist 1: Rhode Island – RIQI –Employed Approach #1: Encouraged market-based solutions, to establish HISPs –Also employed other approaches to solve different HIE problems Panelist 2: Nebraska – NeHII –Employed Approach #2: Offer complete set of services to entire community –Took this a step further to enable HISP services to other States and communities Panelist 3: Oregon – OHA –Employed Approach #3: Fill in the gaps –Leveraged existing regional HIT investments and initiatives 6

7. Panelist #1: Rhode Island – RIQI KEY TENET IMPLICATION APPROACH RIQI shouldn’t be a HISP Be HISP-agnostic Be value-add (or not) Educate, facilitate, enable, but don’t “do” Make “certificates” invisible Enable “trust” RIQI should facilitate introduction of “good” HISPs to providers HISPs can differentiate themselves via price, service, or value-added services (over and above vanilla) Business relationships are between providers and HISPs RIQI should develop a REC service to help providers adopt RIQI should offer a certificate “product” (optional) As a trusted 3 rd party, RIQI will create and manage a “trust community” Market-based Solution Market-based Solution Market-based Solution Fill in the gaps Offer service 7

8. Panelist #2: Nebraska – NeHII Current HIE Environment –Mature HIE in NeHII Offering Complete HIE Functionality –VA, Medicaid, and External Demand –National Focus Through HIO Shared Services Objectives –Provide Value to Patients –Provide Value to Participants 8

9. Panelist #2: Nebraska – NeHII Alternatives –Buy –Build Direction –Enable HISP and Associated Services for: NeHII Participants Non-NeHII Participants Other States and Communities 9

10. Panelist #3: Oregon – Oregon Health Authority Current HIE Environment Numerous regional-based Health Information Organizations (HIOs) at varying levels of maturity HIOs clustered around large population centers and patterns of referral Geographically, most of state unserved by HIOs Heterogeneous technology adoption 10

11. Panelist #3: Oregon – Oregon Health Authority Objective: Leverage existing investments in HIT and HIE to reach as many providers and participants as possible and provide enough services to allow all qualifying providers and hospitals to meet Meaningful Use Approach: Provide flexible and common shared services, policies, and processes that are necessary for statewide HIE to occur while fostering growth in the market –Support markets (i.e., HIOs and local/regional HIE) to reach as many providers as possible –Knit markets into a statewide fabric of HIE by facilitating communication between them Common policy and qualification framework Common shared services – Trust, Provider Directories, Messaging (HISP) –Fill the gaps – offer services to providers not served by HIOs Key Take-Aways: –All providers will have an option to participate in HIE regardless of HIO coverage –Reliance on HIOs means “monitor and adapt” will be key to Oregon’s success 11

12. Q&A

13. Poll 13