1. Building sustainable HIE for the North Bay region of California COMMUNITY STAKEHOLDER MEETING SEP 19, 2012 SUTTER SOLANO MEDICAL CENTER

2.  Intros of Attendees All 6:30 – 6:50 pm  Intros of Board & Alternates 6:50 – 6:55 pm  Sutter Health HIE Sundeep Desai, MD 6:51 – 6:55 pm  HealthBridge  Presentation Keith Hepp 7:01 – 7:45 pm  Q&AKeith Hepp 7:46 – 8:00 pm  Update  ActivitiesLyman Dennis 8:01 – 8:05 pm  Study Teams & Workplans Teams 8:06 – 8:35 pm  Q&ATeams 8:36 – 8:45 pm  Next Meeting LD 8:46 – 8:50 pm AGENDA

3. PARTICIPANT INTRODUCTIONS

4. BOARD AND ALTERNATES

5. CONNECTHEALTHCARE BOARD  Jeremy Mann, MD, Regional CMO for Ambulatory Services  David Jomaoas, CEO  Suzanne Ness, Reg VP  Kathryn Amacher, DO  Alice Hughey, Assistant Director  Paul Alcala, VP/CIO  Robert Moore, MD, CMO  Lori Sklar  Kathy Ficco, Ex Dir, Comm Hlth  Lyman Dennis, Ex Dir  Adventist Health—Northern CA Network  Community Medical Centers  Hosp Council of N & Cent CA  Medical Societies  Napa Co. Health & Human Services Agency  NorthBay Healthcare  Partnership HealthPlan of CA  Redwood Com Hlth Network  St Joseph Health System  ConnectHealthcare

6. CONNECTHEALTHCARE ALTERNATES  Gwen Matthews, Sr VP for Operns  Kathleen Marshall  Rebecca Rozen  Maryanne Eckhout, Cynthia Melody  Mitch Wippern, Dep Dir, Operns  Justin Graham, MD, CMIO  Liz Gibboney, Dep Ex Dir  Mary Maddux-Gonzalez, MD  Paul Sampedro, HIE Pgm Dir  Carl Thomas, Ex Dir  Adventist Health  Community Medical Centers  Hosp Council of N and Cent CA  Medical Societies  Napa Co Hlth & Hmn Svc Agency  NorthBay Healthcare  Partnership HealthPlan of CA  Redwood Com Hlth Network  St Joseph Health System  SCBH, for ConnectHealthcare

7. SUTTER HEALTH HIE

8. KEITH HEPP, HEALTHBRIDGE

9. HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of the HealthBridge Data Analytics & IT Infrastructure Keith Hepp, CEO September 19, 2012 9

10. HealthBridge Background One of the nation’s largest, most advanced and successful health information exchanges (HIE) Provides HIE connectivity for Greater Cincinnati tri-state area and five other HIEs – including Greater Dayton Connection Statistics Participants: 50 hospitals, 7500 physicians, 800 practices Delivers 3-6 million clinical messages per month More than 60 million messages annually Clinical information for 3+ million unique patients 10

11. Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010 Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors, 60+ versions Provide technology infrastructure for four other HIEs – Dayton HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network 26 local hospitals in Kentucky, Ohio and Indiana 5500+ physicians 17 local health departments Large commercial, hospital, & physician office labs Diagnostic centers Network Size & Adoption 11

13. Strategic Direction 13 Pre ARRAPost ARRA Value added services EHR Implementation Basic Messaging Value Added Services HER Implementation Basic Messaging

14. HIE Value Progression – Meaningful Use, Medical Home and Payment Reform Basic HIE Stage 1 MU EHR Adoption (REC Services) Basic Electronic Messaging (NHIN DIRECT) Community Portal Web-Based Results Delivery Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency Intermediat e HIE Stage 2&3 MU Structured Data Delivery to EHRs Results Delivery (Lab, Rad, ADT, etc.) Summary Record Exchange (CCD) Value: Necessary to achieve truly electronic workflows; Dramatic increase in efficiency Advanced HIE PCMH, ACO & Payment Reform Readiness Data Warehouse & Analytics Disease Registry Quality Reporting Support Full Integration Services & Bidirectional Exchange Value: Dramatic improvements in quality and performance

15. Clinical “Inbox”

16. HIE Services  EHR Integration/Interfaces  Electronic Results Delivery –  Labs, Radiology, ADT, etc.  Electronic Order Entry  E-Prescribing  HIE Portal & User Management  HIE Technology Support – Master Patient Index, Provider Directory and Record Locator Service  Summary Record Exchange  Nationwide Health Information Network Direct and CONNECT Gateway & Connectivity  Public Health Reporting & Syndromic Surveillance  Billing and Eligibility Verification  HIE Consulting, Outsourced Technology & Implementation 16

17. Innovation & QI Capabilities New Suite of Health Care Innovation & Quality Improvement Tools and Services through Beacon Program:  Disease Registry  Data Warehouse  Data Analytics and Business Intelligence  Alerts & Notifications  Transitions in Care Assistance  Quality Reporting Support  Process Improvement and Workflow Redesign 17

18. Shared IT & Data Background HealthBridge implemented new CPC-ready Shared Community IT Infrastructure over the last two years that can: Patient and Physician Attribution Translate and combine data across different IT systems Risk stratification Enables consistent community measures Support quality and population health improvement Assist plans in understanding which providers are delivering value vs. volume 18

19. 19 Infrastructure Components Impact Intelligence Provider Claims Analytics & Reports Impact Intelligence Provider Claims Analytics & Reports Impact Pro Patient Claims Analytics & Reports Impact Pro Patient Claims Analytics & Reports Provider & Payer Data Translation Master Patient & Provider Index Claims Analysis Tools (Optum Symmetry) Claims Analysis Tools (Optum Symmetry) Claims and Clinical data warehouse CPC Required Measures Custom Analytics & Reports Available Today Optional Applications Optional Applications

20. Infrastructure Components Translation Tool Semantic Data Normalization Master Patient and Provider Index Community Master Patient Index Patient & Provider Identification Clinical and Claims Repository Data Warehouse & Clinical Analytics Covers 16 of the 18 CPC Measures OPTUMInsight’s Symmetry Data Analytic Engines Patient Attribution Methodologies 20 Match patients across data sets accurately Combines big data sets – both clinical and claims Combines big data sets – both clinical and claims Helps data speak the same language Patient Attribution, Risk Assignment, & Cost Aggregation

21. 21 Translation Top half of screen is a source catalog of lab test codes & descriptions Bottom half of screen are candidate LOINC codes for the term highlighted on the top (blue row)

22. 22 Tracking Patient/Provider Attribution Attribution Method A John Doe, 1/1/12 -12/31/12 Attribution Method B Sue Smith, 1/1/12 -12/31/12 Attribution Method C Adam Doe, 1/1/12 -12/31/12 Attribution Method D Betty White, 1/1/12 -12/31/12 Attribution Method A John Doe, 1/1/13 -12/31/13 Attribution Method B John Doe, 1/1/13 -12/31/13 Multiple attribution methods could be simultaneously used and tracked in the MPI The Patient/Provider attribution is also time-bound with beginning and ending effective dates

23. 23 Medical Neighborhood Tracking

24. Clinical and Claims Repository CPC Measure NQF #59 Diabetes Mellitus: Ha1c Poor Control (>9%) Summary

26. Episodic Risk Score Computation

27. 27 Questions and Discussion

28. UPDATE

29.  Submitted Cal eConnect Planning Grant  Virtual Site Visit  Announcement of awards delayed  LD HIE Best Practices Toolkit for Planning Grantees  Submitted Infrastructure Grant LOI  Board Meeting Sep 14, 18  Other below ACTIVITIES

30. Source: HIE Best Practices Toolkit for Planning Grantees, Lyman Dennis, Cal eConnect, Sep 2012. EXCHANGE FUNCTIONS

31.  Master Patient Index  Record Locator Service  Connectivity to the NwHIN and CONNECT Gateway  Secure Clinical Messaging (includes Direct)  EHR Interfaces  Provider Directory  Consent Management (opt-in, opt-out, no options) CORE SERVICES

32. Part 1  Receipt of Structured Lab Results  ePrescribing  Sharing of Patient Care Summaries (across unaffiliated organizations using different EHRs) Part 2  Immunization Reporting  Reportable Laboratory Results  Syndromic Surveillance Data BASIC EXCHANGE SERVICES

33.  HIE Portal  Lab Ordering  Personal Health Record  Advance Directives ADDITIONAL SERVICES

34.  Referrals to Specialists  Authorizations  Clinical Data Repository  Transcription Service  EHR Light  Clinical Decision Support / Data Analysis  Meaningful Use Registry  Disease Management  Enterprise Image Viewer VALUE-ADDED SERVICES, PART 1

35.  Portal to HIE  Medication Reconciliation  EDI Services (X12 administrative transactions)  Eligibility Checking  Provision of Educational Materials Electronically  Quality Improvement Reporting  Credentialing Services VALUE-ADDED SERVICES, PART 2

36.  Group Purchasing  Workflow Redesign for Providers  Hosted Helpdesk for Providers  Systems Implementation Technical Assistance  Clinical Trials Management VALUE-ADDED SERVICES, PART 3

37. COMMUNITY STUDY

38. COMMUNITY HIE STUDY TEAM  Lyman Dennis, Lead  Justin Graham, MD  David Jomaoas  Jeremy Mann, MD

39.  Service area – write up what has been done  Community statistical data  Provider distribution – have hospital and physician data. Need other health provider data.  Health financing programs – and imminent changes, e.g., Healthy Families to Medi-Cal  IT systems used by larger providers, in some detail  Current & planned HIE COMMUNITY STUDY WORKPLAN

40. PROCUREMENT OF HIE SERVICES

41. PROCUREMENT TEAM  Paul Alcala, Lead  Robert Moore, MD  Paul Sampedro  Lori Sklar

42.  Determine exchange priorities of participating organizations  Services sought  Interface support desired  Assess HIO/vendor options  Full RFI  Collect summary data from selected vendors  Obtain summary data from selected vendors  Draft business plan  Issue RFI to group of HIOs and vendors PROCUREMENT WORKPLAN, PART 1

43.  Assess offers  Negotiate agreement and execute  Finalize provider rates  Finalize business plan PROCUREMENT WORKPLAN, PART 2

44. DOCUMENT DEVELOPMENT

45. DOCUMENTS TEAM  Alice Hughey, Lead  Mitch Wippern  Consultant, Cal eConnect

46.  Participation Agreement  Likely use Cal eConnect Modular Agreement  Appropriate for California  Developed with input from Alan Briskin, part of the Markle Connecting for Health team that drafted the Markle Model Contract  DURSA  Standard agreement available  Some possible changes due to change of hosting organization DOCUMENTS WORKPLAN, PART 1

47.  Policies and Procedures – draw from  Markle Model Privacy Policies  Rhode Island Quality Institute  Redwood MedNet  Other sources DOCUMENTS WORKPLAN, PART 2

48. NOT-FOR-PROFIT FILING

49.  Lyman Dennis, Lead  Paul Smith, Esq., Hooper, Lundy & Bookman NOT-FOR-PROFIT FILING TEAM

50. PROVIDER CONTRACTING

51. PROVIDER CONTRACTING TEAM  Suzanne Ness, Lead  Lyman Dennis  Robert Moore, MD

52.  Profile functions desired by each provider  Determine first movers  Focus on California Model Modular Participation Agreement, include DURSA  Rates will be determined as agreement is refined  Review policies and procedures with parties PROVIDER CONTRACTING WORKPLAN

53. ADVISORS

54. ADVISORS TEAM  Kathy Amacher, DO  John Buzolich  Sundeep Desai, MD  Kathy Ficco  Patricia Rehfield, DO

55.  Review work products  Second opinion  Consider community interests beyond current participants ADVISORS

56. ANNOUNCEMENT

57.  http://www.youtube.com/user/redwoodmednet http://www.youtube.com/user/redwoodmednet PRESENTATIONS & DEMOS FROM REDWOOD MEDNET CONFERENCE

58. FINANCIALS

59. NEXT COMMUNITY STAKEHOLDER MEETINGS

60. TopicsDateLocation Redwood MedNet, Orion HealthNov 15, 2012Adventist Health, St Helena Mirth Corporation (HIE Solution, Tools)Jan 17, 2013Partnership HealthPlan of CA, Fairfield Status UpdateMar 21, 2013NorthBay Healthcare, Fairfield UPCOMING COMMUNITY STAKEHOLDER MEETINGS

61. Lyman Dennis Ldennis@connec tHealthcare.org 707-863-0130 DISCUSSION