1. Demonstrating The Value Of Local Exchanges Connecting to the PC-EHR & Health Information Exchanges July 19th, 2011 Ted Kremer Executive Director, Rochester RHIO

2. © Ingenix, Inc. 2 Rochester RHIO One of several regional New York Health Information Exchanges Rochester RHIO covers 1.3 million patients in 13 counties Outside of Rochester predominantly rural

3. Roughly 3000 physicians, both independent and hospital practices 20% EHR adoption in ambulatory care setting Hospital Clinical information systems all automated 20 Hospitals across 13 counties Well defined medical trading area Rural and Urban mix with referrals coming into larger urban hospitals Three health plans with 70% of market share Large employer self ensured based Regional and community history of collaborative care improvement projects Market dynamics still using information access as competitive advantage Medical delivery area landscape

4. Exploring how a small regional exchange can become a trusted value partner

5. Core Value Propositions: 1) Improving the Quality of Care Lower risk of mistakes Fewer unnecessary tests Easier second opinions Better emergency care Greater convenience for patients Reduced hospital readmissions Smoother transitions of care More effective patient coaching and community prevention efforts

6. Core Value Propositions: 2) Enhancing System Efficiency Lower risk of mistakes Fewer unnecessary tests Easier second opinions Better emergency care Greater convenience for patients Reduced hospital readmissions Smoother transitions of care More effective patient coaching and community prevention efforts

7. Emerging Value Propositions: Supporting Health Reforms & Care Improvements Support for meaningful use requirements Accountable care organizations Medical home grants Hospital readmission reduction program Quality care reporting requirements Administrative simplification Independence at home pilot programs Federal healthcare innovation efforts

8. Rochester RHIO Timeline 2006 2007 2008 2009 2010 Initial Grant Incorporation Stakeholder collaboration Policy development Technology foundation Consumer focus groups Pilot RHIO services Increase in quantity & types of data Full-scale deployment Increase in physician adoption Consumer Marketing HIE growth EHR adoption & integration

9. Growth in Numbers Physicians Total users Connected EHR Systems Consented Patients 133 450 6 42,00 20092010 Today 866 2,500 115 225,00 1,222 3,985 145 482,788

10. Sources of data 51 million records + million each month From over 70 sources Services Setup Configuration Monitoring Data quality Support Users 419 organizations 3,985 users 1222 physicians Information = Adoption & Value

12. Maturing Revenue Streams Initial Startup PhaseTransitional PhaseMature Phase Grants 20062007200820092010201120122013+ Heal NY 1 (start HIE) Heal NY 5 (HIE & EHR) Heal NY 17 (medical home) Revenue RHIO Contribution Plan Hospital Subscription Plan Fees Sustainability From Grant Funding to Sustainability

13. RHIO 1.0 – A Clinical Exchange RHIO 1.0 Our initial exchange focus was between Hospitals, Labs, Radiology practices and Physicians With initial start up funding based on a 2 year grant we sought to build services quickly Took an opportunistic build approach Met participants and vendors where they were with an eye to where we wanted to go Leveraged standards wherever possible (HL7-> IHE)

14. Started with a vision of supporting 2 HIE modalities: 1)Query services Using Virtual health Record (VHR) (requires consent) 2)Results services Supporting 14 EHR vendors systems (does not require consent) With only 20% initial EHR adoption VHR services trended up first. With more EHRs connected, VHR use has dropped but delivery volumes have trended up Moving into CCD exchange

15. Privacy & Consent As of 6/30/11 Total Consents: 682579 Total Unique Patients Consented: 482788 Consent to view model Consent per covered entity Consent controls query use

16. Consumer marketing & education All household mailings to 400,000 households Movie theatre advertising Radio & print advertising Advertising and article space bank for hospital & health plan newsletters to include patient education in their materials Communications group with PR professionals from multiple organizations PR firm active in getting newspaper and radio coverage PR firm assists rural and regional facilities to get local coverage Patients now often ask for the HIE consent form when it is not presented to them

17. Tools to assist providers with consent Patient tri-fold brochure Commonly asked questions Consent forms Counter cards Clipboards Chart stickers Practice scripts Practice guidelines Optional scanning Consumer & Provider web site Patient Portal live in April PHR Gateway pilot in June

18. RHIO 2.0 – A Community Care Exchange Care Coordination o New communication patterns o Additional sources of care information Patient Engagement Health Analytics

19. Care Coordination: Communication Patterns Electronic Health Record (EHR) interoperability Initial model was results delivery (push) Improved filtering & turning off paper Dual routing to both EHR and ACO care engines Moving to 2-way EHR interoperability EHR requesting a CCD from the exchange Send CCD from an EHR o Send to RHIO (event based, manual) o Send to other provider (CCD & C62) Care alerts (subscriptions & notification) Configure per provider subscription sources Capability of EHR to consume sources Mobile HIE application support (iPhone, iPad)

20. Care Coordination: Additional Sources of Information Additional types & Sources of Data More complete hospital transcribed/clinical reports More complete Admissions and Discharges information Office of the Aging information Eligibility information Emergency medical services information Mobile image providers Advance directives Care engines updates (problems, communications) Patient submitted data from PHRs Kiosks/Home monitoring (vitals)

21. Patient Engagement Patient marketing & education Patient portal services Consent management Audit requests Advance directives PHR gateway with 2 way PHR connectivity Consumer/Retail health kiosks Home monitors Linking communications from care engines

22. RHIO 2.0 – A Connected Community of Health Your Info Goes Where You Go Our initial HIE efforts focused on quick value creation to build a track record and a foundation for future efforts The bigger opportunities are ahead