1. 0 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee HITSP Real World Sites Medication Management Webinar 8 September 10th, 2009 | 2:00 – 3:30 pm (Eastern) Moderator:Ken Majkowski, Surescripts Presenters: J. Marc Overhage, Regenstrief Institute Peter Kaufman, DrFirst

2. Slide 1 HITSP – enabling healthcare interoperability 2009 Webinar Series Learning Objectives  During this 90-minute webinar, participants will learn: — Learn how the HITSP Medication Management Interoperability Specification is being used today by the Regenstrief Institute, DrFirst, and Surescripts — Explore the value and limitations of external sources of medication history — Learn how various standards are employed in the HITSP Medication Management transactions — Discover how DrFirst and Regenstrief have employed HITSP in the real world in the areas of e-prescribing, patient eligibility, formulary and benefit inquiry, and medication reconciliation

3. Slide 2 HITSP – enabling healthcare interoperability 2009 Webinar Series Agenda  What is HITSP?  Surescripts case study  Regenstrief Institute case study  DrFirst case study  Overview of the 2009 Webinar Series  Questions?

4. Slide 3 HITSP – enabling healthcare interoperability 2009 Webinar Series Mission To serve as a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States.

5. Slide 4 HITSP – enabling healthcare interoperability 2009 Webinar Series  HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services — Created in 2005  HITSP develops Interoperability Specifications (IS) – documents that harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records — Production to date:13 IS and 60 related constructs Overview

6. Slide 5 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Stakeholders  Patients  Consumers  Employers  General Practitioners  Outpatient Providers  Government Agencies  Hospitals  Review Boards  Practice Guidelines  Residential Care Providers  Standards Developers  Specialists  Payers  Suppliers Current Participation in HITSP: 800+ organizations1,000+ individuals Over 25,000 volunteer hours

7. Slide 6 HITSP – enabling healthcare interoperability 2009 Webinar Series HIT Standardization HITSP members agreed that a standard is a well-defined approach that supports a business process and... — has been agreed upon by a group of experts — has been publicly vetted — provides rules, guidelines, or characteristics — helps to ensure that materials, products, processes and services are fit for their intended purpose — is available in an accessible format — is subject to an ongoing review and revision process Standards Harmonization is required when a proliferation of standards prevents progress rather than enabling it.

8. Slide 7 HITSP – enabling healthcare interoperability 2009 Webinar Series Released Accepted Recognized Federal projects must use HITSP recognized standards Per Executive Order 13410 Panel approved for submission to HHS Secretary of HHS has accepted for a period of testing Secretary of HHS has recognized the IS for immediate implementation Status: Interoperability Specifications

9. Slide 8 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 01 Electronic Health Record (EHR) Laboratory Results Reporting IS 02Biosurveillance IS 03Consumer Empowerment IS 04 Emergency Responder Electronic Health Record (ER- EHR) IS 05 Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management HITSP Interoperability Specifications (IS) Accepted Recognized

10. Slide 9 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 08Personalized Healthcare IS 09Consultations and Transfers of Care IS 10Immunizations and Response Management IS 11Public Health Case Reporting IS 12Patient – Provider Secure Messaging IS 77Remote Monitoring IS 107EHR Centric HITSP Interoperability Specifications (IS) Released / Panel Approved Accepted

11. Slide 10 HITSP – enabling healthcare interoperability 2009 Webinar Series “Meaningful Use” From existing Interoperability Specifications, determine subset required for “meaningful use” as called for in the American Recovery and Reinvestment Act (ARRA). Effort began on April 7, 2009.

12. Slide 11 HITSP – enabling healthcare interoperability 2009 Webinar Series All based on previous HITSP work

13. Slide 12 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 01 Electronic Health Record (EHR) Laboratory Results Reporting IS 02Biosurveillance IS 03Consumer Empowerment IS 04 Emergency Responder Electronic Health Record (ER- EHR) IS 05 Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management Today’s Focus... Accepted Recognized

14. 13 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Medication Management Real World Sites Surescripts Ken Majkowski, Pharm. D. Vice President, Clinical Affairs and Product Strategy, Surescripts

15. Slide 14 HITSP – enabling healthcare interoperability 2009 Webinar Series Definition of E-Prescribing  E-Prescribing supports a shift to a paperless and more informed way for payers, prescribers and pharmacists to communicate.  E-Prescribing occurs when a prescriber uses a computer or handheld device with software that enables him or her to: — Electronically access that patient’s prescription benefit. — With a patient’s consent, electronically access that patient’s prescription history. — Electronically route the prescription to the patient’s choice of pharmacy. When the patient runs out of refills, his or her pharmacist can also electronically send a prescription renewal request to the physician’s office for approval.

16. Slide 15 HITSP – enabling healthcare interoperability 2009 Webinar Series Provides electronic delivery of patient prescription history from payers and pharmacies to prescribers Prescription History Data:  Date Range of History  Drug Name (Brand/Generic)  Oldest Fill Date, Most Recent Fill Date  Number of Fills, Days Supply, Quantity Dispensed  Pharmacies/Prescribers

17. Slide 16 HITSP – enabling healthcare interoperability 2009 Webinar Series Surescripts National Progress Report Summary Adoption200620072008Q2 2009 Prescription Benefit 33M37M 79M 9% patient visits 66M Prescription History 4M7M 16M 1.8% patient visits 24M Prescription Routing 11M29M 68M 4% eligible Rxs 78M Total Message Volume 69M107M242M303M Opportunity: According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons. According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)

18. Slide 17 HITSP – enabling healthcare interoperability 2009 Webinar Series Opportunity: Adoption200620072008Q2 2009 Prescribers 16K36K74K 126K 21% prescribers Payer Member Records 160M200M230M222M Community Pharmacies 34K41K47K 50K 82% pharmacies Mail Order Facilities 3366 According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons. According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.) Surescripts National Progress Report Summary, continued

19. Slide 18 HITSP – enabling healthcare interoperability 2009 Webinar Series Medication History for Hospitals Provides clinicians access to up-to-date medication history for patients they are treating in an inpatient setting  Person search  Dispensed claims medication history

20. Slide 19 HITSP – enabling healthcare interoperability 2009 Webinar Series Medication History for Hospitals, continued  Delivered to the acute care setting via strategic distribution partners: — DrFirst — Emerging Health — GE Healthcare — Healthcare Systems — InterMedHx  HL7 Interface — ADT — RDS — ORU — Regenstrief — Siemens — Standard Register — others

21. Slide 20 HITSP – enabling healthcare interoperability 2009 Webinar Series Value Drivers – Disaster Relief  In response to the lessons learned in the aftermath of Hurricane Katrina, a collaborative of public and private organizations launched ICERx.org (In Case of Emergency Prescription Database).  This online resource allows authorized physicians and pharmacists to get evacuees’ medication records  Prescription history information is pooled from a variety of sources, including Surescripts, payers and state Medicaid programs.  This information allows health care professionals to safely renew prescriptions for evacuees and help coordinate care, while avoiding harmful prescription errors and potential drug interactions.  For more information, visit www.icerx.org.

22. Slide 21 HITSP – enabling healthcare interoperability 2009 Webinar Series Additional External Medication History Sources  State Medicaid Programs  Enterprise Medication History Databases  Pharmacy Benefits Managers (PBMs)  Health Plans  Pharmacies  Personal Health Records (PHRs)  Others

23. Slide 22 HITSP – enabling healthcare interoperability 2009 Webinar Series For More Information The E-Prescribing Resource Center www.surescripts.com A Comprehensive Resource Center for Payers, Prescribers and Pharmacists http://www.surescripts.com/news-sign-up.html

24. 23 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Medication Management Real World Sites Regenstrief Institute J. Marc Overhage, M.D., Ph.D. Director of Medical Informatics and Research Scientist, Regenstrief Institute

25. Slide 24 HITSP – enabling healthcare interoperability 2009 Webinar Series Background

26. Slide 25 HITSP – enabling healthcare interoperability 2009 Webinar Series Regenstrief – Solutions and Problems Solved  Incomplete medication histories  Fragmented patient data  Difficult to obtain electronic formularies  Difficult to maintain pharmacy data  Providers without an Electronic Medical Record (EMR)

27. Slide 26 HITSP – enabling healthcare interoperability 2009 Webinar Series  ePrescribing — Provide a comprehensive medication history (greater starter set) — Incorporate allergies and other clinical data — Incorporate formulary decision support — Capture prescriptions written  Medication Management — Provide a comprehensive medication history — Incorporate allergies and other clinical data — Incorporate formulary decision support Regenstrief – Use Cases

28. Slide 27 HITSP – enabling healthcare interoperability 2009 Webinar Series E-Prescribing Flowchart Dispensing Databases PBM Databases Claims Database Formulary Databases Provider’s Appointment System Prescribing Databases Medication History Patient Matching Merge Sources Merge providers Aggregate De-duplicate Records Age Records Compute MPRs Matching prescription and dispensing data Provide views of merged data Allergy checking Clinical decision support Formulary Prescription Records HL7 Appointment Surescripts

29. Slide 28 HITSP – enabling healthcare interoperability 2009 Webinar Series E-Prescribing Flowchart, continued Surescripts Prescribing Databases Prescription HITSP T43 Med Order NCPDP SCRIPT Std. Update Prescribing Database

30. Slide 29 HITSP – enabling healthcare interoperability 2009 Webinar Series  Constructs — C 26 : Nonrepudiation of Origin — C 38 : Patient Level Quality Data Document — C 44 : Secure Web Connection — C 80: Clinical Document and Message Terminology  Transactions — T 16: Consistent Time — T 17: Secured Communication Channel — T 31: Document Reliable Interchange — T 68: Patient Health Plan Authorization Request and Response  Transaction Packages — TP13: Sharing of documents — TP20: Access Control Transaction Package — T 15: Collect and Communicate Security Audit Trail Transaction — TP 43: Medication Orders Transaction Package — TP 46: Medication Formulary and Benefits Information Transaction Package HITSP Constructs Used

31. Slide 30 HITSP – enabling healthcare interoperability 2009 Webinar Series Solution & Benefits  More complete medication histories for more patients  Data from multiple sources enriched the clinical context (laboratory results, allergies, diagnoses)  More formularies available  Patients cared for by providers without Electronic Medical Records (EMRs) still received the benefit of clinical decision support

32. Slide 31 HITSP – enabling healthcare interoperability 2009 Webinar Series Successes  Reduced number of adverse drug events  Improved therapeutic monitoring  Improved formulary adherence  lower patient costs  Improved provider satisfaction

33. Slide 32 HITSP – enabling healthcare interoperability 2009 Webinar Series For More Information www.regenstrief.org

34. 33 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Medication Management Real World Sites DrFirst Peter N. Kaufman, M.D. Chief Medical Officer, DrFirst, Inc.

35. Slide 34 HITSP – enabling healthcare interoperability 2009 Webinar Series Impact of E-Prescriptions on Physician Office Workflow  Improve efficiency - Increase staff productivity  Improve patient safety, quality of care, and satisfaction  Minimize time spent phoning/faxing to clarify prescriptions and authorize renewal requests  Minimize time spent phoning and faxing to ensure formulary compliance  Minimize chart pulls - Reduce time to find prescribing information  Simplifying staff workflow, allowing completion of refill authorizations in seconds, not hours  Remotely check patient medications and allergies – and prescribe

36. Slide 35 HITSP – enabling healthcare interoperability 2009 Webinar Series Information Available in the E-Prescribing Workflow via HITSP and SDO Technical Standards  Patient Demographics (HL-7, CCD)  Eligibility (X12 270/271)  Medication History (NCPDP SCRIPT) — Pharmacies — Payors  Formulary and Benefits (tiers, co-pays, substitution) (NCPDP SCRIPT)  Renewal Requests (NCPDP SCRIPT)  New Prescription (retail and mail order) (NCPDP SCRIPT)

37. Slide 36 HITSP – enabling healthcare interoperability 2009 Webinar Series Workflow: example  Staff confirms on arrival: — Demographics — Pharmacy - ask patient — Medication History List - pull down through Surescripts and confirm with patient  Prescriber: — Reviews current medication list — Insurance eligibility is displayed — Formulary alerts, substitution, co-pay etc. present when medication is chosen — Clinical alerts present during prescribing, if applicable

38. Slide 37 HITSP – enabling healthcare interoperability 2009 Webinar Series Standards Not Yet in Wide Use for E-Prescriptions  Allergies (CCD)  Diagnoses (CCD)  Prior authorization (NCPDP SCRIPT)  RxNorm (to supplement/replace NDC codes)  Structured and codified SIG (NCPDP SCRIPT)

39. Slide 38 HITSP – enabling healthcare interoperability 2009 Webinar Series Remember... Having a feature is not the same as having a usable feature

40. Slide 39 HITSP – enabling healthcare interoperability 2009 Webinar Series How Physicians Realize the Benefits of True Electronic Prescribing  Improves efficiency — Minimizes time spent phoning and faxing to clarify prescriptions, authorize renewal requests and ensuring formulary compliance  Inbound calls decreased from 36% to 18.5% of RX filled; outbound calls were reduced by more than 50%  Increases staff productivity — Simplifies staff workflow, allowing completion of refill authorizations in seconds, not hours — Enables remote access to patient medications and allergies — Re-allocate staff time to other activities

41. Slide 40 HITSP – enabling healthcare interoperability 2009 Webinar Series  Improves quality of care — Improves safety and quality of care: drug/drug drug/allergy, drug/diagnosis and dose checking, medication history — Reduces errors due to misread prescriptions and medications with similar sounding names  Increases patient satisfaction — Decreases pharmacy wait times while improving safety — Formulary compliance can reduce co-pays How Physicians Realize the Benefits of True Electronic Prescribing, continued

42. Slide 41 HITSP – enabling healthcare interoperability 2009 Webinar Series Peter N. Kaufman, MD CMO, DrFirst 3206 Tower Oaks Blvd. #310 Rockville, MD 20854 Cell: 301-806-8004 pkaufman@drfirst.com For More Information

43. Slide 42 HITSP – enabling healthcare interoperability 2009 Webinar Series Webinar 1 Advances in Sharing Information in Healthcare IT Thursday, January 15, 2009 — 2:00-3:30 pm Eastern Webinar 7HITSP eTown Hall II with Dr. John Halamka Thursday, August 27, 2009 — 2:00-3:30 pm Eastern Webinar 2Personalized Healthcare Interoperability Specification (IS 08) Thursday, February 12, 2009 — 2:00-3:30 pm Eastern Webinar 8Medication Management Real World Sites Thursday, September 10, 2009 — 2:00-3:30 pm Eastern Webinar 3Consultations and Transfers of Care Interoperability Specification (IS 09) Thursday, March 12, 2009 — 2:00-3:30 pm Eastern Webinar 9HITSP EHR Centric Interoperability Specification Thursday, October 8, 2009 — 2:00-3:30 pm Eastern Webinar 4NHIN Real World Sites Thursday, April 16, 2009 — 2:00-3:30 pm Eastern Webinar 10Security, Privacy, and Infrastructure Thursday, November 12, 2009 — 2:00-3:30 pm Eastern Webinar 5HITSP eTown Hall I with Dr. John Halamka Thursday, June 18, 2009 — 2:00-3:30 pm Eastern Webinar 11Quality Measures Real World Sites Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern Webinar 6Health Information Exchange (HIEs) in the Real World Thursday, July 9, 2009 — 2:00-3:30 pm Eastern NOTE: Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.  The 2009 Webinar Series www.HITSP.org/webinars       

44. Slide 43 HITSP – enabling healthcare interoperability 2009 Webinar Series Questions Welcomed

45. Slide 44 HITSP – enabling healthcare interoperability 2009 Webinar Series View the Complete Set of HITSP Deliverables www.HITSP.org www.HITSP.org

46. Slide 45 HITSP – enabling healthcare interoperability 2009 Webinar Series  Use or specify recognized HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs)  Ask for CCHIT certification  Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future  Ask... Is there a HITSP standard we could be using?  Get involved in HITSP... Help shape the standards Implementation feedback to HITSP is welcome How YOU can become involved

47. Slide 46 HITSP – enabling healthcare interoperability 2009 Webinar Series Allyn Clemons, HIMSSTheresa Wisdom, HIMSS aclemons@himss.orgaclemons@himss.org twisdom@himss.orgtwisdom@himss.org Re: HITSP Technical Committees Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.org or contact:www.hitsp.org

48. Slide 47 HITSP – enabling healthcare interoperability 2009 Webinar Series Sponsor Strategic Partners www.HITSP.org