1. CP1318694-0 Bridging the Chasm Nina Schwenk, MD FACP Washington DC April 20, 2009 Nina Schwenk, MD FACP Washington DC April 20, 2009

2. CP1318694-1 Meeting Goals Establish the value of standards and interoperability to the clinical community Identify priorities from a clinical perspective Have clinicians clearly articulate their requirements in non-technical terms Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community Establish the value of standards and interoperability to the clinical community Identify priorities from a clinical perspective Have clinicians clearly articulate their requirements in non-technical terms Identify common processes by which the specialty groups can define and communicate information requirements to the HIT community

3. CP1318694-2 Thank You

5. CP1318694-4 Health Care Information Technology Standards & Interoperability Summit November 18 - 20, 2008 Providers invited to summit included: Cleveland Clinic Dartmouth Health Partners Henry Ford Health System Kaiser Permanente Intermountain Healthcare Lahey Clinic Mayo Clinic Ochsner Health System Palo Alto Medical Foundation Partners Healthcare University of Pittsburgh Medical Center Vanderbilt Medical Center Virginia Mason Medical Center

6. CP1318694-5 Health Care Information Technology Standards & Interoperability Summit November 18 - 20, 2008 Vendors invited to summit included: Avaya Cerner Cisco Dell Epic GE Health Care Google Hewlett Packard IBM Intel Lawson McKesson Microsoft Oracle Siemens Sun Microsystems

7. CP1318694-6 Summit Goal Through a consensus process identify three to six health care IT-dependent solutions that will overcome critical barriers to patient-centered health care delivery through increased interoperability and application of established national and international standards. Engage participating provider and IT partner groups to work collaboratively to develop these solutions.

8. CP1318694-7 Provider Session

9. CP1318694-8 Agenda Barriers to Patient-Centered Care Delivery Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions Dr. Robert Kolodner Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery Creating an Action Plan for Providers Barriers to Patient-Centered Care Delivery Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions Using Health IT to Advance Health Care Reform: Moving Beyond Theory to Pragmatic Solutions Dr. Robert Kolodner Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery Creating an Action Plan for Providers

10. CP1318694-9 Which of these statements best describes the U.S. health care system today? (select one) 1.Complete state of crisis 2.Overall – major problems 3.Some segments with major problems 4.Few segments with major problems 5.No significant problems 1.Complete state of crisis 2.Overall – major problems 3.Some segments with major problems 4.Few segments with major problems 5.No significant problems

11. CP1318694-10 Rank these entities on the degree they would influence health reform: (Rank each item 1 to 10 with 1 being no influence, 10 being major influence) Federal government State government Health care providers Health care payers Employers/non-health organizations Consumers/individuals Federal government State government Health care providers Health care payers Employers/non-health organizations Consumers/individuals

12. CP1318694-11 In your opinion, how much influence do you think the following groups have had on increasing medical costs in the United States? (Rank the list in order of influence) 1.Doctors and hospitals 2.Drug companies 3.Medical technology companies 4.Insurance companies 5.People who don’t take care of themselves 1.Doctors and hospitals 2.Drug companies 3.Medical technology companies 4.Insurance companies 5.People who don’t take care of themselves

13. CP1318694-12 In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics: (Rank each item 1 to 10 with 1 being not difficult,10 being very difficult) 1.Healthcare 2.War 3.Illegal immigration 4.Automaker bailout 5.Banking bailout 6.Foreign Policy 1.Healthcare 2.War 3.Illegal immigration 4.Automaker bailout 5.Banking bailout 6.Foreign Policy Difficulty

14. CP1318694-13 In the next 100 days, how difficult/important will it be for President Elect Obama to address the following topics: (Rank each item 1 to 10 with 1 being not important, 10 being very important) 1.Healthcare 2.War 3.Illegal immigration 4.Automaker bailout 5.Banking bailout 6.Foreign Policy 1.Healthcare 2.War 3.Illegal immigration 4.Automaker bailout 5.Banking bailout 6.Foreign Policy Importance

15. CP1318694-14 ImportanceImportance Difficulty

16. CP1318694-15 Barriers to Patient-Centered Care Delivery Health Care Reform Cornerstones Creating Value Coordinated Care Payment Reform Health Insurance for All Health Care Reform Cornerstones Creating Value Coordinated Care Payment Reform Health Insurance for All

17. CP1318694-16 Barriers to Patient-Centered Care Delivery Perspectives Patient Provider Purchaser Payer Perspectives Patient Provider Purchaser Payer

18. CP1318694-17

19. CP1318694-18 Using Health IT to Advance Health Care Reform “Moving Beyond Theory to Pragmatic Solutions” “Moving Beyond Theory to Pragmatic Solutions” Dr. Robert Kolodner “Moving Beyond Theory to Pragmatic Solutions” “Moving Beyond Theory to Pragmatic Solutions” Dr. Robert Kolodner

20. CP1318694-19 Overview of the Federal Health IT Strategic Plan Establish a governance structure that coordinates organizational processes Establish a governance structure that coordinates organizational processes Protect the privacy and security of patient health information Protect the privacy and security of patient health information Enable the movement of health information by setting standards that allow interoperability Enable the movement of health information by setting standards that allow interoperability Promote adoption of technologies Promote adoption of technologies Establish a nationwide health information network Establish a nationwide health information network Establish a governance structure that coordinates organizational processes Establish a governance structure that coordinates organizational processes Protect the privacy and security of patient health information Protect the privacy and security of patient health information Enable the movement of health information by setting standards that allow interoperability Enable the movement of health information by setting standards that allow interoperability Promote adoption of technologies Promote adoption of technologies Establish a nationwide health information network Establish a nationwide health information network

21. CP1318694-20 * Information Sharing & Exchange * Standards & Interoperability

22. CP1318694-21 Engaging Health Care IT to Reduce Barriers to Patient-Centered Care Delivery

23. CP1318694-22 Patients Providers Purchasers Payers Industry Regulators Compliance Government Health Care Ecosystem Today

24. CP1318694-23 Lack of “interoperable” health care ecosystem

25. CP1318694-24 Business Case for “Interoperable” Health Care Ecosystem Value Cost Coordinated Care Innovation New Business Opportunities Effectiveness and Efficiency Intelligence gathering Market Value Cost Coordinated Care Innovation New Business Opportunities Effectiveness and Efficiency Intelligence gathering Market

26. CP1318694-25 Health Care IT Dependent Opportunities Personal Health Record Patient Provided Information Vocabulary Universal Patient Identifier Clinical Data Architecture Standard, interoperable core medical information Affordability to purchasers and patients/efficiency Standard measures of value Personal Health Record Patient Provided Information Vocabulary Universal Patient Identifier Clinical Data Architecture Standard, interoperable core medical information Affordability to purchasers and patients/efficiency Standard measures of value Safety (clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized network-to- network interoperability Infrastructure vendor collaboration EMR vendor collaboration

27. CP1318694-26 (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Patient Centered Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration

28. CP1318694-27 (Rank each item 1 to 10 with 1 being low priority, 10 being high priority) Business Value Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration Personal Health Record Patient provided information Vocabulary Universal patient identifier Clinical data architecture Core medical information Affordability to purchasers and patients /Efficiency Standard measures of value Safety (Clinical quality) Coordination of care Device manufacturer standardization Clinical decision support tools Medication reconciliation Standardized Network-to-network interoperability Inter-organizational interoperability Infrastructure vendor collaboration EMR vendor collaboration

29. CP1318694-28

30. CP1318694-29 Provider priorities to support health care Value and Coordinated Care Universal patient identifier Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more. Vocabulary Standardized network-to-network interoperability (i.e. NHIN) Medication reconciliation Universal patient identifier Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for communication among EMRs, PHRs, medical devices and more. Vocabulary Standardized network-to-network interoperability (i.e. NHIN) Medication reconciliation

31. CP1318694-30 Creating an Action Plan for Providers 1. Establish a provider coalition that would drive a collective agenda to advance the top two priorities developed here 2. Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape 3. Advance the top two priorities developed here by integrating with the existing landscape 1. Establish a provider coalition that would drive a collective agenda to advance the top two priorities developed here 2. Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape 3. Advance the top two priorities developed here by integrating with the existing landscape

32. CP1318694-31

33. CP1318694-32 Creating an Action Plan for Providers Establish a provider coalition to advance the top two priorities developed here that connects to the larger landscape

34. CP1318694-33 Joint Provider/IT Vendor Session

35. CP1318694-34 Agenda Review Provider session outcomes Engage IT Vendors in discussion regarding barriers and solutions Engage IT Vendors in discussion regarding barriers and solutions Determine next steps Review Provider session outcomes Engage IT Vendors in discussion regarding barriers and solutions Engage IT Vendors in discussion regarding barriers and solutions Determine next steps

36. CP1318694-35 Provider expectations for IT Partners Universal patient identifier IT partners must support the use of a voluntary and/or required universal patient identifier Universal patient identifier IT partners must support the use of a voluntary and/or required universal patient identifier

37. CP1318694-36 Provider expectations for IT Partners Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others. Vocabulary Standardized network-to-network interoperability (i.e. NHIN) Medication reconciliation IT partners must support interoperability standards Standardized, interoperable core medical information (meds, allergies, problem list as a starting point) for exchange among EMRs and PHRs and others. Vocabulary Standardized network-to-network interoperability (i.e. NHIN) Medication reconciliation IT partners must support interoperability standards

38. CP1318694-37

39. CP1318694-38 Joint Action Plan for Providers and IT Vendors Establish a coalition to advance the top two priorities developed here that connects to the larger landscape

40. CP1318694-39 Coalition Output to Date Letter of support to Congress (HIT funding) HIT Framework for Action (principles for HIT investment) Input to the ONC on its Strategic Plan update Letter of support to Congress (HIT funding) HIT Framework for Action (principles for HIT investment) Input to the ONC on its Strategic Plan update

41. CP1318694-40 Coalition Output to Date Position on “Meaningful Use” provision in the Stimulus Bill Grant proposal for stimulus funding to further coalition objectives Invite additional members? Position on “Meaningful Use” provision in the Stimulus Bill Grant proposal for stimulus funding to further coalition objectives Invite additional members?

42. CP1318694-41 Thank You

43. CP1318694-42 Thank You