1. Why Initiate: The foundation for healthcare interoperability Lorraine Fernandes, RHIA Senior Vice President, Healthcare Practice Bill Klaver Product Manager

2. 2 About Initiate Systems and interoperability Over 2 billion records analyzed 1,400 healthcare facilities use Initiate technology Typically discover duplication rates of 15-30% in clean files Installations from 500K to 500M+ records Search and link across 150M records in sub second Offices Chicago, CA, TX, AZ, Australia, UK, Canada … Establish patient identity … Provide meds history profile … Create national prototype … Determine a member … Access clinical info on demand … Enable complete 360° Rx view … Advance interoperability … Share data securely … Create a national EHR

3. 3 The healthcare reality Volume of patient data increasing exponentially Quality of patient data declining Fragmented, duplicate and conflicting patient information within and across databases and touch points Regulatory and safety issues drive new requirements ADT Rob Johnson 1000 Main St. ADT Rob Johnson 1000 Main St. PACS Bob Johnson (555) 123-4567 PACS Bob Johnson (555) 123-4567 Lab Robert Johnson robj@aol.com Billing Bobby M. Johnson credit card# 5555-55-1234 Billing Bobby M. Johnson credit card# 5555-55-1234

4. 4 Patient identification enables the interoperability of tomorrows virtual health record EHRs, RHIOs and NHIN Improve patient care and reduce medical risks Improve efficiency by reducing redundant care activities Support consumer directed health information management Comply with regulations Enhance operational productivity and efficiency ROI

5. 5 Interoperability challenges in healthcare ecosystem Clinics, Labs, Imaging Hospital 1 Hospital 1 Hospital 2 Hospital 2 Hospital 3 Hospital 3 Physicians Network Clinical System Clinical System Pharmacy & Pharmacy Benefits Mgmt. Hospitals (for Inpatients & Outpatients) Hospitals (for Inpatients & Outpatients) Labs & Imaging Lab Systems Physician Public Health County General County General Real-time Query API Nightly Update XML Real-time Query API Real-time Updates SOAP Search Flat File Real-time Updates HL7 NCPDP Real-time Query Identity Identity Identity Identity Identity Identity Identity EHR, RHIO, NHIN

6. 6 Interoperability with Initiate starts with the Identity Hub P&C policyholder data Claims and billing data Debbie Becker NULL 5555-55-1234 Local identifier DBECKER1234 Commercial policyholder data Debbie Becker 9146 E VILLA DEL SOL NETOWN, CA 45885 Local identifier HOSPABC98765 Store #3908, Zip = Debbie Dozier - Becker 9146 E VIA DEL SOL NETOWN, CA 45883 Local identifier 12/19/61 – 727 Debbie Dozier NEED INFO 5555-55-1234 Local identifier 12345ABCDE Web self service data Debbie Becker 9146 VIA DEL SOL 480-473-3486 Local identifier BECKER4804733486 Initiate Identity Hub software 1.Derives & standardizes data for efficiency 2.Finds all potential matches 3.Use sophisticated probabilistic statistics to compare many attributes & score records 4.Puts results in 3 buckets – link, dont link, needs manual review Trusted system of record Trusted system of record 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234

7. 7 By answering these questions Do I know this person? Query (IHE PIX Manager) By ID information from both source and generated at the PIX Manager By demographics enhanced by multiple sources contained in the PIX Manager (PDQ capabilities) Where do I know this person from? Source demographics (IHE PIX & PDQ functionality) Source identity information is never lost from within and across sources What do I know about this person? Event demographics (IHE PDQ functionality) Information about events (i.e. patient chart, diagnosis, etc.) that have triggered a patient record How do I know this person? Linkage summary (IHE PIX Manager) Record of truth view across sources including the most current attributes Is there anything else I know about this person? Household information (Extended IHE PIX Manager) Information on patient relationships either household information within source across sources What can I do with this information? HL7 message integration (IHE Interoperability) Send, received, and updated via HL7 messaging How Initiate fits in with IHE?

8. 8 EMPI questions that drive interoperability What View of the patient are you allowed to see? What other information do we know about the patient? What can we do with this patient information? Do we know the patient? Is this the correct patient ? How do we keep the patient information in-sync? How do we get to the other information about the patient?

9. 9 EHR Healthcare ecosystem – interoperability applications Laboratory management Radiology management Medication management Patient financial management Medication management Medical management Patient portal On ramp to RHIO Patient financial management Composite public data On ramp to RHIO Medical management

10. 10 Healthcare expectations that drive interoperability Customer Portal Specific views – Create common view of customer per organizations objectives and marketing requirements. May address consumer, member, patient portal. Public Health EHR - Create virtual EHR of public databases such as immunization, disease-specific, biosurveillance, - with option to be payer specific for state funded healthcare.

11. 11 Billing Care delivery Purchasing Research Diagnosis Treatment Scheduling Communications The invocation of the necessary services to provide the most accurate information to the right place at the right time RegistrationProcessProcess Interoperability defined Patient Payor Provider PBM Supplier Pharmacy Public Health Public Health Radiology RHIO PeoplePeople Physician Etc. ERP Clinical Rx Resource Formulary Financial Research Data DI Patient 3 rd party/ Ref. data 3 rd party/ Ref. data Etc. Provider Privacy, Security, Standards, Regulatory Compliance

12. 12 Solution Reference architecture Lab mgt EMPI HIS Clinical Financial Provider 3 rd party Radiology mgt Customer portal Business Integration Hosting Medical mgt Medication mgt Sticky applications On ramp to RHIO Business Logic Infrastructure Application Services Core Business Services Messaging Services and Source Adapters Data Services Identity Services Consulting Data Services Security Services Initiate Standards Service