1. Interoperable EHRs Proposed Vision for HIE in Southern Illinois Stakeholder Meeting April 23, 2009 Nick Bonvino Executive Consultant Connect SI *NB Consulting, Inc. 2008 All rights reserved Reproduction or use without permission is prohibited

2. Agenda Brief review of national, state, and local initiatives…the Ultimate Objective Sustainability Model Administration and Operations Technology Architecture Project Work Plan and Budget Stakeholder Consortium

3. Executive Order, April 2004: The President created the National Coordinator position To advance the vision of developing a nationwide interoperable health information technology infrastructure To achieve the Presidents goal of widespread adoption of interoperable electronic health records (EHR) by 2014 Key Role for ONC: Provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care K e y R o l e f o r O N C : P r o v i d e l e a d e r s h i p f o r t h e d e v e l o p m e n t a n d n a t i o n w i d e i m p l e m e n t a t i o n o f a n i n t e r o p e r a b l e h e a l t h i n f o r m a t i o n t e c h n o l o g y i n f r a s t r u c t u r e t o i m p r o v e T h e q u a l i t y a n d e f f i c i e n c y o f h e a l t h c a r e a n d T h e a b i l i t y o f c o n s u m e r s t o m a n a g e t h e i r h e a l t h National Health IT Agenda Office of the National Coordinator (ONC)

4. Nationwide Health Information Network Five Critical Components Necessary For Nationwide Interoperable Health Information

5. The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. David M. Eddy (1990) Source: CBO Evidence on the Costs and Benefits of Health Information Technology May 2008 4% 14% Percent of Physicians

6. 100 80 60 40 20 0 3% 23% Size of Hospital > 500 beds Hospital* Percentage < 50 beds *Rate of hospital use does not represent physician use; only ¼ of implemented hospitals report 50% MD use (or more) 100 80 60 40 20 0 68% 11% Level of Function Full or partial adoption Minimally Functional EHRs Hospital* Percentage Current HOSPITAL EHR Adoption Rate (2007)

7. Physician Office rate of EHR Adoption varies by definition 43% Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the United States, Preliminary Data 20% 4% 14% 23% 0% 25% 50% 75% Historical NAMCS EHR Minimally Functional EHR All electronic Part paper, part electronic Percent of Physicians 2007 AMBULATORY results

8. Full-Function EHRs - The Ultimate Objective EHRs used interactively at the point of care delivery interoperable with all relevant data sources complimenting the caregiver with a body of knowledge and clinical tools accessible by patients and other providers Enabling the practice of Evidence Based Medicine and Quality Measures

9. Managing Patient Behavior & Care Delivery Reducing the variation of treatment thru alerts and reminders at the point of care (45% of care is either under or over utilized) Providing Quality measures and reporting against evidence based medicine (EBM) standards Managing and influencing patient behavior by increased communications with caregivers and patient health information

10. Sustainability Model Create a Sustainable Business Model that funds the initial investment and ongoing support of this future state vision with all stakeholders contributing their pro-rata share based upon the accrual of benefits.

11. Administration and Operations Determine the appropriate neutral entity to serve as the focal point for collaboration representing all stakeholders. This will be the actual provider of shared services to support the governance and operations of the HIE.

12. Technology Architecture Identify the appropriate Technology Architecture consistent with standards outlined by the Office of the National Coordinator (ONC) and as a component of a state-level HIE, including: Certification Privacy & Security Interoperability Governance

13. Project Work Plan and Budget Produce a Project Work Plan and Budget that plans a program for the mass deployment of EHRs and an HIE. This will take advantage of economies of scale and shared services to most efficiently and effectively transform healthcare in Southern Illinois.

14. Stakeholders Connect SI will coordinate and facilitate HIE planning with a Consortium that represents a minimum of 50% of the covered lives, 75% of medical transactions, 50% of Stakeholder groups including FQHCs & Public Health Departments in our MTA.