1. An EHR isn’t Enough: Information Exchange for Meaningful Use June 18, 2010 Tri-State REC Kickoff Michele Fronckiewicz Executive Director Child Health Administrative Services, LLC

2. What is CHAS? Subsidiary of Cincinnati Children’s Provides customized practice management, clinical and workflow solutions to community physicians Supports both pediatric and adult, primary and specialty care physicians in Indiana, Kentucky and Ohio

3. Our EMR Journey Best of breed vs. integrated model Primary and specialty care Physician engagement

4. Required Functionality - 2004 Patient record flow is intuitive Entry of data for documentation allows for different methods – keyboard; checkboxes; light pen; mouse; touch screen; handwriting recognition. Allergy checking and adverse reaction tracking Design and store patient education materials Automatic printing of immunization history on a state-accepted form Print out prescription to give to patient Disease/condition specific assessment templates automatically pop up based on “Chief Complaint” Physical assessment can be grouped by body systems with drop down boxes which default to normal findings. Automatic assignment of CPT codes based on documentation Telephone calls can be documented as part of the patient record

5. Additional Service Needs - 2004 Interface with CCHMC for labs/radiology Interface with State immunization registries in Ohio and Indiana Interface with patient registries

6. HealthBridge: The Ideal Solution National leader in health information exchange With one interface, connect to 26 facilities, 3 national labs and local diagnostic centers HealthBridge’s relationship with HealthLINC in Bloomington provides access to additional Indiana based facilities Willing partner for expansion to new facilities

7. HealthBridge Outcomes Since September, 2008 –62,207 results processed through the interface Including lab (65%), radiology and transcription (35%) –Feedback highly positive from physicians and nurses –Great opportunity to provide greater impact: nurse practitioners; additional transcription and ordering physician processes

8. Original Workflow Paper result arrives in provider office. Staff sorts results and distributes to MD. Nurse contacts family with result status. Nurse presents paper result for filing/scanning. Staff pulls chart and files or scans and indexes result to e-chart. MD reviews and provides direction for phone call to family.

9. New Workflow Electronic result arrives in patient chart and provider approval queue. MD reviews, approves and forwards request to nurse to initiate phone call to family. Nurse contacts family with result status.

11. CCHMC Community EMR Project Launches July, 2010 Provides access to a subsidized EMR via the Stark-AKS HIT exceptions Builds upon existing HealthBridge-NextGen exchange functionality

12. Meaningful Use (PFR) – Stage 1 Receive structured results and display in readable format Exchange clinical information electronically with other providers Submit data to immunization registries Submit reportable lab results to public health agencies Submit syndromic surveillance data to public health agencies

13. Meaningful Use – Key Components Physician champion and engaged physicians and staff EHR vision and specific, measurable goals EHR application with interoperability capabilities Strong, local support of the application

14. You can lead a horse to water….