1. 1 February 15, 2006 The Community Health Record: Beyond Interoperability Dan Soule Director, Provider & National Health Strategies

2. 2 Presentation Topics Overview of the National Agenda Health Information Exchange and interoperability Community Health Record, going beyond interoperability Case Study: TennCare Benefits

3. 3 National agenda…in summary Support for Health Care IT is Growing  Federal Focus and Coordination  Bi-partisan Support  Funding Sources Emerging  Pay-for-Performance Demonstrations  CMS  DOQ-IT  Others (Bridges to Excellence) RHIOs are Underway…  Acute & Ambulatory EHRs  Personal Health Records  Health Information Exchange “RHIOs” Brailer’s office gets structure from HHS  Office of Health Information Technology adoption  Office of Interoperability and Standards  HITSP, CCHIT, HSPC, NHIN contracts

4. 4 Provider Electronic Health Record  CPOE, ePrescribing, used in multiple venues of care, administrative management, billing, reporting, etc. Personal Health Record  Personal health status Community Health Record “RHIO”  Serves a geography and/or health system network  Ties into a national infrastructure  Derives summary record derived from multiple sources  Serves the population  Enables biohealth, public health, outcomes management  Pay for performance Types of electronic health record (EHR)

5. 5 Basic Community Health Information Exchange (HIE) Community Health Record Person Directory (CMPI) Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR) IHE Patient Identity (PIX, PDQ) Interoperable Document Sources & Consumers (XDS) IHE Document Registry (XDS) IHE Document Repository (XDS) Distributed or centralized IHE Document Repository (XDS) Distributed or centralized

6. 6 Clinicians without an EHR Helping Non-EHR Enabled Clinicians Community Health Record Person Directory Current and near term state: Large number of non-EHR clinicians (cost, complexity, trust, etc.) CHR Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR)

7. 7 Clinicians without an EHR Improving Data with Health Plan Claims Community Health Record Person Directory Claims data can be a reasonable substitute in the absence of original clinical data CHR Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR) Health Plans\ (claims) Health Plans (claims)

8. 8 Clinicians without an EHR Hybrid Architecture (distributed & centralized) Community Health Record Person Directory CHR Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR) Comprehensive data set Health Plans\ (claims) Health Plans (claims) Minimal patient safety data set: medications, allergies, problems, etc.

9. 9 CHR Viewer for Non-EHR Clinicians Payer PBM Payer and State Registry Reference Labs Provider

10. 10 Clinicians without an EHR Prescription Processing Payer PBM Pharmacy E-Prescribing Adds Sustainable Value Community Health Record Person Directory CHR Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR) Health Plans\ (claims) Health Plans \ (claims) Patient Safety Data Set enables ePrescribing benefits

11. 11 Treatment map for Hypertension. Drug classes with medications approved to treat the condition displayed along with formulary and drug-drug, drug-allergy indicators (if applicable) CHR e-Prescribing

12. 12 Clinicians without an EHR Prescription Processing Payer PBM Pharmacy Additional Stakeholder Benefits Community Health Record Person Directory Additional “RHIO” stakeholders and functionality Outcomes Utilization Fraud and Abuse Biosurveillance Disaster Management Immunization Registry Clinical Trials Enrollment Protocol Management Life Sciences Discovery Clinical Research Public Health Analytics CHR Dx/Tx Providers Lab D.I. Personal Health Record (PHR) Personal Health Records (PHR) Provider Electronic Health Records (EHR) Health Plans\ (claims) Health Plans \ (claims)

13. 13 Community Health Record: Beyond Interoperability Helping non-EHR enabled providers: with a light-weight EMR Hybrid architecture combines benefits of centralized and distributed models Filling in the clinical data gaps with Health Plan data Adding sustainable value with ePrescribing Benefits for other stakeholders: Public Health, Outcomes, Clinical Research ic

14. 14 TennCare Medicaid population  TennCare coverage: 1.1 million out of 5 million (~25%)  BCBST is MCO for 55% of TennCare. (Six other MCO cover 45%) TennCare funding issues  Relatively generous benefits (“as medically necessary”)  Large waiver population above Federal Medicare limits  Average TennCare patient gets 30 prescriptions/year, compared to national average of 12  McKinsey Report: “Unconstrained, TennCare will consume 90% of each new state tax dollar in the year 2008” Funded by State  Per month / per month basis  Immediate positive return for the state TennCare – Early Adopter

15. 15 Population  TennCare lives - 1,100,000  BCBST commercial lives - 2,000,000 (targeted Q2, 2006)  Medicare lives - 870,000 (targeted Q4, 2006) Services  Phase 1 “Core” – community health record (CHR), EMPI, and lightweight documentation (EPSDT)  ePrescribing pilots in process, broad physician roll-out targeted Q2, 2006 Current progress  All 1,100,000 TennCare lives with a CHR  Approximately 2,500 unique users (400 plus sites)  Adding ~ 100 new users a week Tennessee - Early Adopter

16. 16 Improve care coordination and/or reduce clinical waste  Reduce inpatient admissions due to incomplete data in the ED  Reduce repeat outpatient visits due to incomplete patient data  Decrease wasteful diagnostic tests More efficient use of medications  Reduce adverse drug events (ADEs)  Increase formulary-driven savings (generics)  Promote evidence-based prescribing (stepped care & therapeutic switch)  Reduce medication waste (redundant orders; over-utilization) Reduce fraud and abuse Improve health maintenance compliance  Increase participation rates for EPSDT and immunizations  Reduce costs around EPSDT (monitoring and legal liability) Details Of Expected Benefits

17. 17 Thank You Dan Soule Director, Provider & National Health Strategies dsoule@cerner.com