1. HealthBridge is one of the nation’s largest and most successful health information exchange organizations. An Overview of the IT Strategies for Transitions in Care Transforming Health Care Through Connectivity and Collaboration May 20, 2011

2. Background 2 One of the nation’s largest and most successful community health information exchanges In operation since 1997 Provides secure, real-time electronic health information exchange for Greater Cincinnati- Northern Kentucky tri-state area One of only a handful of HIE/RHIOs nationwide with cash-positive, sustainable business model (Pre ARRA) 97% of revenue from fees; <3% grants 5-8% annual return for last seven years

3. Network Size 3 Delivers more than 3 million clinical messages PER MONTH; more than 32 million messages for 2010 Greater Cincinnati Tri-State area includes 24 local hospitals in Kentucky, Ohio and Indiana 5500+ physicians 17 local health departments Large commercial, hospital, & physician office labs Diagnostic centers EMR Feeds to 26 different vendors, 60+ versions 68 HIS/Data Provider connections for 10 different organizations Provide technology infrastructure for four other HIEs – Total of 50+ hospitals, 7500 physicians

4. Today’s Discussion HIT Perspective Key Definitions The Mysterious C32 Alert system for ER & Hospital Admissions Rapid Identification of potential readmits within 30 days Summary record exchange supporting key Transitions in Care 4

5. Key Definitions Continuity of Care Record (CCR): A core data set of the most relevant facts about a patient’s health care. The CCR provides information that is: (1) appropriate, succinct, organized and up- to-date; (2) interoperable through use of specified XML code; and (3) a necessary bridge to a different environment, often with new practitioners who know little about the patient. It may be prepared, displayed and transmitted on paper or electronically. 5

6. Key Definitions Continuity of Care Document (CCD): An XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange. It provides a means for one health care practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another practitioner, system or setting to support the continuity of care. Its primary use case is to provide a snapshot in time containing the pertinent clinical, demographic and administrative data for a specific patient. The CCD specification is a constraint on the HL7 Clinical Document Architecture (CDA) standard, a summary record of care as originally defined by ASTM as CCR and then jointly developed by ASTM and HL7 as CCD. The CDA specifies that the content of the document consists of a mandatory textual part (which ensures human interpretation of the document contents) and optional structured parts (for software processing).

7. The Mysterious C32 A Specific Format for a CCD with the broadest set of Clinical, Administrative and Financial Content Is used by most EMR vendors as the standard way to transfer data from one EMR to another including EPIC The minimum desired content includes Problems, Allergies, Medications and Test Results Content varies widely depending on the EMR vendor’s implementation Used to inform the receiving provider on the current health status of the patient at a particular moment in time

8. Supporting Transitions in Care ED / Inpatient Alerts Notifies PCP or other interested parties about an ED Registration or Inpatient Admission within minutes HIE receives all ADT messages from acute care providers Alert initiates other care coordination activities Alert anticipates a future care transition

9. Readmissions within 30 days A potential unanticipated transition with serious future financial implications for hospitals Huge Cost driver especially for Medicare Alert anticipates a future care transition Supporting Transitions in Care

10. Summary Record Exchange (CCD/C32) Local Physician group (PIP) with support from Greater Cincinnati Health Council studied the issue of what information is desired by receiving provider following an acute care discharge Beacon focus on CCD/C32 exchange between Hospitals to PCP after ED visit or Inpatient stay PCP to Consulting Physician and return Extensive work required with Hospital EMR vendors and Practice EMR vendors Supporting Transitions in Care

11. Transitions in Care Thank You