1. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Christopher Ross, CIO 1 The Present and Future of Interoperable Health IT at Mayo Clinic

2. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Mayo Clinic at a glance Rochester and Midwest, Phoenix, Jacksonville Rochester and Midwest, Phoenix, Jacksonville 4000 physicians 4000 physicians 66,000 employees 66,000 employees Rochester - HIMSS Level 7 and Most Wired Rochester - HIMSS Level 7 and Most Wired Phoenix, Jacksonville, Midwest hospitals – Level 6 Phoenix, Jacksonville, Midwest hospitals – Level 6 MU 2 Certified MU 2 Certified 1.5M patients/year, 50 states, 150 countries 1.5M patients/year, 50 states, 150 countries Member, DirectTrust.org Member, DirectTrust.org 2

3. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Strategy 3 We have come to realize that Mayo’s most scalable product is our knowledge We are pursuing a business model based on knowledge management and diffusion of knowledge as our integration tool rather than consolidation, mergers, and acquisitions of assets The important next step is sharing that knowledge more broadly through accessible tools

4. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Mayo Clinic Care Network 4

5. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Digital strategy evolution 5 Plummer record Pioneering electronic tools Campus EMRs Converged EMR Refined tools: YES, Aware, others Knowledge to Delivery Connected Care Ease, Watson Unified data platform Digital care Digital health system integration Health Care Automation Health Care Digitization Inside Physical Scale Standardization Quality Effectiveness Automation Outside Reach Scope Diversification Flexibility Adaptability Digitization Unified platforms – knowledge, process Central lab Mayo Scheduling System Destination 2.0: Mayo Clinic is the digital destination where clinicians, patients, and consumers find answers, hope and healing. Knowledge Content Management System

6. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Goals for Interoperability Enable patient care for a premier destination medical center Enable strategic vision “knowledge to delivery” and “meaningful relationship with 200 million people” – health care, guidance, information Create “bridges to somewhere” – forward/backward compatibility 6

7. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Building Blocks Proprietary and pre-HIE examples – Online Services for Referring Physicians (OSRP) Application to request and access Mayo records, knowledge, and specialty care from a distance. Submit requests for eConsults, referrals, and medical records. >27,000 accounts – Connected Care examples eConsult Telestroke eICU Image exchange (Dicom Grid) 7

8. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 HIE pioneering Care Connectivity Consortium – Geisinger, Group Health Cooperative/OCHIN, InterMountain Health, Kaiser Permanente, Mayo – 2011 – bridge amongst and between geographic HIEs, NwHIN, Connect Beacon – ONC-funded pilot for regional exchange – Asthma trials Geographic HIE – AZ, FL, MN, WI 8

9. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Digital adjacency to HIE MayoClinic.org 344 million unique visitors 2013 Ask Mayo Clinic Online Best-selling Mayo Clinic Diet Program online Healthy Living Online Better E-consults Ask Mayo Expert Knowledge Content Management System Mayo Clinic Patient App 9

10. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Mayo Clinic App 10

11. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Core HIE - Connect 11

12. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Core HIE - Direct 12

13. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Assembling and integrating We need national (international) class HIE – Attributes Trusted, secure and private Ubiquitous Economical Effective clinical content Effective transaction methods and rules – Reach beyond inter and intra-EHR connectivity – Ladder of adoption and backwards compatibility Congruent with our other digital strategies 13

14. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 What can we use today? Transaction types – Results (HL7 V2 ORU) – ADT (HL7) – Transcriptions (HL7 V2 MDM) – Financial transactions – Financial (X12 837), Pharmacy (NCPDP B1) – ePrescribing (NCPDP) – Direct (SMTP + S/MIME) (MU2 and DirectTrust drive scale) – Patient Portal + C-CDA Download (HTTPS + C-CDA) 14

15. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Gaps? Ubiquity of Direct and new transport technologies – REST/FHIR/OAuth inevitable – Bridges from Direct SMTP to FHIR content and services Usability of clinical content – CCDA Query Patient identification Record locator Physician directories and trust Security – evolved and evolving effectiveness 15

16. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Where is the puck going? More granular, bidirectional interoperability FHIR-based content and services Scalable identity OpenID Connect / OAuth2 DirectTrust as identity provider/broker (beyond Directed Exchange) NSTIC App frameworks SMART on FHIR Consumer apps - Apple HealthKit 16

17. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Remaining frontiers Knowledge interoperability – Clinical decision support – Contextual knowledge tools and services for clinicians – Effective guidance and information tools for health-seekers – Semantic interoperability / cognitive computing – Fully secured with inter-organizational identity management Business models for interoperability – Regulatory, financial and ethical frameworks – Emerging dominant utility players 17

18. www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Thank you Comments, challenges, disagreements, questions? 18