1. Putting the pieces together: EHR Incentive Programs, Meaningful Use, and Health Information Exchange

2. - 1 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. MAEHC Mission: Facilitate Universal EHR Adoption Company launched September 2004 –Non-profit registered in the Commonwealth of Massachusetts CEO on board January 2005 Backed by broad array of 34 non-profit MA health care stakeholders

3. - 2 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. MAeHC Selected Three Pilot Sites From 35 Applicants: Brockton, Newburyport, North Adams Provided EHRs to ~600 clinicians practicing in over 200 office locations Created health information exchanges connecting the physicians with each other and with the hospitals Created a quality data center to extract clinical data from EHRs to evaluate effectiveness and measure performance

4. - 3 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Since the pilot program, MAeHC has expanded its experience base and involvement in a variety of projects 300 Physician EHR implementation – Beth Israel Deaconess Physician Organization (BIDPO) Community-wide EHR Implementation, HIE, and Quality Data Center – Large Healthcare Foundation HEAL 5 New York – New York State Department of Health and New York eHealth Collaborative (NYeC) HEAL 10 New York – Adirondack Region Medical Home Pilot State-level HIE technical services vendor procurement – Missouri HIO State Level Health Information Exchange Strategic and Operational Plan Development – New Hampshire Regional Extension Center planning, deployment, and operations – New York, Massachusetts, Rhode Island, New Hampshire

5. - 4 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

6. - 5 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Regional Extension Center of New Hampshire Award

7. - 6 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Program requires a full-service REC, which we are creating through a mix of REC staff and local partnerships Education and outreach Vendor selection and group purchasing Implementation and project management Practice and workflow redesign including: -Sharing of best practices from the National Learning Consortium -Sharing of privacy and security best practices -Functional interoperability and health information exchange -Progress towards meaningful use Local workforce support We are providing these services through a combination of: REC staff Sub-recipient partners Exact mix will be determined as we get more information on target PPCP population and potential partner capabilities We are providing these services through a combination of: REC staff Sub-recipient partners Exact mix will be determined as we get more information on target PPCP population and potential partner capabilities Required REC Direct Assistance Services

8. - 7 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Overview of the New Hampshire Regional Extension Center -Sources: -$6,240,415 (federal share) -$ 693,379 (non-federal share) -Uses: -$1,500,000 (core funding) -$ 4,506,415 (direct assistance - $3,500 or $5,000 per PPCP) -$ 234,000 (direct assistance $18,000 per CAH) -$ 693,379 (flexible – “in-kind services”) ­Leverage hospital EHR strategies and programs ­Integrate EHR and HIE strategies and programs ­Tailored program to provide EHR and HIE capacity to level-set and accelerate Hospital and EP MU Stage 1 achievement Total award is for $6.9 million to cover 1,000 clinicians and 13 CAHsOverall Strategy

9. - 8 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Practice and Workflow Redesign People TechnologyProcess Staff roles & responsibilities Credentials and capabilities Using technology effectively Privacy & Security Right place, right time Policies & Procedures

10. - 9 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Meaningful Use is distributed throughout the medical office correlating to health related goals CPOE Rx Drug-Drug *Formulary ePrescribe Demographics Problems Medications Rx Allergy Vitals Smoking CDS CQM *eLabs *Dx List *Reminders Pt. eCopy Clinical Summary *Pt. eAccess *Education HIE Capable *Rx Reconcile *Referral summary *Immunizations *Syndromic Data Privacy & Security ` * Menu Items Improve quality, safety, efficiency and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information

11. - 10 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Re-organizing Meaningful Use tasks can follow patient flow Pre-VisitRegistration Patient Intake Provider Visit Check-OutPost Visit *Dx List *Reminders Demographics Vitals Smoking Rx Allergy *Rx Reconcile CPOE Rx Drug-Drug *Formulary ePrescribe Problems Medications CDS *eLabs Pt. eCopy Clinical Summary *Pt. eAccess *Education CQM HIE Capable *Referral summary *Immunizations *Syndromic Data Privacy & Security ` * Menu Items

12. - 11 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Meaningful Use is built into the major common components of patient visit flow and at the point of care in the medical office Pre-VisitRegistration Patient Intake Provider Visit Check-OutPost Visit Privacy & Security

13. - 12 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Lab results delivery Prescribing Health summaries for continuity of care Quality & immunization reporting, if available 2011 Increases volume of transactions that are most commonly happening today – Lab to provider – Provider to pharmacy Summary of care record is new process step Registry and public health reporting Claims and eligibility checking Electronic ordering Receive public health alerts Home monitoring Populate PHRs 2013 Substantially steps up exchange – Provider to lab – Pharmacy to provider – Office to hospital & vice versa – Office to office – Hospital/office to public health & vice versa – Hospital to patient – Office to patient & vice versa – Hospital/office to reporting entities Access comprehensive data from all available sources Experience of care reporting Medical device interoperability 2015 Starts to envision routine availability of relatively rich exchange transactions – “Anyone to anyone” – Patient to reporting entities Meaningful Use objectives requiring health exchange Meaningful Use and Health Information Exchange

14. - 13 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. New Hampshire Health Information Exchange Plan Approved by ONC The plan is the result of collaborative planning among over 80 stakeholders 380 stakeholder comments were addressed in the current version The plan will continue to evolve as we refine the strategy, obtain broader stakeholder input, and add more detail Current strategic plan is posted at http://www.dhhs.nh.gov/hie/strategic.htmhttp://www.dhhs.nh.gov/hie/strategic.htm

15. - 14 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Leveraging existing networks with platform for secure routing

16. - 15 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Medicare and Medicaid Incentives and Penalties Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION EXCHANGE State Grants for Health Information Exchange Standards & Certification Framework Privacy & Security Framework Regional Extension Centers Workforce Training MEANINGFUL USE 15 HITECH – how the pieces fit together

17. - 16 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. New Hampshire Unified Health IT Vision MAeHC RECNH NH Stakeholder Advisory Committee New Hampshire DHHS NH HIO Advisory role Fiduciary responsibility Contractors Sub-recipientsREC field staff Core Staff (EP)Core Staff (CAH)

18. - 17 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. http://www.maehc.org/rec_nh_index_.html Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Up-to-Date Information and User Groups

19. - 18 - Massachusetts eHealth Collaborative © MAeHC. All rights reserved. Jeff LoughlinJen MonahanLeo McNamara Executive DirectorProgram CoordinatorProject Manager (508) 326-3944(603) 717-5420(781) 434-7755 jloughlin@maehc.org jmonahan@maehc.orglmcnamara@maehc.org Nancy FennellJaime DupuisDave Delano Practice ConsultingPractice ConsultingCAH Consultant (603) 717-5021 (603) 717-5225(339) 222-4036 nfennell@maehc.org jdupuis@maehc.orgddelano@maehc.org Regional Extension Center of New Hampshire c/o New Hampshire Medical Society 7 North State Street Concord, NH 03301 Tel: 603.717.5420 Fax: 866.440.3007 nh-rec@maehc.org jloughlin@maehc.orgjmonahan@maehc.orglmcnamara@maehc.org nfennell@maehc.orgjdupuis@maehc.orgddelano@maehc.org nh-rec@maehc.org Massachusetts eHealth Collaborative © MAeHC. All rights reserved.