Midwestern Grandparents on Vacation TUESDAY, 10:00 – 10:50AM Midwestern Grandparents on Vacation Communities Working Together to Improve Quality, Safety and Efficiency Using the NHIN Rodney Cain, Chief Information Officer, HealthBridge Joyce Beck, Chief Executive Officer, Thayer County Health Services Will Ross, Chief Operating Officer, Redwood MedNet

Midwestern Grandparents on Vacation HealthBridge Located in Cincinnati, Ohio Represented by Rodney Cain, CIO Redwood MedNet Located in Ukiah, California Represented by Will Ross, COO Thayer County Health Services Located in Hebron, Nebraska Represented by Joyce Beck, CEO HIMSS 2010

TUESDAY, 10:00 – 10:50AM Rodney Cain, CIO

HealthBridge Background In operation since 1997 Provides secure, real-time electronic health information exchange for Southwestern Ohio, Northern Kentucky and Southeastern Indiana One of only a handful of HIE/RHIOs nationwide with cash-positive, sustainable business model 97% of revenue from fees; <3% from grants 5-8% annual return for last five years HIT Regional Extension Center Awardee, February 2010 HIMSS 2010

HealthBridge Network Includes: 24 local hospitals in Kentucky, Ohio and Indiana 5000+ physicians and other professionals at hundreds of sites 17 local health departments Large commercial, hospital, & physician office labs Diagnostic centers Delivered 2.9 million clinical results in December 2009; more than 30 million total results in 2009 EMR Feeds to 28 different vendors, 60+ versions 47 hospital information system connections for 10 different organizations HIMSS 2010

Collaborative HIE Network HealthLINC is a community-based organization leading the health information exchange (HIE) effort on behalf of healthcare stakeholders in Monroe and surrounding counties in South Central Indiana. CCHIE was founded in 2007 as a multi-stakeholder non-profit  community-wide health information exchange for the benefit of the medical community in Springfield, Ohio and surrounding areas. HIMSS 2010

HealthBridge NHIN Architecture Independent. Labs, Imaging & Diagnostic Centers Independent Practices Health System Exchange with NHIN, Other HIEs Ambul. EHR Push & Pull Capability Use Case Specific Data Stores Community Patient / Provider Index Integration Layer NHIN Gateway Adapter APIs / Web Service API Inpt EHR PMS, EHR LIS, RIS, etc Quality Reporting Results / Orders / Summary Record Summary Record Exchange Results Delivery Registry eRx Basic ASP EHR Modular EHR Exchange Services Public Health Reporting Order Entry Applications NHIN Other Providers - Pharmacies, Nursing Homes, etc. Inbound / Outbound Interfaces Patient Discovery Document Query / Retrieve Consumer Preferences HIMSS 2010

HealthBridge Use of NHIN Center for Medicare and Medicaid Services CARE–Health Information Exchange Project (C-HIEP) Social Security Administration Disability Benefits Determination HIMSS 2010

Cross Country Data Exchange Demonstration Midwestern Grandparents on Vacation Mr. & Mrs. Gordon Fakepatient Residents of Hebron Nebraska Visit daughter in Cincinnati Visit grandsons in California Privacy & Security Posture Patient consents to provider exchange of data for treatment HIMSS 2010

Midwestern Grandparents on Vacation CBC & CMP tests Upper GI Test Rx history Cardiac Enzymes EKG Stress Test HIMSS 2010

Summary Record View from ER at HealthBridge HealthBridge Demonstration – Lab Report HIMSS 2010

Will Ross, COO Launching Redwood MedNet Policy Themes TUESDAY, 10:00AM – 10:50AM Will Ross, COO Launching Redwood MedNet Policy Themes CONNECT Demonstrations

California Redwood MedNet HIE Home Region Pacific Ocean HIE Home Region 7,000 Square Miles in Northern California (larger than Connecticut) 600,000 population 1 to 4 hours north of San Francisco 14 hospitals (5 Critical Access) with 1,200 beds 10 FQHCs, 12 RHCs, 4 Tribal Clinics, 1 VA Satellite Clinic HIMSS 2010

Redwood MedNet Startup Funding Since 2005 $1.2 Million in Grants About $100,000 in contracts or revenue HIMSS 2010

Redwood MedNet HIE Project Plan Health Policy Start from the Connecting for Health “Common Framework” Harmonize with State and Federal privacy & security requirements Business Operations Focus on clinical data, not billing data Focus on site level workflow from the perspective of an individual user (adaptive business rules rather than imposed rules) Make clinical data agile, with or without EHRs Leverage open source software to disrupt legacy software lock in and incompatible data silos Build HIE services incrementally HIMSS 2010

Redwood MedNet HIE Business Plan Startup from 2005 to 2010 Grant funded HIE operations startup Develop open source software as appropriate Build enterprise health data exchange services Transition from grants to paid services Sustainability Model Estimated breakeven point = 400 providers using the service At current pace 400 providers should be on the system in 2011 400 providers will require expansion beyond startup territory of Mendocino, Lake and Sonoma Counties HIMSS 2010

Redwood MedNet Timeline 2004 Steering Committee with members from local Medical Society, County Public Health and Community Clinic consortium 2005 Established an independent 501(c)(3) nonprofit corporation 2007 Pilot test new open source software for HIE operations 2008 Began production laboratory test result delivery in April 2009 Demonstrated CONNECT gateway in June; Began production radiology report delivery in September 2010 Live use of CONNECT gateway in February; Scheduled to begin e- Prescribing services in third quarter HIMSS 2010

HIMSS 2010

EHR Adoption Reality Check “Four percent of physicians reported having an extensive, fully functional electronic records system, and 13% reported having a basic system.” DesRoches, Campbell, et al. July 2008 New England Journal of Medicine HIMSS 2010

Redwood MedNet EHR Adoption Survey, 2009 8% of providers use EHR 5% of providers receive lab results in their EHR 90% of providers have broadband Internet in their office 59% of providers can access their office network from offsite 13% of providers say EHR is ready for broad adoption 30% of providers plan to implement EHR in the next 2 years 55% of providers do not plan to implement EHR in the next 2 years HIMSS 2010

Health Information Liquidity “EHRs are necessary but not sufficient for interoperability” Penfield, Anderson, Edmunds & Belanger January 2009 Booz Allen Hamlilton HIMSS 2010

Crossing the Health Care IT Chasm “Providers will appropriately be drawn to IT only if, where and when it can be shown to enable them to do their jobs more effectively.” Stead & Lin February 2009 National Academies Press HIMSS 2010

Making Smart Health Care IT Investments “We need to have more of an ‘enterprise’ approach to health IT implementation, but most of the health care industry isn’t part of an enterprise.” Halamka March-April 2009 Health Affairs HIMSS 2010

Deciding When to Pursue and EHR “Rushing to the EHR solely to optimize the amount of incentive funding is a recipe for disaster.” Rishel September 2009 Gartner Industry Research HIMSS 2010

The Business Case for Interoperability “Labs may decide it does not make business sense for them to send electronic results to physicians who do not represent enough business.” Frohlich October 2009 Testimony to HIT Standards Implementatation Workgroup HIMSS 2010

Avoid Silos of Disconnected Information “Exchange within business groups will not be sufficient. The goal is to have information flow seamlessly and effortlessly to every nook and cranny of our health system, when and where it is needed.” Blumenthal November 2009 ONC Email HIMSS 2010

Are EHRs Helpful For Care Coordination? “There is a gap between policy-makers’ expectation of current EMRs’ role in the coordination of care and clinicians’ real-world experience with them.” O’Malley, Grossman, et al. December 2009 Center for Studying Health System Change HIMSS 2010

CONNECT v2.0 Demonstration in 2009 HIMSS 2010

CONNECT v2.0 Demonstration in 2009 HIMSS 2010

Summary Record View from Redwood MedNet HIMSS 2010

Joyce Beck, MS, CEO NHIN Connectivity Through The Eyes Of A Patient TUESDAY, 10:00 – 10:50AM Joyce Beck, MS, CEO NHIN Connectivity Through The Eyes Of A Patient How Connectivity Improves Patient Care Southeast Nebraska Health Information Exchange (SENHIE)

Reason for Demonstration Test Data had only been sent on the NHIN between facilities Information Technology said it would work There were doubts from other HIE’s in Nebraska about NHIN If NHIN was to be endorsed I had to see it myself If our actions do not help a patient than all is for nothing HIMSS 2010

Wellness Check Began at Thayer County Health Services in Hebron, Nebraska Dr. Bryan Hubl ordered lab test in Hebron for wellness check Lab results obtained and placed in EHR in Hebron Lab results then made available to Redwood Mednet in California for actual wellness exam Information also available on USB to fulfill meaningful use HIMSS 2010

Second Step of Trip was Travel to Healdsburg, California for Wellness and Radiology Exam Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California Lab results and patient visit summary from Thayer County retrieved by Redwood MedNet via CONNECT gateway Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR Results could be placed on USB bracelet at patient request HIMSS 2010

Final Step Returned to Thayer County Health Services to be seen by Dr. Hubl Wellness exam as well as results of x-ray was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California HIMSS 2010

Conclusion Information flowed from one facility to another without difficulty Duplication of testing was avoided due to availability of information via the NHIN and patient USB device Ease of availability of medical information provided better patient care The NHIN is functioning, provides patients with the information needed HIMSS 2010

Summary Record View from Thayer County HIMSS 2010

Midwestern Grandparents on Vacation HealthBridge Rodney Cain, CIO rcain@healthbridge.org Redwood MedNet Will Ross, COO wross@redwoodmednet.org Thayer County Health Services Joyce Beck, CEO jbeck@tchsne.org HIMSS 2010

Thank You The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal Health Architecture or the Department of Health and Human Services.