1. Overcoming the largest obstacle to health information exchange: One HIE’s story Joaquim Neto, Senior Solutions Architect, Verato Nicholas Hess, Project Manager, SDHC

2. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Agenda About San Diego Health Connect (SDHC) The challenges with patient record exchange Changing the way SDHC matches patient records Overview of Verato and Verato technology Results of working with Verato Questions

3. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato San Diego Health Connect – What is it? Not-for-profit, public benefit organization Connectivity – secure, private network Medical information exchange Portal access Secure messaging Interoperability 100% HIPAA compliant – no greys

4. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato The SDHC mission To connect healthcare stakeholders to deliver quality, comprehensive information for better care. When every individual’s health information is securely available to their doctors when and where they need it: Doctors can provide better, more informed care. Duplication of tests and procedure decreases. Costs go down.

5. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato San Diego 4,526 square miles 70 miles of coastline Geographic diversity: Coast, mountain, desert 86 miles of international border - Busiest land- border crossing in the world 3 Military Facilities 18 federally recognized Indian Reservations 19 Acute Care Hospitals 4 Non-acute/Rehab Hospitals 115 clinics 9,000 physicians 3.2 million people Second most populous County in the state, 5th most populous county in the U.S.

6. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Connecting San Diego Healthcare Public Health Agencies Schools EMS Pharmacies Physician Practices Home Health Nursing Homes Behavioral Health Providers Patients and Caregivers Hospitals Lab Companies Health Plans Community Health Centers

7. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Why use HIE? Healthier patients: Fewer medical errors, improved patient safety, improved continuity of care, and better patient outcomes More efficient: Automated sharing of information, less paperwork, reduced time to access clinical information at the point of care, fewer repeat tests and procedures Informed treatment decisions: A more complete and up-to-date patient medical record, including information from all a patient's health care providers Supports public health: Automates process of reporting mandatory reportable conditions to San Diego County Health and Human Services and California’s Department of Public Health

8. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato A sample of SDHC’s 25 participating organizations Health and Human Services

9. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato SDHC uses an MPI as a record locator service SAN DIEGO HEALTH CONNECT Mirth Match Mirth MPI At providers A,B At provider C 25 provider institutions 3.2 M patients 7.5 M transactions / month A B C A A C B B C AB C C AB

10. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato SAN DIEGO HEALTH CONNECT Mirth Match Mirth MPI At providers A,B At provider C Exception queue ? When records do not match, they end up in an “Exception queue” 3.2 M patients 7.5 M transactions / month A C B C AB C C A B C 25 provider institutions

11. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Exception queue Each new provider led to more backlog, due to data quality and differences in governance Manual effort 2 FTEs, 4 months 2 FTEs, 1 year Ultimately: 187,000 tasks 2 FTEs, 8 years 2 FTEs, 2 years

12. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato SDHC decided they needed a better way to match.

13. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato SDHC’s working group was key in making this decision 41 13 2 Total members Different organizations Meetings per month

14. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato How Verato is different Fragmented Data Information Providers Data RICH Algorithm poor MPI Technologies Probabilistic Matching Algorithm RICH Data poor Algorithm RICH Data RICH + Referential Matching Complete, Unified Data Cloud-based IBM | Informatica Oracle | SAP Acxiom TransUnion Experian | Equifax

15. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Identity data is a collection of attributes which often change over time Bio graph Name(s), Address, Gender, Birthdate Family graph Parents, Siblings, Spouses, Children Social graph Friends, Roommates, Associations Professional graph University, Degrees, Employers, Coworkers, Prof credentials, Associations Government graph SSN, National Benefits ID, Drivers’ Permits, Legal Records Financial graph Fin. Accounts, Homes, Cars, Boats, Mortgages, Loans, Credit Commercial graph Loyalty cards, Purchases Cyber graph Phone, Email, Social IDs, Device IDs, IP 1980 1990 2000 2010 2020

16. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato One person… …resulting in different identities across provider systems. 2 1 3 Name change Address change Phone/email change Married | Divorced Birth | Death Time Spelling error Transcription error Homonym error Errors Ambiguity Hyphenated name Nicknames Jr/Sr, Twins Default entries Missing data Data quality Data content Privacy controls Formatting Data Gov. …can be represented by old, incorrect, or incomplete data… Time, errors, and governance differences lead to multiple “identities” for one person

17. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Correct and incorrect data 300M+ Identities Identity Assembly Algorithm 60M updates per month Credit Header Data Telco Records Gov’t & Legal Records CARBON™ – the most comprehensive reference database of identities in the US

18. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato ✓ Match Referential matching with CARBON works despite different or bad identity data X No Match Referential matching is a revolutionary new way to match patient records MPI matching (deterministic or probabilistic) can’t see through different or bad identity data

19. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato 45,000 tasks 142,000 new matches 60% pediatrics 40% very ambiguous data Verato automatically resolved 75% of SDHC’s manual tasks Exception queue (187,000 tasks) V

20. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Verato also found 126,000 additional matches in the MPI V SDHC MPI 126,000 new matches Same person

21. 75% reduction 110% improvement 45K exception queue 512K matches 187K exception queue 244K matches In total, SDHC increased the number of matches in its MPI by 110%

22. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Of the new matches identified by Verato… 1.3% Had conflicting birthdates 7% Had a last name difference 13.1% Had a different address >20% Had at least one of those three critical errors

23. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Trusted health information exchange… HL7 FHIR ISO Is built on technical interoperability CCR SNOMED DICOM LOINC NCPDP RxNorm CPT ICD-9/10 Uses document standards to achieve functional interoperability Patient Matching: No false positives Minimal false negatives Is enabled by semantic interoperability

24. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Summary of benefits received from working with Verato Better patient matching More efficient medical records exchange HIEs Less manual data stewardship Less time to onboard providers Providers Fewer redundant tests and procedures Lower costs Patients Higher quality patient care

25. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Providers Fewer redundant tests and procedures Lower costs 50% 35% Patients Higher quality patient care 25% Summary of benefits received from working with Verato Better patient matching HIEs Less manual data stewardship Less time to onboard providers 75% 20% More efficient medical records exchange

26. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato How you can get started 26 Verato will review 10,000 potential match tasks in 10 days Steps: 1.Send Verato a file of unresolved patient records (via secure transfer) 2.Verato returns a file with match and no-match decisions and justifications 3.Plug the Verato file back into your MPI

27. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Questions? 27 Joaquim Neto Senior Solutions Architect Joaquim.Neto@verato.com Nick Hess Project Manager nhess@sdhealthconnect.org @verato_software linkedin.com/company/verato @SDHealthConnect linkedin.com/company/san-diego-health-connect

28. Verato Proprietary, Do Not Copy, Reproduce, or Use Content Without Explicit Written Permission from Verato Thank you 28