1. Pennsylvania Health Information Exchange NJHIMSS - DVHIMSS Enabling Healthcare Transformation Through Information Technology September, 2010

2. Topics HITECH – How the Pieces Fit Together PHIX Governance State HIE Cooperative Agreement Program Strategic and Operational Plans Coordination with Other States Where We Are Now Next Steps

3. HITECH: How the Pieces Fit Together Medicare and Medicaid Incentives and Penalties Health IT Practice Research Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION EXCHANGE State HIE Cooperative Agreement Standards & Certification Framework Privacy & Security Framework Regional Extension Centers Workforce Training MEANINGFUL USE 3

4. Cooperative Agreement Program State Health Information Exchange Cooperative Agreement Program  Issued by the Office of National Coordinator (ONC)  Support states or State Designated Entities (SDEs) in establishing health information exchange (HIE) capacity  State programs to promote HIE will help to realize the full potential of EHRs to improve the coordination, efficiency and quality of care and enable providers to meet meaningful use requirements  $17.1 million awarded for Pennsylvania Health Information Exchange (PHIX)

5. Cooperative Agreement Domains Governance: What is the structure of the State’s governance entity responsible for developing and maintaining a multi-stakeholder process to ensure the exchange of information through the HIE is in compliance with applicable policies and laws? Finance: What are the pricing strategies, public and private financing strategies, financial reporting, business planning, audits, and controls for the HIE? Technical Infrastructure: What are the technological aspects that will physically enable the technical services for the HIE in a secure and appropriate manner, including architecture, hardware, software, applications, network configurations? Business and Technical: What are the business and technical activities, including procurement, identifying requirements, process design, functionality development, project management, help desk, systems maintenance, change control, program evaluation, and reporting? Legal and Policy: What are the State’s legal/policy activities associated with creating a common set of rules to enable health information exchange while protecting consumer interests?

6. 6 PHIX will be the connecting network for health information exchange across Pennsylvania, with other states and the NHIN. PHIX will be built on a secure, internet-based architecture using recognized federal and state health information technology standards. The architecture will provide for connection to regional HIEs, health systems and individual hospitals to leverage existing investments in their HIE efforts. Pennsylvania Health Information Exchange

7. 7 PHIX will support meaningful use for eligible professionals and hospitals by offering:  The ability to exchange patient information among unaffiliated entities  Clinical messaging between providers  Connection with the Statewide Immunization Information System (SIIS) and other public health reporting systems  The ability to exchange lab results using structured data  The ability to exchange patient information with providers in other states. Pennsylvania Health Information Exchange

8. Health Care Reform Cabinet Overall Approval Governor PHIX Advisory Council Internal and External Stakeholders GOHCR State HIT Coordinator Strategic and Tactical Direction Current PHIX Governance Consumer Advocate Committee Legal Workgroup Bus. Process & Relationship Committee Requirements Committee Finance Workgroup Governance Workgroup Communications Workgroup

9. Strategic and Operational Plans GOHCR convened a core group to provide guidance in the development of the PHIX Strategic Plan required by ONC’s HIE Cooperative Agreement Program –Representatives from the providers, academic programs, regional health information organizations, patient advocacy, and payer groups participated in strategic planning workshops –Strategic Plan was publicly vetted –Strategic and Operational Plan submitted to ONC in August 2010 for review and approval

10. PHIX High-Level Technical Concept Pharmacies Insurers Security and Privacy Provider DirectoryEMPI RLS Emergency Departments Provider Offices Personal Health Records PHIX Infrastructure Regional HIE Health Systems (Edge Servers) Hospitals Community Hospitals Edge Servers Radiology Public Health Immunizations Medicaid Edge Server Hospitals Labs Edge Server Interfaces or Portal Exchange Gateway Clearinghouses HostingReporting & Measurement

11. 11 Has the patient authorized the sharing of information? Is the patient data safely encrypted? Is the user’s access to information based on their role? Connecting to PHIX Labs Pharmacies Health System Insurer Regional HIE’s Commonwealth Agencies Provider signs-on to PHIX with User ID and Password. System Authenticates User and Verifies Patient Permissions. Information sent from various sources through PHIX. Is it the correct provider? Are they authorized to use PHIX? Is this provider credentialed? PHIX

12. Coordination With Other States Sharing Immunization Records with New Jersey Medicaid sharing with New Jersey Connecting with Delaware PA hospital participating in Southern Tier HealthLink NY

13. PHIX Implementation - Propo sed Year 1 Build infrastructure components: o Master Patient Index o Record Locator Service o Provider Directory o Storage for Medicaid o Storage for National Labs Connect: o 3 Large Health Systems o 1 Regional HIE o 3 Community Hospitals o 5 CHIPRA Grant Hospitals Total Estimated Connectivity: o 35 Hospitals o 3,600 Providers o 2 Million Patients Year 2 Continue Implementation: o Clinical Messaging o Query Capability Additional Connectivity: o 32 Hospitals o 2,400 Providers o 2 Million Patients Total Connectivity by Year 2: o 67 Hospitals o 6,000 Providers o 4 million Patients Year 3 Continue Implementation: o Clinical Messaging o Query Capability Additional Connectivity: o 36 Hospitals o 3,000 Providers o 2 Million Patients Total Connectivity by Year 3: o 99 Hospitals o 9,000 Providers o 6 million Patients Year 4 Continue Implementation: o Clinical Messaging o Query Capability Additional Connectivity: o 32 Hospitals o 3,000 Providers o 2 Million Patients Total Connectivity by Year 4: o 121 Hospitals o 12,000 Providers o 8 million Patients Year 5 Target Totals by Year 5: o 148 Hospitals (90%) o 21,000 Providers (70%) o 10 Million Patients (80%)

14. Where We Are Now RFP Issued April 1, 2010 Weekly meetings with Medicaid Bi-weekly meetings with all stimulus-funded activities –  Medicaid  RECs  Beacon Community  Broadband  Monthly Meetings with PHIX Advisory Council

15. Next Steps PHIX Vendor Selection Identify a Sustainable Financial Model Create Privacy and Security Policies Complete Communications Plan Create PHIX Authority

16. Phil Magistro Deputy Director, Program Implementation State HIT Coordinator Governor’s Office of Health Care Reform pmagistro@state.pa.us 717-214-8174 Contact Information