1. 1 Colleen Woods Health IT Coordinator State of New Jersey June 8, 2012 Connecting Patients to a Greater State of Health

2. 2 The Population is Aging (Baby Boomers) Nursing, Physician and Other Clinical Shortages More than 51% of the US Population’s healthcare is financed in some way by tax dollars (Medicare, Medicaid, Charity Care, Government Employees, Armed Services, Firefighters, Police, Teachers, Etc…) Healthcare IT adoption is 12 years behind other industries Today’s healthcare information network for sharing clinical information is connect via phones and fax In New Jersey 60 – 70% of providers are still using paper- based medical records (NJHA Estimate)

3. 3 David Brooks New York Times Columnist “The average 56-year-old couple pays about $140,000 into the Medicare system over a lifetime and receives about $430,000 in benefits back. The program is also completely unaffordable. Medicare has unfinanced liabilities of more than $30 trillion. The Medicare trustees say the program is about a decade from insolvency. “ – New York Times, Monday June 6, 2011

4. 4 1.Electronic Health Records (EHRs) 2.Health Information Organizations (HIOs) 3.Health Information Network (HIN) Payment Transformation Delivery of Care Transformation Health Information Technology Transformation

5. 5 Primary Care Practices of Better Health Greater Cleveland Practices that use electronic health records saw significantly higher achievement and improvement in meeting standards of care and outcomes in diabetes than practices using paper records. --NEJM, September 1, 2011 Nearly 51% of patients in EHR practices received care that met all of the endorsed standards. Only 7% of patients at paper-based practices received this same level of care– a difference of 44%. After accounting for differences in patient characteristics between EHR and paper-based practices, EHR patients still received 35% more of the care standards.

6. 6 * Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts, clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care. Source: 1. 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians Percent reporting at least 9 of 14 clinical IT functions* Adoption of health information technology (IT) among primary care practices is highly variable across countries, with the United States lagging well behind other nations

7. 7 Source: 1.CDC/NCHS, National Ambulatory Medical Care Survey Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2010, and Preliminary 2011 State Estimates New Jersey (31%) has a lower percentage of physicians potentially able to meet meaningful use core criteria when compared with national average *Also includes office-based physicians who have EHR system capabilities to support eight Stage 1 Core Set meaningful use objectives New Jersey (16%) has the lowest percent of physicians in the country using any EMR/EHR system

8. 8 Salem Camden (Noteworthy) Hospitals: Cooper University Hospital Kennedy University Hospital (Turnersville, Cherry Hill, Stratford) Lourdes Medical Center of Burlington County Our Lady of Lourdes Medical Center Underwood Memorial Hospital Virtua Hospital (Berlin, Marlton, Memorial, Voorhees) Federally Qualified Health Centers: CAMcare Health Corporation Project Hope, Inc. Camden (Noteworthy) Hospitals: Cooper University Hospital Kennedy University Hospital (Turnersville, Cherry Hill, Stratford) Lourdes Medical Center of Burlington County Our Lady of Lourdes Medical Center Underwood Memorial Hospital Virtua Hospital (Berlin, Marlton, Memorial, Voorhees) Federally Qualified Health Centers: CAMcare Health Corporation Project Hope, Inc. Integrated Delivery Networks Hospitals: AtlantiCare Regional Medical Center (Atlantic City, Mainland Campus) South Jersey Healthcare (Regional Medical Center, Elmer Hospital) Integrated Delivery Networks Hospitals: AtlantiCare Regional Medical Center (Atlantic City, Mainland Campus) South Jersey Healthcare (Regional Medical Center, Elmer Hospital) MOHIE (ICA) Hospitals: Bayshore Community Hospital Community Medical Center Jersey Shore University Medical Center Kimball Medical Center Monmouth Medical Center Ocean Medical Center Riverview Medical Center Southern Ocean Medical Center Federally Qualified Health Center: Monmouth Family Health Center MOHIE (ICA) Hospitals: Bayshore Community Hospital Community Medical Center Jersey Shore University Medical Center Kimball Medical Center Monmouth Medical Center Ocean Medical Center Riverview Medical Center Southern Ocean Medical Center Federally Qualified Health Center: Monmouth Family Health Center Health-e-cITi-NJ (IGI Health / ORBIT) Hospitals: Christ Hospital East Orange General Hospital Jersey City Medical Center Meadowlands Hospital Medical Center Newark Beth Israel Medical Center Saint Michael's Medical Center St. Joseph's Hospital (Paterson, Wayne) UMDNJ-University Hospital Federally Qualified Health Centers: Newark Community Health Centers, Inc. Newark Homeless Health Care Horizon Health Center North Hudson Community Action Corporation Health Center Metropolitan Family Health Network Home Health Visiting Nurse Association of Central Jersey Health-e-cITi-NJ (IGI Health / ORBIT) Hospitals: Christ Hospital East Orange General Hospital Jersey City Medical Center Meadowlands Hospital Medical Center Newark Beth Israel Medical Center Saint Michael's Medical Center St. Joseph's Hospital (Paterson, Wayne) UMDNJ-University Hospital Federally Qualified Health Centers: Newark Community Health Centers, Inc. Newark Homeless Health Care Horizon Health Center North Hudson Community Action Corporation Health Center Metropolitan Family Health Network Home Health Visiting Nurse Association of Central Jersey Jersey Health Connect (McKesson RelayHealth) Hospitals: CentraState Medical Center Children's Specialized Hospital Clara Maass Medical Center Hackensack University Medical Center Holy Name Medical Center Hunterdon Medical Center JFK Medical Center Morristown Memorial Hospital Newton Memorial Hospital Overlook Hospital Robert Wood Johnson University Hospital (New Brunswick, Hamilton, Rahway) Saint Barnabas Medical Center Saint Clare's Hospital (Denville Campus, Dover General, Sussex) Saint Peter's University Hospital Somerset Medical Center Trinitas Regional Medical Center Physicians Summit Medical Group Central Jersey HIE Project (CHIEP) Long Term Care PARKER Jersey Health Connect (McKesson RelayHealth) Hospitals: CentraState Medical Center Children's Specialized Hospital Clara Maass Medical Center Hackensack University Medical Center Holy Name Medical Center Hunterdon Medical Center JFK Medical Center Morristown Memorial Hospital Newton Memorial Hospital Overlook Hospital Robert Wood Johnson University Hospital (New Brunswick, Hamilton, Rahway) Saint Barnabas Medical Center Saint Clare's Hospital (Denville Campus, Dover General, Sussex) Saint Peter's University Hospital Somerset Medical Center Trinitas Regional Medical Center Physicians Summit Medical Group Central Jersey HIE Project (CHIEP) Long Term Care PARKER Trenton Health Team (Covisint ) Public Health Department City of Trenton Hospitals: Capital Health Regional Medical Center Capital Health Medical Center – Hopewell St. Francis Medical Center Federally Qualified Health Center: Henry J. Austin Health Center, Inc. Trenton Health Team (Covisint ) Public Health Department City of Trenton Hospitals: Capital Health Regional Medical Center Capital Health Medical Center – Hopewell St. Francis Medical Center Federally Qualified Health Center: Henry J. Austin Health Center, Inc. Atlantic Bergen Burlington Camden May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Somerset Cape Union Passaic Sussex Warren Salem www.nj.gov/njhit

9. 9 State Data Sources: Immunizations Medicaid Blood Screening Bio surveillance DMV Demographics Other registries Health Entity Directory Web Services Registry Provider Directory (supporting DIRECT) Provider Credentialing Certificate Authority NJHIN Core Services State Gateway Services Relay Service (External Queries) Patient Discovery & Document Exchange Statewide Data Aggregation GATEWAY NJHIO Nodes Pt Discovery & Document Exchange Gateways HIO-level MPI HIO-level Record Locator Consent Mgmt (interim) DIRECT Services Security Compliance Surescripts & Labs NJHIN Onboarding Security Compliance

10. 10 * * Physicians in these hospitals access data within their own hospitals only www.nj.gov/njhit

11. 11 Use Case NameDescription 1. Medication History Patient medication histories are made available for Emergency Room admissions only. This Use Case will include the Cross Community Patient Discovery (XCPD) Profile to support accurate patient identification. 2. Public Health Data (Immunization Data) To provide patient immunization history directly to the physician EHR. The State registry connection will be direct to the physician EHR. 3. Diagnostic Results Available to All HIE Customers To provide patient laboratory test and radiology images results (later Use Case will address the Order side as well as open order/pending result). This Use Case will include the radiology report and not the image. 4. ED/Acute Discharge Summary The transfer of patient information in the form of discharge notes to the PCP or specialists at the time of discharge. Near term – ED/Acute Hospital discharge information only. 5. Transition of Care- Referral Information This Use Case is to enhance communications between PCP and specialist with an opportunity to use “Direct” as a near-term way to conduct secure exchange of health information.

12. 12 Source: EHR Incentive Program Registrations and NJHA survey Hospital EHR Adoption HospitalsCountEHR AdoptionEHR Adoption % Total Hospitals1116357% General Acute Care71 6186% Comprehensive Rehabilitation14 17% Special15 17% Psychiatric11-- www.nj.gov/njhit

13. 13 CountyPopulation PCPs in Patient Care Atlantic270,609244 Bergen889,9151,527 Burlington445,492434 Camden517,739626 Cape May96,47042 Cumberland156,78494 Essex767,0751,191 Gloucester288,168189 Hudson592,111506 Hunterdon129,806279 Mercer364,571490 Middlesex785,3241,242 Monmouth641,864984 Morris486,946717 Ocean569,662336 Passaic488,364457 Salem66,19436 Somerset323,160587 Sussex151,43177 Union521,816551 Warren109,897117 NJ TOTAL8,663,39810,726 County Health Rankings 2011 Primary care physicians include practicing physicians specializing in general practice medicine, family medicine, internal medicine, pediatrics, and obstetrics/gynecology. The measure represents the population per one provider. The data on primary care physicians were obtained from the Health Resources and Services Administration’s Area Resource File (ARF) for 2009. The ARF data on practicing physicians come from the AMA Master File (2008), and the population estimates are from the U.S. Census Bureau’s 2008 population estimates. County Health Rankings (CHR) Web site. CHR is a program of the Robert Wood Johnson Foundation (RWJF) and the University of Wisconsin Population Health Institute.

14. 14 Physician EHR Adoption PhysiciansTotal EHR Adoption # EHR Adoption % Total Licensed Physicians33,8408,33025% Active Physicians25,629 Active Patient Care Physicians 21,958 Hospital-Based 3,428 Target Priority: Office-Based 18,530 6,41135% Primary Care Physicians 10,726 3,30531% Specialists 7,804 3,10640% BME: New Jersey Board of Medical Examiners AAMC: Association of American Medical Colleges, Estimate SK&A: Research Vendor County Health Rankings, NJ-HITEC www.nj.gov/njhit

15. 15 Medicare EHR Incentive Payments Provider Type Provider Count Medicare Incentive Payment Amount Eligible Professionals 1,87832,930,174 Eligible Hospitals1437,070,065 Total: $70,000,239 NJ Medicaid EHR Incentive Payments Provider Type Provider Count Medicaid Incentive Payment Amount Eligible Professionals 69914,621,421 Eligible Hospitals3745,800,838 Total: $60,422,259 CMS, June 5, 2012 Total EHR Incentive Program Registrants: Eligible Professionals = 5,884 Eligible Hospitals = 57 www.nj.gov/njhit

16. 16 Highest utilizers of HIOs – office staff, medical records staff, nurse practitioners Real cost savings seen in the administrative processes – referrals, prior authorization Communication with the patient Point of care reminders PCP’s who have EHR’s now want HIE www.nj.gov/njhit

17. 17 HIE to HIE and the NJHIN – slow Trust agreements – difficult Implementation – climb the wall, reenergize Moving closer to the “tipping point” New focus on accuracy Consent – a bear Integration/Interoperability – hard Collaboration is vital! www.nj.gov/njhit

18. 18 Reference: www.nj.gov/njhit