1. Nov 2011 Lyman Dennis Organizer & Facilitator

2. What is Health Information Exchange? Exchange of clinical (and administrative) information among unaffiliated providers Push data point-to-point called “clinical messaging” Starter approach; will always work but more complex as add more participating providers Options 1. Direct provider-to-provider exchange 2. Provider-to-central HIE; HIE to relevant providers

4. HIE Players Cal eConnect – State-designated entity Active HIEs (e.g.s) Standalone HIEs Santa Cruz HIE Western Health Information Network Redwood MedNet Orange County Partnership… (OCPRHIO) Vertical HIEs Kaiser VA John Muir Sutter Health CHW Partnership HealthPlan of California Startups

5. Meaningful Use for Incentives Stage 1 EHR Basic exchange Limited number of clinical measures Stage 2, Stage 3 Use of EHR features for more patients (to 50% to 90%) Menu items become core items Electronic medication administration Chemotherapy automation Record patient communication preferences Judge clinician performance based on patient adoption of PHRs Longitudinal care planning Public health enhancements

6. Why bother with HIE?

7. Cal eConnect – Current Plan Focus on what is important to the stakeholders Focus on what is needed to sustain the grant funding from ONC and the State: Provide an ability for ePrescribing Receipt of structured lab results Sharing patient care summaries Enabling data sharing through Direct and emphasizing importance of and reliance on local HIEs

8. Cal eConnect Strategic & Operational Framework Governance ¹ Technical Assistance² ¹ Policy, Leadership, & Barrier Removal ² Expert support to select or develop solutions to problems ³ Conserving scarce resources and making big impacts Coordination³ ONC & CHHS Priorities Establish Trust Environment Robust Support for Ancillary Services Public Health Community Pharmacies Community Diagnostic Laboratories Coordinate, Monitor, & Report on HIE Landscape Sustainable HIE in California

9. Interoperability States’ Vendors’ EHR/HIE Interoperability Project – Increase the value of the individual EHR systems by assuring integration with HIE providers – Create a set of interoperable implementation specifications not unlike what IHE has developed for the Interoperability showcase – Leverage the power of a consortium of states to influence vendors to adopt the reference implementations (1/3 to ½ of the US population) – Encourage vendors to provide these standard interfaces “out-of-the-box” for all installs – Encourage other states and vendors to adopt the reference implementations

10. Multi State/Vendor Collaborative Allscripts eClinicalWorks eMDs Greenway McKesson NextGen Sage Siemens States California New York Maryland Massachusetts New Jersey Ohio Oregon Delaware Colorado EHR Vendors

11. HIE Vendors Medicity Axolotl InterSystems Cerner New States Arizona Florida Virginia Maine Texas New HIE Vendors

12. Accomplishments August: Data and Metadata Workgroup completed work on the C32 specifications to create a fully defined and constrained implementation specification. September: Push Workgroup completed work on a robust specification for implementation of NwHIN Direct using SMTP s/MIME or SOAP/HPD+ with Directory Services. September: C32 specification fully aligned with Beacons and ONC S&I efforts. October: Pull Workgroup completed a constrained implementation specification for NwHIN Connect using XCPD and an optional state-wide MPI. In Process: Alignment of the States’ Interop work with ONC – ONC statement of support imminent. Pilots being sought.

13. Privacy & Security Privacy & Security Advisory Board and CalOHII have led the State in development of guidelines. PSAB Eliminated by Gov Brown Exec Order. Regulations now in their second draft out for public comment and input: http://www.ohi.ca.gov/calohi/ Committees: Privacy Committee: Focused on consent and use of data http://www.ohi.ca.gov/calohi/eHealthPolicy/PrivacySteeringTeam.aspx Security Committee: Focused on securing the data http://www.ohi.ca.gov/calohi/eHealthPolicy/SecuritySteeringTeam.aspx

14. Privacy & Security Cal eConnect Committees: Policy Advisory Group: Focused on policies governing the use of Cal eConnect funded services. The goal is to build and leverage HIE policy based on evidence and supported by consensus. http://www.caleconnect.org/?page_id=525 Technology Advisory Group: Provides a neutral forum for adoption and/or establishment of standards-based approaches to technical operations for those organizations that wish to participate in Cal eConnect services. http://www.caleconnect.org/?page_id=527