1. THE SEQUOIA PROJECT Trusted Convener of Industry & Government to Address Health IT Interoperability 1 © 2015 The Sequoia Project. All Rights Reserved.

2. Healtheway rebrands to reflect expanding mission for health IT interoperability, including: Increasing number of collaborative initiatives Enhancing interoperability education Promoting industry-wide best practices 2 © 2015 The Sequoia Project. All Rights Reserved.

3. Why “The Sequoia Project”? Sequoia trees are among the most enduring, massive living things. An interconnected root system allows individual trees to support each other, making the entire system stronger. A thriving health IT community requires interconnected organizations working together for the benefit of all. Connected We Stand. 3 © 2015 The Sequoia Project. All Rights Reserved.

4. The Sequoia Project is the trusted, independent convener of industry and government Works to address the challenges of secure, interoperable nationwide health information exchange (HIE). 4 The Sequoia Project’s Role NATIONWIDESECUREINTEROPERABLE © 2015 The Sequoia Project. All Rights Reserved.

5. Continued Support for Carequality and eHealth Exchange The Sequoia Project will continue to serve as the steward of its independent initiatives. The initiatives will continue to be governed independently by its respective members. The Sequoia Project will be actively pursuing additional interoperability initiatives that will aid in making secure data exchange a reality in the U.S. More information will be forthcoming within the year. 5 © 2015 The Sequoia Project. All Rights Reserved.

6. Acting in the Public Interest As a nonprofit 501 (c) 3 organization operating in the public interest, our public-private governance process insures transparent oversight of this work. The Sequoia Project serves as a neutral, third party convener. The practical application of our work: Enables consensus agreement on the policies and standards required to reduce barriers to data exchange Advances development and continued support for health information exchange governance frameworks Provides services that enable health information exchange networks to interoperate 6 © 2015 The Sequoia Project. All Rights Reserved.

7. The Sequoia Project Initiatives The Sequoia Project’s independent initiatives each have their own: Mission Governance Membership Structure The Sequoia Project is an ideal home for projects that require a collaborative environment where multiple parties with differing perspectives can work together. 7 © 2015 The Sequoia Project. All Rights Reserved.

8. Current Sequoia Project Initiatives The eHealth Exchange is the largest and fastest growing health information exchange network in the US Carequality is a public-private collaborative building consensus on a national-level interoperability framework to inter-connect networks 8 © 2015 The Sequoia Project. All Rights Reserved.

9. The Sequoia Project and Care Connectivity Consortium (CCC) Strategic Alliance CCC is a collaborative of 5 prominent healthcare organizations: – Geisinger (PA) – Intermountain Health (UT) – Kaiser Permanente (CA, OR, WA, VA, MD, HI, GA, CO) – Mayo Clinic (MN, FL, AZ, GA, WI) – OCHIN (17 states) CCC enhances capabilities of current HIE technologies and allows for sharing between organizations and health IT systems The CCC aids eHealth Exchange growth by: – Serving as a test bed for new technologies – Contributing innovations to the eHealth Exchange community The CCC participates in Carequality and serves on its: – Steering Committee – Trust Framework Work Group – Query Work Group – Operations Work Group 9 © 2015 The Sequoia Project. All Rights Reserved.

10. The Largest Health Information Exchange Network in the U.S. 10 © 2015 The Sequoia Project. All Rights Reserved. An initiative of

11. Introduction to the eHealth Exchange Rapidly growing network for securely sharing health information over the Internet 11 Shared Governance and Trust Agreement Common Standards, Specifications & Policies Tech Vendors Federal Govt States PharmaciesPayers HIEs Care Facilities © 2015 The Sequoia Project. All Rights Reserved.

12. 10 Years of Progress 2006 ONC sponsors prototype architectures, followed by trial implementations. 12 2008 Focus shifted to supporting production pilots 2009 First production exchange between Social Security Administration and MedVirginia, followed by Veterans Health Administration and Kaiser Permanente 2012 Exchange transitions from government to private sector. Private sector connectivity increases 2015 Nationwide implementation across 50 states © 2015 The Sequoia Project. All Rights Reserved.

13. Largest Health Information Exchange Network in the U.S. Today, the eHealth Exchange connects: 13 10,000 medical groups 900+ dialysis centers 8,200 pharmacies Supporting more than 100 million patients All 50 states Four federal agencies (DoD, VA, HHS including CMS, and SSA) 30% of U.S. hospitals © 2015 The Sequoia Project. All Rights Reserved.

14. eHealth Exchange Growth (2015 Projected) 14 Operations supported by ONC Network doubles Growth fueled by MU2 TOC measures Testing Program launched ONC Initiative: NwHIN Exchange 2009201320142015 2011 Network matures Product Testing Program launched Increased network adoption New use case New types of participants / networks Enhanced capabilities Streamlined testing / onboarding 44 Total Participants Total Participants 23 Total Participants 4 81 Total Participants 150+ Projected Participants © 2015 The Sequoia Project. All Rights Reserved.

15. eHealth Exchange Overview eHealth Exchange Has Trust Foundation – Legal Agreement – Governing Committee – Operating Policies and Procedures eHealth Exchange Uses Technical Services – Web services registry (phone book of network Participants) – Security (x.509 Managed Certificate Authority) – Automated testing using Aegis platform 15 © 2015 The Sequoia Project. All Rights Reserved.

16. Sample Use Cases Treatment / Care Coordination Allows access to critical information (e.g., test results, medication history, allergy info, immunizations) and makes available to providers when patient is transferred Responder Only Profile Supporting the Treatment Use case (New) Allows other networks (e.g., release of info companies and SAAS model vendors) to respond to queries from eHealth Exchange Participants on behalf of their client Military/Veteran Health DoD and VA exchange active service members and veterans’ records to provide government and private caregivers with up-to-date medical histories Disability Determination Social Security Administration requests claimant records electronically to make disability determinations. Cuts down claims processes from months to days Quality Reporting for the End Stage Renal Disease Program – CMS Allows Dialysis centers to send quality data to CMS to assure that individuals with End Stage Renal Disease receive the highest quality of care 16 © 2015 The Sequoia Project. All Rights Reserved.

17. eHealth Exchange: Benefits 17 BenefitHow eHealth Exchange Achieves Benefit Reducing Costs Using common standards, legal agreements and governance enables participants to reduce legal fees and avoid building custom interfaces with trading partners. Improving Clinical and Business Decisions Access to a nationwide data sharing network provides secure access to the comprehensive health data that healthcare providers, pharmacies and payers require to improve clinical decision making, patient safety, process improvement and fair payment. Exchanging Data with Government Agencies Federal participation in the eHealth Exchange supports data sharing among all participants and with agencies such as Centers for Medicare & Medicaid Services, the Department of Defense, the Social Security Administration and the Department of Veterans Affairs. Planning for the Future Because the eHealth Exchange is governed by a representative set of participants, its multi-purpose interoperability platform has the ability to evolve and incorporate new use cases, standards, etc. © 2015 The Sequoia Project. All Rights Reserved.

18. Carequality for a Common HIE Framework Accelerating seamless, interoperable health information exchange among networks 18 © 2015 The Sequoia Project. All Rights Reserved. An initiative of

19. The Challenge What if you had a cell phone plan that only allowed you to call other customers of your carrier? 19 That’s the situation for most healthcare providers today, when they join a data sharing network. © 2015 The Sequoia Project. All Rights Reserved.

20. The Solution Carequality creates a standardized, national-level interoperability framework to link all data sharing networks 20 Carequality is creating a web of interconnected networks © 2015 The Sequoia Project. All Rights Reserved.

21. A Multi-Faceted Approach Carequality’s strength lies in its diverse stakeholder base. We approach the interoperability challenge from all sides. 21 Collaborative Multi- Stakeholder Open Real- World Carequality is Managed by The Sequoia Project is a nonprofit acting in the public interest. It convenes industry and government to address common interoperability challenges. © 2015 The Sequoia Project. All Rights Reserved.

22. The Carequality Community Physicians Consumers Government Agencies Data Sharing Networks Payers Behavioral Health Acute Care Long Term and Post-Acute Care 22 Hospice and Home Care Research Public Health Vendors Standards Development Orgs. Pharmacies EMS Services © 2015 The Sequoia Project. All Rights Reserved.

23. 23 Carequality Members © 2015 The Sequoia Project. All Rights Reserved.

24. A Brief History 24 February 2014 Carequality Launch May 2014 Operating Principles & Governance Model June 2014 Steering Committee Formed Aug/Sept 2014 Advisory Council & Work Groups Chartered January 2015 Principles of Trust Adopted April 2015 Initial Rollout Kickoff © 2015 The Sequoia Project. All Rights Reserved.

25. Essential Elements 25 Common rules of the road: In order for the varied participants to trust each other with health information, everyone needs to have a legal obligation to abide by the same rules. Well-defined technical specs: Shared rules are not enough; clear standards must be laid out in an implementation guide that all implementers can follow. A participant directory: To connect using the common standards, systems must know the addresses and roles of each participant. © 2015 The Sequoia Project. All Rights Reserved.

26. 26 © 2015 The Sequoia Project. All Rights Reserved.

27. Carequality Initial Rollout Began April 2015! 27 Initial Use Case Implementation Guide: Implement the technical, business, and policy requirements outlined in the Query Use Case Implementation Guide, and provide feedback to inform the version of the Guide adopted for general public use Legal Framework for Exchange: Provide feedback on Carequality’s legal framework, and implement the standardized terms once they are adopted It’s not too late to participate in the initial rollout! For information, contact admin@carequality.org © 2015 The Sequoia Project. All Rights Reserved.

28. Carequality Initial Rollout Participants 28 © 2015 The Sequoia Project. All Rights Reserved.

29. Carequality Initial Rollout Coverage 29 The initial rollout has have broad impact, covering: 200,000 Physicians Over 2,000 Hospitals Over 40,000 Clinics More than 15 million patient records shared per month © 2015 The Sequoia Project. All Rights Reserved.

30. 30 There’s a lot more to health IT interoperability than document queries. The initial Query for Documents Use Case is just the beginning. The Carequality framework is flexible and is meant to be applied to many different use cases. © 2015 The Sequoia Project. All Rights Reserved.

31. Stakeholder Focus Groups 31 Exploring other areas for potential use cases Requesting input from stakeholder groups on use cases that matter most to them Likely stakeholder areas for exploration are: – Payers – Mental and Behavioral Health – Long Term/Post-Acute Care – Population Health If you’d like to join the conversation, please contact us at admin@carequality.org and indicate your area of interest. © 2015 The Sequoia Project. All Rights Reserved.

32. Thank You! 32 © 2015 The Sequoia Project. All Rights Reserved.