1. EHealth In Northern Kentucky: Keith Hepp CFO, VP Business Development khepp@healthbridge.org

2. Greater Cincinnati Demographics 2.2 million population 2.2 million population 14 county tri-state area (OH, KY, IN) 14 county tri-state area (OH, KY, IN) 25 hospitals / $4 billion annual expenses 25 hospitals / $4 billion annual expenses 3 dominate private health plans 3 dominate private health plans Approximately 4,000 active physicians Approximately 4,000 active physicians Engaged employers / Low reimbursement Engaged employers / Low reimbursement History of collaborative activities History of collaborative activities

3. HealthBridge Timeline 1997: Funded by 5 Health Systems & 2 Insurers 1997: Funded by 5 Health Systems & 2 Insurers 2000: Purchased Axolotl Clinical Messaging 2000: Purchased Axolotl Clinical Messaging 2003: Public health/physician alerts added 2003: Public health/physician alerts added 2004: Syndromic Surveillance added 2004: Syndromic Surveillance added 2006: Community–wide electronic lab ordering 2006: Community–wide electronic lab ordering 2006: With Northrop Grumman consortium on NHIN demonstration 2006: With Northrop Grumman consortium on NHIN demonstration

4. MercyChildren’sSt. ElizabethHealth AllianceTriHealthDrake Greater Cincinnati HealthBridge Network Health System Content Available To HealthBridge Users

5. The HealthBridge Portal Homepage

7. FaxElectronic Mail MD EMRs Clinical Messaging Servers Centralized Printing HealthBridge Clinical Messaging System Overview Mercy Health Partners Health Alliance TriHealth St. Elizabeth Cincinnati Children’s Health Systems – 17 Hospitals Lab Results, Radiology Reports, Transcribed Reports, ADT Transactions Physician Access to Clinical Results -HL-7 Data -MD Directory -Patient Index -HIPAA Access Audit Fax Server Syndromic Surveillance RODS Lab LabOne MD Dictation Ancillary Data Feeds Community Standards Legacy Result Delivery Public Health Health Alerts

10. Clinical Messaging Electronic “Inbox”

11. Sample of a Clinical Messaging CBC Result

12. Final View- Used To Access All Electronic Results for a Practice

14. Key Learnings Governance is key – the closer the decision to the community, the easier the collaboration Governance is key – the closer the decision to the community, the easier the collaboration Some portions of healthcare needs to remain local (disease management) and some are national in nature (prescriptions) Some portions of healthcare needs to remain local (disease management) and some are national in nature (prescriptions) To be self sustaining, RHIO’s need to look for areas other than just messaging To be self sustaining, RHIO’s need to look for areas other than just messaging Too many RHIO’s do not have credible plans for sustainability. Grants for seed funding is fine but operations should be self sustaining Too many RHIO’s do not have credible plans for sustainability. Grants for seed funding is fine but operations should be self sustaining

15. Key Learnings Flexibility of technology important due to varying skills in the physician office Flexibility of technology important due to varying skills in the physician office Logical RHIO area may be across state boundaries Logical RHIO area may be across state boundaries “EMR Lite” provides a flexible way to start electronic communications and moves physician offices in right direction “EMR Lite” provides a flexible way to start electronic communications and moves physician offices in right direction Currently, EMR’s can create islands of information again Currently, EMR’s can create islands of information again Process, process, process… Process, process, process…

16. 2006 Projects Medication history at the ED Medication history at the ED Automated reporting of Class A diseases Automated reporting of Class A diseases Improvements to Case Management Improvements to Case Management Diabetes and other disease registries Diabetes and other disease registries Automation of Bridges to Excellence reporting and analysis Automation of Bridges to Excellence reporting and analysis Automation of hospital/health plan reporting Automation of hospital/health plan reporting

17. EHealth In Northern Kentucky: Keith Hepp CFO, VP Business Development khepp@healthbridge.org