1. REGIONAL COLLABORATIVES September 14, 2009

2. - 1 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE Company launched September 2004 –Non-profit registered in the State of Massachusetts CEO on board January 2005 Backed by broad array of 34 MA health care stakeholders

3. - 2 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ARCHITECTURE AND DATA FLOWS BrocktonNewburyportNorth Adams Community-level: HIE Outcomes analysis Benchmarking MAeHC-level: Analysis Negotiated reporting to plans P4P Chart review MAeHC-level: QDC Provider-level: EHR

4. - 3 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. QUALITY MEASURES DON’T HAPPEN, THEY GET DONE Overall project management Readiness assessment & planning Practice transformation & workflow planning System deployment & Implementation Post- implementation support Reporting, decision support, and performance measurement Inter-operating with internal and external systems Illustrative EHR Implementation Value Chain Vendor contracting and management Gaps at any point along the way will undermine adoption

5. - 4 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. WHY DO SO MANY PHYSICIANS OFFICES LOOK LIKE THIS? Courier just dropped off more envelopes Courier just dropped off more envelopes Prescription refill request on fax machine (Right behind the joke of the day) Prescription refill request on fax machine (Right behind the joke of the day) Unopened mail Printer with results from one lab “Hey Sally! Where is Mrs. Jones x-ray?” Unsorted results About to ring with stat results Web portal (from one hospital)

6. - 5 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CLINICAL USE OF DEPLOYED EHRs % of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008) Community 1Community 2Community 3 %

7. - 6 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BREAKOUT OF CLINICAL USE MEASUREMENT

8. - 7 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. NORTH ADAMS HIE SCREEN SHOT

9. - 8 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ARCHITECTURE AND DATA FLOWS Outcomes analysis BenchmarkingOther reporting P4P Chart review BrocktonNewburyportNorth Adams How to handle consent policy for unanticipated expansion of use, even if it’s legally allowed? Is 5-10% opt-out acceptable for public health and population health? How to handle physician desire for routine re- identification? Are physicians enthusiastically pursuing consent? How to deal with “non-believers” and free-riders? Entity-by-entity opt-in consent (North Adams exception) Encrypted identifiers Re-identifiable

10. - 9 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. DATA BEING SENT TO THE MAEHC QDC TODAY Problems Procedures Allergies Medication Demographics[de-identified] Social/Family hx if it can be sent in discrete data Smoking status- if it can be sent over in discrete data Visits Diagnosis Lab results Rad results Future[ inpatient data to include surgical history]

11. - 10 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. Records Received By MAeHC QDC Through May 2009 North Adams Newburyport Brockton 000 437,000 total records since Jul 2008 57,000 records received in May 2009

12. - 11 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC QDC DATA COUNTS (I) Patients Patient visits DiagnosesProcedures North Adams Newburyport Brockton

13. - 12 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. Problems Lab results MedicationsVaccinations MAEHC QDC DATA COUNTS (II) North Adams Newburyport Brockton

14. - 13 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC QDC LOG-IN SCREENSHOTS

15. - 14 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAEHC QDC REPORT SCREENSHOTS Peer comparison report (1) Drill-down reportBenchmark summary report Peer comparison report (2)

16. - 15 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. QUALITY DATA CENTER IS BECOMING A “PUBLIC UTILITY” AS WELL AS A COMMERCIAL PLATFORM

17. MEANINGFUL USE INTEROPERABILITY REQUIREMENTS COULD PUSH THE ENTIRE INDUSTRY TOWARD HIE Lab results delivery Prescribing Claims and eligibility checking Quality & immunization reporting, if available 2011 Increases volume of transactions that are most commonly happening today – Lab to provider – Provider to pharmacy Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Receive public health alerts Home monitoring Populate PHRs 2013 Substantially steps up exchange – Provider to lab – Pharmacy to provider – Office to hospital & vice versa – Office to office – Hospital/office to public health & vice versa – Hospital to patient – Office to patient & vice versa – Hospital/office to reporting entities Access comprehensive data from all available sources Experience of care reporting Medical device interoperability 2015 Starts to envision routine availability of relatively rich exchange transactions – “Anyone to anyone” – Patient to reporting entities Meaningful Use objectives requiring health exchange

18. - 17 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CREATING INFRASTRUCTURE TO FACILITATE MEANINGFUL USE Regional Health IT Extension Centers Non-profit implementation assistance organizations to facilitate meaningful use among “priority primary care providers” 70 will be set up across the country – 3 cycles of funding – 12/09, 4/10, 9/10 Awards of $1M to $30M – does NOT pay for hardware, software, or interfaces Must commit to getting at least 1000 priority PCPs to meaningful use in 2 years Matching funds required: – Years 1 & 2: 10% – Years 3 & 4: 90% State-level HIE Each state given planning and implementation grants to implement HIE 50 awards across the country – Awards announced 12/09 Awards of $4M to $40M Managed by States or non-profit state- designated entities (SDEs) Must implement state plans aligned with federal goals State-level directories eligibility and claims eRX & medication histories Lab ordering and results Public health reporting Quality reporting Clinical summary exchange Matching funds required: – FY 2010: 0% – FY 2011: 10% – FY 2012: 25% – FY 2013: 12.5% $564 million $598 million

19. - 18 - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. http://www.maehc.org http://www.maehc.org Micky Tripathi, PhD MPP President & CEO mtripathi@maehc.org 781-434-7905 mtripathi@maehc.org