1. IHE Conference June 11, 2007

2. Who are we? Multi-State Region 750,000 Patients ( 2 / 3 in TN, 1 / 3 in VA) 18 Hospitals 2 Large Community-Based Health Systems 1,200 Physicians Many Rural and Smaller Practices No dominant payor 25% Medicare, 20% Medicaid 18% uninsured 2-20% Other Few Large Employers Eastman Chemical – (7,000) is the largest Government and healthcare entities next largest

3. Innovative Regional Cooperation To Improve Health Active, representative membership, including Employers: Eastman Chemical Company, CGI Payors: Blue Cross Blue Shield, John Deere Health, Cariten PHP Hospitals: Mountain States Health Alliance, Wellmont Health System, Frontier Health, Johnston Memorial Hospital, Quillen V.A. Medical Center, Laughlin Memorial Physicians: Holston Medical Group, Highlands Wellmont Health Network, Health Alliance PHO, Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Rural Health Services Consortium Education: East TN State University School of Medicine, College of Nursing, College of Public and Allied Health Public Health: Regional Health Departments: Sullivan and Northeast Regional in TN, Cumberland Plateau and Lenowisco in VA Community: Kingsport Tomorrow, United Way of Kingsport, Rotary Club of Kingsport Patient Advocates: American Cancer Society, Minority Health Coalition Technology: Intellithought, LucentGlow, eTechSecurityPro, Holston Technology, the CreativeTrust, ntara, OnePartner

4. CareSpark Mission To improve the health of people in Northeast Tennessee and Southwest Virginia through the collaborative use of health information Regional Population Has High Disparities of: Diabetes Cardiovascular Disease Hypertension Lung Disease Cancer CareSpark region has $2,400 higher per capita patient care costs than other regions of the country

5. Goals & Priorities – Parallel Pathways 1.Interoperable EHR Adoption – Encourage and support increased use of EHRs (with e-prescribing and decision support tools) among providers 2.Regional HIE Platform – Implement infrastructure and connectivity for sharing of information among providers, payors, public health Align with AHIC national standards and Nationwide Health Information Network infrastructure to connect with other networks Align with statewide initiatives in Tennessee and Virginia 3.Public Health Improvement – Increased biosurveillance, community-wide aggregation and study, improved disease reporting, prevention services and chronic disease identification, management and outcomes 4.Financial Incentives – Implement financial incentives for payor and provider participation

6. CareSparks Core Values Cooperation Privacy Integrity Inclusiveness Community Accountability Continuous Improvement Process Stakeholder Parity

7. CareSpark RHIO Consortium National / International: Local / Regional: ActiveHealththe Creative Trust AllScriptseTechSecurityPro CGIHolston Technology CiscoIntellithought CovisintLucentGlow DellOnePartner GE Healthcare InitiateState: IntelTennessee McKessonVirginia Misys Oracle Quovadx Siemens SureScripts

8. Physician Adoption Phase 1.2 Inputs and Outputs EMR 1 EMR 3 EMR 2 Helpdesk Hardware and Software Infrastructure Security (C/I/A) Infrastructure Physicians Application Use Pharmacy HL7 Rx Orders Health Information Exchange Interface Engine RHIO Master Patient Index Providers Terminology/Normalization Portal Platform Physician Portal Patient Portal Business Intelligence/ Reports Helpdesk Hardware and Software Infrastructure Security (C/I/A) Infrastructure RHIO Record Location Service RHIO Clinical Data Repository HL7 Demographics Discharge Summaries Rx Orders, Results User Management Physicians Patients Public Health Perf Measures P4P Pilot Portal Reports Access Requests HL7 Clinical/ Demographic/ CC Data Provider EMR Labs Pharmacy HL7 Orders HL7 Results Care Considerations ActiveHealth Decision Support Decision Support Payors Provider List Member List ActiveHealth Care Engine Care Considerations messages HL7 Clinical Data HL7 Demographics Discharge Summaries Rx Orders, Results Portal/EMR-Lite

9. Proposed CareSpark IHE Architecture CareSpark XDS Document Registry XDS Document Registry XDS Patient Identity Source (MPI) XDS Patient Identity Source (MPI) Portal Wellmont Phys Portal IHE DocConsumer Wellmont McKesson IHE DocConsumer MSHA Phys Portal IHE DocConsumer MSHA Siemens IHE DocConsumer HMG AllScripts IHE DocConsumer Clinical Data Repository Other Providers FILTER Clinical Data Repository Public Health Data Mart De-Identified Data Mart For Patient Care For Public Health Improvement

10. CareSpark IHE-compatible Architecture Provider X Lab IHE Embedded Repository IHE Embedded Repository Transcription Email/Paper/ Rich Media Legacy App App without Repository CareSpark IHE XDS Document Registry IHE XDS Document Registry IHE PDQ Demographics Server Wellmont Phys Portal IHE DocConsumer Wellmont McKesson IHE DocConsumer MSHA Phys Portal IHE DocConsumer MSHA Siemens IHE DocConsumer CareSpark Portal IHE DocConsumer HMG AllScripts IHE DocConsumer IHE DocSource EHR System PACS Other Providers

11. CareSpark commitment to IHE- compatible architecture Accommodates both federated and centralized document repositories and clinical data repositories (hybrid model) Utilization of internet between secure nodes via encrypted, dual-authenticated links Centralized audit management, security, and consent policies IHE is promoted and supported by Federal standards bodies which worked to define standardized data sets and formats That CareSpark Will Leverage The IHE Cross- Enterprise Document Exchange (XDS) Profile

12. Compliance with US National Health Info Network HITSP Interoperability Specs and CCHIT Roadmap Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Cross-Enterprise Document Media Interchange Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Patient ID Mgmt Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting true-copy and origin Security Clinical and PHR Content Health Data Exchange Request Form for Data Capture Other Cross-Enterprise Document Reliable Interchange Accepted by HITSP&CCHIT in 2006 Candidates for HITSP&CCHIT in 2007 Notification of Document Availability Public Health Reporting

13. Gaps for IHE and CareSpark Patient Consent Identity Management Central Repository for public health improvement Clinical Data Presentation

14. Patient Consent – CareSpark and IHE CareSpark Consensus: Passive enrollment mechanism Control consent at the patient/provider level Providers help patients manage their consent CareSpark never stores or transfers non-consensual data Questions for IHE: How do IHE solutions accommodate patient consent? How does consent connect to EMPI and IHE network? Is Basic Patient Privacy Consent ready for prime-time use? Are there demonstration projects?

15. Identity Management – CareSpark and IHE CareSpark Consensus: Develop federated trust network across CareSpark providers Minimize overhead of identity management at CareSpark level Questions for IHE: What is practicality of XUA implementation across Vendor Consortium solutions? Are there demonstration projects we should look to as a reference?

16. Centralized Repository – CareSpark and IHE CareSpark Consensus: Easy way to report health metrics and monitor public health # of Patients 18-75 with ICD-9 code of 250.00- 250.99 (Diabetes) and having two HgA1c values at least 91 days apart during the 12 months prior to the date of data gathering Reporting and analysis (research, surveillance) Questions for IHE: What part of XDS and/or vendor solutions address this?

17. Clinical Data Presentation – CareSpark and IHE CareSpark Consensus: Present RHIO data in clinicians native systems (not a separate portal whenever possible) Have physician-centric view of XDS clinical data within providers native EHR systems Integrated with local data Not a big list of other HIE data Questions for IHE: What are vendors doing to make document-centric XDS data usable to physicians? Have directions been defined about document grouping for display?

18. Why does CareSpark matter? Voluntary commitment to interoperability (local, regional, state, national, international) Participation in NHIN prototype demonstrations, state-level pilots Private-sector, market-driven approach to assure sustainability Attention to outcomes and measurable results

19. Who are we? CareSpark plans to be RHIO Done Right

20. Better Health for Central Appalachia www.carespark.com Liesa Jenkins, Executive Director 423-963-4970 ljenkins@carespark.com