Why Initiate: The foundation for healthcare interoperability

1. Why Initiate:The foundation for healthcare interoperability Lorraine Fernandes, RHIA Senior Vice President, Healthcare Practice Bill Klaver Product Manager

2. Over 2 billionrecords analyzed 1,400 healthcare facilities use Initiate technology Typically discover duplication rates of 15-30% in “clean” files Installations from500K to 500M+ records Search and link across 150M records in sub second Offices Chicago, CA,TX, AZ, Australia,UK, Canada About Initiate Systems and interoperability … Establish patient identity … Provide meds history profile … Create national prototype … Determine a member … Access clinical info on demand … Enable complete 360° Rx view … Share data securely … Create a national EHR … Advanceinteroperability

3. The healthcare reality • Volume of patient data increasing exponentially • Quality of patient data declining • Fragmented, duplicate and conflicting patient information within and across databases andtouch points • Regulatory and safety issues drivenew requirements ADT Rob Johnson 1000 Main St. Lab Robert Johnson robj@aol.com PACS Bob Johnson (555) 123-4567 Billing Bobby M. Johnson credit card# 5555-55-1234

4. Patient identification enables the interoperability of tomorrow’s virtual health record EHRs, RHIOs and NHIN • Improve patient care and reduce medical risks • Improve efficiencyby reducing redundant care activities • Support consumer directed health information management • Comply with regulations • Enhance operational productivity and efficiency ROI

5. Hospital 2 Hospital 1 County General Hospital 3 Identity Public Health Identity General Real-time Updates Real-timeQuery HL7 API Clinics, Labs, Imaging Real-time Query Identity Hospitals (for Inpatients & Outpatients) Real-time Query API Identity Pharmacy& Pharmacy Benefits Mgmt. NCPDP Nightly Update Search XML Identity Flat File SOAP Real-time Updates Identity Clinical System Identity Physicians Network Lab Systems Physician Labs & Imaging Interoperability challenges in healthcare ecosystem EHR, RHIO, NHIN

6. Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234 Trusted system of record 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Initiate Identity Hub™ software • Derives & standardizes data for efficiency • Finds all potential matches • Use sophisticated probabilistic statistics to compare many attributes & score records • Puts results in 3 buckets – link, don’t link, needs manual review Interoperability with Initiate starts with the Identity Hub P&C policyholder data Debbie Dozier -Becker 9146 E VIA DEL SOL NETOWN, CA 45883 Local identifier 12/19/61 – 727 Claims and billing data Debbie Becker NULL 5555-55-1234 Local identifier DBECKER1234 Debbie Dozier NEED INFO 5555-55-1234 Local identifier 12345ABCDE Commercial policyholder data Debbie Becker 9146 E VILLA DEL SOL NETOWN, CA 45885 Local identifier HOSPABC98765 Web self service data Store #3908, Zip = Debbie Becker 9146 VIA DEL SOL 480-473-3486 Local identifier BECKER4804733486

7. How Initiate fits in with IHE? By answering these questions Do I know this person? Query (IHE PIX Manager) • By ID information from both source and generated at the PIX Manager • By demographics enhanced by multiple sources contained in the PIX Manager (PDQ capabilities) Where do I know this person from? Source demographics (IHE PIX & PDQ functionality) • Source identity information is never lost from within and across sources What do I know about this person? Event demographics (IHE PDQ functionality) • Information about events (i.e. patient chart, diagnosis, etc.) that have triggered a patient record How do I know this person? Linkage summary (IHE PIX Manager) • Record of truth view across sources including the most current attributes Is there anything else I know about this person? Household information (Extended IHE PIX Manager) • Information on patient relationships either household information within source across sources What can I do with this information? HL7 message integration (IHE Interoperability) • Send, received, and updated via HL7 messaging

8. EMPI questions that drive interoperability Do we know the patient? Is this the correct patient? What “View” of the patient are you allowed to see? What other information do we know about the patient? How do we get to the other information about the patient? What can we do with this patient information? How do we keep the patient information in-sync?

9. On ramp to RHIO Laboratory management Medication management Radiology management Patient financial management Medical management On ramp to RHIO Medication management Medicalmanagement Patient financial management Compositepublic data Patient portal Laboratory management Medical management Healthcare ecosystem – interoperability applications EHR

10. Healthcare expectations that drive interoperability CustomerPortal Specific views – Create common view of “customer” per organization’s objectives and marketing requirements. May address consumer, member, patient portal. Public Health EHR - Create virtual EHR of public databases such as immunization, disease-specific, biosurveillance, - with option to be payer specific for state funded healthcare.

11. Process Registration Scheduling Billing The invocation of the necessary services to provide the most accurate information to the right place at the right time Purchasing Care delivery Diagnosis Treatment Communications Research Interoperability defined People Public Health Pharmacy RHIO Payor Provider PBM Supplier Radiology Physician Etc. Patient Privacy, Security, Standards, Regulatory Compliance Data Patient 3rd party/ Ref. data ERP Clinical Financial Etc. DI Provider Rx Resource Formulary Research

12. Data Services Reference architecture Medicalmgt Radiologymgt Customer portal Medicationmgt On rampto RHIO Labmgt Service Sticky applications Business Business Logic Application Services Solution Consulting Standards Core Business Services Integration Initiate Identity Services Hosting Infrastructure Security Services Data Services Messaging Services and Source Adapters 3rd party EMPI HIS Clinical Financial Provider