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David L. Johnson BioCrossroads President and CEO CTSI Annual Meeting April 19, 2010

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David L. Johnson BioCrossroads President and CEO CTSI Annual Meeting April 19, 2010 CLINICAL INFORMATION DRIVES INNOVATION The Indiana CTSI spans and strengthens health information technology (HIT) as a national research center and an Indiana signature strength.

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David L. Johnson

BioCrossroads President and CEO

CTSI Annual Meeting

April 19, 2010


CLINICAL INFORMATION DRIVES INNOVATION The Indiana CTSI spans and strengthens health information technology (HIT) as a national research center and an Indiana signature strength

At the national level, the CTSI Program is premised on the importance of electronic communication of clinical information to advance outcomes and drive research

  • “Bioinformatics is the cornerstone of communication within the [CTSIs] and with all collaborating organizations… To facilitate the conduct of research in health care settings and to transfer research findings into routine care, clinical and translational research must employ applicable standards adopted by the HHS for use in U.S. health care and public health operations.” (U.S. Department of Health and Human Services, RFA for Institutional Clinical and Translational Science Award, March 22, 2007, p. 8)

HIT research is inherently translational anyway

  • Constantly seeks to produce, transmit, aggregate and analyze more and higher quality clinical data for better and higher quality health care delivery and health outcomes
clinical information drives innovation

The IUSM-led consortium won Indiana’s CTSI based, in significant measure, on Indiana’s unique strengths in developing HIT assets and applications

  • The Regenstrief Institute (and the Indiana Health Information Exchange)
  • The Regenstrief Center for Healthcare Engineering
  • The IU School of Informatics
  • Specific proposed HIT-driven collaborations with Eli Lilly and Company (disease modeling/personalized medicine) and WellPoint (drug safety and health outcomes)

The CTSI is now perfectly positioned to provide and sponsor the continuing, collaborative research components essential to advance the “meaningful use” of HIT throughout the Indiana healthcare system and across the United States

  • Tailored research on HIT standards, interoperability and quality measures
  • Focal point for receiving federal grant funds and coordinating significant programs in comparative effectiveness and clinical effectiveness research (CER)

BioCrossroads: WE’RE REALLY IN THIS FOR THE DATAFrom the beginning, BioCrossroads has promoted strong collaborations that bring the promise of better data to healthcare delivery – and discovery

  • BioCrossroads is Indiana’s initiative to build on our healthcare and life sciences strengths. HIT is one of our very best Indiana assets.
  • BioCrossroads drove the structuring and formation of the Indiana Health Information Exchange in 2004, drawing upon the research strengths of the Regenstrief Institute to aggregate and analyze and transmit privacy protected patient information through the development of one of the nation’s largest and most successful regional health information networks.
  • BioCrossroads coordinated the structuring and formation of the Fairbanks Institute for Healthy Communities in 2006, developing a multi-therapeutic platform for longitudinal studies pairing rich clinical information with clinical samples to achieve better health outcomes for communities like Indianapolis.
biocrossroads we re really in this for the data
  • BioCrosroads worked closely with the IU School of Medicine, the Regenstrief Institute, Indiana University and Purdue University in pursuing the CTSI awardin 2008 and in promoting the specific CTSI health outcomes collaborations with our members, Lilly and WellPoint.
  • BioCrossroads continues to work closely todaywith the State of Indiana, our statewide regional health information organizations (including IHIE), IU, Purdue, the Regenstrief Institute and the Regenstrief Center for Healthcare Engineering and Ivy Tech in assisting with the structuring, formation and submission of grant proposals for ARRA funding that have so far brought over $33 million to Indiana and our HIT sector.
  • Better data will benefit all of our stakeholders (e.g., Lilly, Cook, Roche, Clarian, Covance, Medco,WellPoint) as well as our start ups.
Indiana is truly a national leader in HITState’sRobust and Advanced Network Preceded Federal Reform Efforts
  • 5 Health Information Exchange Organizations (HIOs) in Indiana
    • IHIE (Central), MedWeb/MIE (Northeast), MHIN (North Central), HealthLINC (Southwest), HealthBridge (Southeast)
    • Different but complementary structures, markets and models
    • Together, these HIOs cover and connect 45 hospitals, 40 outreach laboratories,12,000 physicians and 12 million patient records and generate over 6.3 million monthly results.
  • These HIOs are innovative enterprises on the frontier of HIT service and software development
  • The network is powered by Indiana’s premier research institutions
    • The Regenstrief Institute is the largest and most comprehensive medical informatics laboratory in the world

The Indiana landscape is conducive to achieving necessary, early success as we move to a national system flowing health information securely from coast to coast

  • Indianapolis-based hospital systems are already freely exchanging data among one another (currently expanding across other communities throughout the state)
    • Indiana’s medical malpractice environment allows hospitals and physicians to securely share data more readily than most states
  • The Indiana network has also achieved effective interstate exchange of data.
    • HIOs in Indiana are now exchanging messages with Kentucky, Michigan and Ohio
  • Indiana’s privately funded collaborative model has enabled market driven advancement toward adoption and interoperability
  • Regenstrief’s INPC repository holds promise for the types of data that can be aggregated and analyzed to generate better health outcomes
    • The demographics of central Indiana’s population can provide valuable insight into therapies for cardiovascular disease and metabolic disorders, as demonstrated by the work of Regenstrief and the Indiana Health Study of the Fairbanks Institute for Healthy Communities
indiana has already built workable regional hie capabilities with home grown resources
Indiana has already built workable, regional HIE capabilities with home-grown resources

Indiana HIE was opportunistically created, privately funded, AND IS OPERATIONAL

Prior to any federal funding, Indiana’s 5 HIOs have collectively invested over $52 million in innovation and implementation of HIE infrastructure and services.


The result is a rapidly growing – and highly promising -- Indiana HIE network

IHIT Board


Advisory Committees


Indiana Health Information Technology, Inc. (IHIT)

(CEO/ State HIT Coordinator)

Implementation Funding




& Contracting

Coordination, Contracting,Policy, & Certification

  • Build-out of required HIE capabilities and services as needed
  • Regional HIE interconnectivity forming the Indiana Health Information Network
  • Expansion to underserved areas



Policy & Standards



Loan Program

Audit, Cert., &

HIE Operations

Licensing Committee


Public Health




Regional CenterProgram


meaningful use (TBD)

As needed for

Tech. Assist.




Provider Desktop


Office Applications





Clinical Summary (CCD)


Patient Care



Hospitals and Physicians


Even before the national healthcare debate began, the Federal Government had already secured HIT-enabled “healthcare reform” through ARRA stimulus funding

  • ARRA is funding $35 billion in new programs advancing the development, adoption and use of health information technology to deliver better healthcare for hospitals, doctors and patients across the United States.
  • The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the ARRA, promotes the adoption and meaningful use of health information technology to:
    • Develop electronic patient records, report test results, prescribe medicines, record doctor visits, and
    • Exchange clinical information among each provider of care for every patient.
  • Currently fewer than 20% of physicians and fewer than 10% of hospitals employ even basic electronic health records for their practices and patients, but this will change…
    • Incentives, and ultimately penalties, have been put in place to drive adoption and meaningful use of electronic health records (EHRs)
      • Eligible professionals will receive up to $44,000 over 5 years from Medicare or up to $63,750 over 6 years from Medicaid
      • Hospitals are eligible for incentive payments from both Medicare and Medicaid
      • Failure to achieve meaningful use brings reimbursement penalties, starting 2015
HIT enabled healthcare reform will improve healthcare quality, safety and efficiencydriving toward Meaningful Use* (MU) of HIT





HIT Enabled Health Reform

HITECH Policies

2011 MU Criteria

Electronically capture health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes

2013 MU Criteria

Encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible

Meaningful Use Criteria

2015 MU Criteria

Promote improvement in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health



Achieving “meaningful use” will require significant public and private resourcesCurrent HITECH funding is the federal down payment for HIT & HIE infrastructure

Funding for Health Information Exchange

Incentives for Adoption

  • $564 million for Statewide HIE Development
    • States receive between $4 and $40 million
    • Indiana received $10.3 million on 3/15/10
  • $220 million for Beacon Community Program
    • 15 HIEs to receive between $10 and $20 million
    • IHIE and Memorial Hospital (MHIN) each applied from Indiana
    • 300 applications were submitted nationwide
    • IHIE awaiting announcement
  • New Medicare & Medicaid payment incentives
  • for HIT adoption
    • $23 billion in expected payments from Medicare
    • to hospitals & practitioners thru 2016
    • $21 billion in expected payments from Medicaid
    • through 2021
    • ~$44 billion expected outlays

Community Health Centers

Funding for Health Information Technology

$1.5 billion in grants through HRSA for

construction, renovation and equipment,

including acquisition of HIT systems

  • $1.2 billion for loans, grants & technical assistance for:
    • Regional Extension Centers ($640M)
      • Purdue awarded $12M
    • Workforce Training ($80M)
      • Ivy Tech awarded $5M (HIT training)
      • IPIC awarded $4.8M (Healthcare training)
    • University Based Workforce Training Programs
      • Indiana University awarded $1.4M
    • Research
      • Regenstrief awaiting announcement
    • HER State Loan Fund (pending)

Broadband and Telehealth

$4.3 billion for broadband & $2.5 billion

For distance learning / telehealth grants


Indiana’s HIT strengths give us a head start in achieving meaningful use U.S. HIT Implementation Readiness: Landscape as of December 2008


indiana s opening advantages in competing for federal funds
Indiana’s opening advantages in competing for federal funds

Indiana has:

  • meaningful data exchange across health provider networks with minimal investment (e.g. IHIE and HealthBridge)
  • a medical malpractice environment (tort reform) that is physician-favorable and allows hospitals to share data
  • a cooperative environment among exchanges working collaboratively to meet meaningful use
  • invested millions of private and philanthropic dollars toward a workable, revenue sustained system already utilized by providers and physicians

VS. Other National Models

California has:

  • multiple parties competing to lead the state’s program to implement federal grant funding
  • not achieved meaningful data exchange across networks
  • invested billions of dollars in systems that are not self-sustaining

Massachusetts (and Boston) have:

  • robust electronic health records in siloed systems that to date have been neither interoperable nor accessible among hospital systems
  • competition for patients and substantial privacy concerns that have inhibited data sharing between hospital systems
indiana s hitech funding for hit and hie efforts to date 33 5 million
Indiana’s HITECH Funding for HIT and HIE Efforts to date = $33.5 million

Funding for Health Information Exchange

State Health Information Exchange Cooperative Agreement Program

  • Indiana Health Information Technology Inc. has been established by the Governor to serve as a governance and contracting structure for extending health information technology exchange capabilities to every corner of the state
  • Indiana Health Information Technology Inc. awarded $10.3 million on March 15.

Beacon Community Program

  • Indiana Health Information Exchange (IHIE) awaiting award

Regional extension center for health information technology

  • $12 million awarded to Purdue

Job training and educational/university grants

  • $5 million awarded to Ivy Tech
  • $4.8 million awarded to Indianapolis Private Industry Council
  • $1.4 million awarded to Indiana University

Funding for Health Information Technology

Expansion projects have been identified and coordinated among Indiana’s stakeholders to further interoperability and meaningful use

Foundational Projects

  • Statewide Provider Directory
  • Nomenclature Normalization
  • Clinical Message Routing
  • Electronic Results Delivery
  • Computerized Order Entry
  • Patient Health Record Integration
  • Data Source Connectivity

Infrastructure Proj. & Use Cases

Central Repository

Quality Reporting

Public Health Reporting

Clinical Summary Capability

Providing a Medicine List

Patient Identity Matching

ePrescribing Application Provision

Results Discovery/Query

ePrescribing Transaction Hub


THE OPPORTUNITYModels achieving early success will be positioned to attract significant additional resources
  • ARRA and the healthcare reform act have demonstrated the federal government’s resolve for rapid implementation of systematic change
    • The prior market driven models of opportunistic (and occasional) HIT and HIE development have been surmounted by the ARRA mandate to create a national health information framework that must be deeply adopted, widely interoperable, and eventually self-sustained
  • Initial funding has been directed broadly to develop “a level playing field” for HIT and HIE capabilities over 50 state “laboratories”
  • But state and regional models that are replicable and scalable will be rewarded with increased opportunity and funding
  • Ultimately, widespread adoption, interoperability and meaningful use will likely be achieved by the selective scaling and deployment of the best and most successful models in multiple markets
the vision for our model indiana s proposed hie network service structure
THE VISION FOR OUR MODELIndiana’s Proposed HIE Network Service Structure
  • Electronic HIE Services
  • Clinical Summary Exchange for Care Coordination & Patient Engagement
  • Discrete Data Provision for CDS & PM
  • Clinical Lab Ordering/Results Delivery
  • ePrescribing and Refill Requests
  • Rx Fill Status/Medication Fill History
  • Eligibility and Claims Transactions
  • Quality Reporting
  • Public Health Reporting

Data Services Users

Health Care Providers

Health Information

Exchange Organizations













Data Routing














Health Plans-





Med Web





Public Health


Case Management


CDS- Clinical Decision Support

PM- Population Management

CTSI – Research


Secure Health




Quality Reporting


THE CHALLENGESOur opportunities to succeed and remain a leader in HIT are tremendous, but challenges remain

Historic challenge:

  • Although we have a group of the nation’s largest and longest-running HIOs, optimal connections among the HIOs have been limited and exchanges were not progressing toward interoperability until recently

Over the past year, Indiana’s collaborative efforts have identified solutions to solve this problem, but adoption and implementation challenges remain on the horizon…

adoption and implementation challenges
Adoption and Implementation Challenges
  • Physician resistance to adoption
    • Real and perceived costs of implementation may not outweigh the incentives for adoption
  • Questions abound on the credibility of threatened reductions in Medicare reimbursement rates
  • Privacy concerns may inhibit access to repository data that will unlock the true potential of better information for reducing costs and increasing quality of healthcare
  • Are personal EHRs the future of healthcare or a distraction?
    • Data ownership at the patient level or system level could enable -- or inhibit -- true meaningful use of data
Despite challenges, recent business developments show the early promise of HIT application in new settings

Drug-safety monitoring

  • Pfizer’s recently announced Aster (adverse drug event spontaneous triggered event reporting) project aimed at making reporting easier and obtaining better data more likely

Product registries

  • The Kaiser Permanente National Total Joint Replacement Registry (TJRR) is a national level database designed as a post-market surveillance system for elective total hip and knee replacement. It has resulted in a successful identification, monitoring, and notification of a hip implant recall as well as identification of patient risk factors for postoperative complications and hospital readmissions, leading to significant changes in surgical indications and preoperative care

Public Health Alerts

  • The Indiana Public Health Emergency Surveillance System now pushes electronic public health alerts to providers in its network during health crises such as H1N1

BETTER HEALTH INFORMATION = BETTER LIFE SCIENCES Success for Indiana HIT and HIE can put all of Indiana’s life science stakeholders at a competitive advantage

  • A centralized repository to study health outcomes and collect post-market data holds tremendous potential to:
    • Increase the efficiency of clinical development
    • Increase the safety of products reaching patients
    • Track clinical outcomes
    • Conduct post-market evaluation of new therapies
    • Provide quality reporting to payers and providers
    • Enhance translational research capabilities
    • Reward innovation