PresentationTitle

1. PresentationTitle Arizona Health Care Cost Containment System Arizona Medical Information Exchange (AMIE) Project Final Assessment and Lessons Learned Report Draft for Review 23 January 2009 Engagement: 221840470 Richard Flowerree Vice President - Gartner Consulting

2. Purpose of This Presentation • The purpose of this presentation is to provide AHCCCS with Gartner’s Final Assessment and Lessons Learned Report for the Arizona Medical Information Exchange (AMIE) Project. • Gartner’s final assessment focused on the Project’s overall success in terms of meeting the goals and objectives documented in the Project’s Transformation Grant and the value provided to Arizona's healthcare community in terms of enhancing healthcare delivery and improving operational efficiency. • The lessons learned focused on documenting the key factors that impacted the AMIE Project. Lessons learned were organized around the following areas: • Planning and Project Management. • Staffing and Team Organization. • System Development and Implementation. • Data Partner and End-user On Boarding Process. • System Training and Operational Support.

3. Presentation Agenda • Executive Summary: • Engagement Objectives • Project Assessment Focus Areas • Assessment Process and Methodology • Gartner HIE Project Best Practices: • Business Strategy Definition • Governance Structure • Project Planning • Stakeholder Engagement • AMIE Project Final Assessment • Project Lessons Learned: • Planning and Project Management • Staffing and Team Organization • System Development and Implementation • Data Partner and End-user On Boarding Process • System Training and Operational Support • Final Thoughts and Closing Comments

4. Executive Summary

5. Ensuring Business Value Gartner’s Project Assessment and Evaluation Approach Bottom Up and Top Down Ensuring Project Success Executive SummaryEngagement Objectives—Reduce Risk and Ensure Success

6. Project Human Resources Project Communication Project Risk Management Project Procurement Executive SummaryProject Assessment Focus Areas (High Level) • Project Success Focus Areas • Project Integration • Project Scope • Project Schedule Compliance • Project Budget Management • Project Quality Management • Deliverables Focus Areas • In-Process Deliverables • Completed Deliverables • Business Value Focus Areas • Functional and Technical Requirements Definition • System Design and Development • Business Process Transformation • Data Conversion • System Validation and User Acceptance Testing • Pilot Rollout and Turnover-to-Production

7. Executive SummaryProject Area Assessment Categories

8. Executive SummaryProject Assessment Approach and Methodology Driven by Gartner Best Practices and Industry Standards

9. Executive SummaryProject Assessment Approach and Methodology (continued) • Data gathering consisting of: • Review of key documents. • Interviews of key stakeholders and project participants. • Analysis and assessment of project risks, including: • Identification of the most urgent risks to address. • Recommendation of mitigating activities to reduce the chance of the most likely risk events occurring. • Development of a report summarizing the analysis • Delivery of the report: • Presentation of the report to senior stakeholders. Gartner Research and Best Practices

10. Gartner HIE Project Best Practices

11. Executive SummaryGartner HIE Project Best Practices • Define the Business Strategy: • Define the business strategy and why it is needed. • Define and prioritize the actions needed to achieve the strategy. • Develop a clear understanding of business processes. • Ensure that the program’s priority is established among the portfolio of other programs that the health system is responsible for delivering. • Define the business process changes necessary for success and their likely impact. • Define the business benefits, ensuring that the benefits are measurable. • Set up an office that is responsible for continually monitoring progress toward achieving the benefits. • Define the risks of the program, understand their probabilities, and develop a risk management and mitigation plan that includes potential corrective action. • Ensure that the program’s managers are given incentives to take well-managed risks and that the implications of risk are communicated to managers early and often. • Incorporate IT where appropriate as part of the business strategy. The above definitions formed the foundation for our assessment findings and recommendations over the course of our engagement activities.

12. Executive SummaryGartner HIE Project Best Practices (continued) • Establish Appropriate Governance Structures: • Create a dedicated program management organization with strong leadership. • Ensure that proper accountabilities exist and that the managers of the program are held personally accountable for effective project management and delivery of the benefits. • Ensure that the business case for the program has such overwhelming benefits that it will be very hard for a politician to oppose it. • Ensure that the program has dedicated funding that cannot be used for other purposes. • Create governance structures that enable clear and effective decision making so that correct decisions are made swiftly, in line with business strategy and tied to business benefits. • Ensure that the program organization has the necessary program management skills and capacity. The above definitions formed the foundation for our assessment findings and recommendations over the course of our engagement activities.

13. Executive SummaryGartner HIE Project Best Practices (continued) • Execute Project Planning Effectively: • Define the full costs of the program, including the costs of implementation, training, data migration and business process change. • Design a flexible enterprise architecture for the program that incorporates business and IT factors. • Set deadlines (project milestones) that are conservative and realistic. • Plan for implementation, training and change management. • Plan for integration with existing applications. • Procurement of IT systems and services should only happen after the steps outlined in the aforementioned sections have been completed. The above definitions formed the foundation for our assessment findings and recommendations over the course of our engagement activities.

14. Executive SummaryGartner HIE Project Best Practices (continued) • Engage Stakeholders: • Involve a wide spectrum of clinicians in the design of the strategy and governance of the program. • Ensure that the program meets clinicians’ basic (highest-priority) needs first; then, add other functions. • Involve local IT managers in defining the reach of the program and understanding its effect on local organizations. • Identify and nurture promoters of change among clinicians and IT managers. • Engage citizens. • Devote resources to engaging media and other influencers. The above definitions formed the foundation for our assessment findings and recommendations over the course of our engagement activities.

15. AMIE Project Final Assessment

16. Executive SummaryAMIE Project Final Assessment - Summary • As documented in the Medicaid Transformation Grant dated September 29, 2006 the Project’s goal was to develop and implement a web-based HIE utility and ASP within two years that would achieve the following outcomes: • Reduction in overall medical costs of an average of 3% per year associated with prescription errors, diagnostic lab/radiology test redundancy, unnecessary emergency room utilization, claims coding errors and medical errors; • Connection of 35% of AHCCCS providers, who will be able to actively share electronic health information through the HIE utility by the end of 2009, 60% by the end of 2010 and over 90% by the end of 2011; • Reduction in overall Medicaid health system administrative costs of 2% annually through fewer manual medical record reviews, record copying, denial of claims, claims errors, and avoidance of fraud and abuse through effective beneficiary identification; • Improved quality of care oversight and quality transparency by providing timely performance information to providers and beneficiaries; • Improved coordination of care for chronic diseases and increase preventive interventions; • Improved coordination between behavioral health and physical health services which will reduce medication errors/abuse and increase case management effectiveness; and • Enhanced opportunities for better self-management of chronic illnesses by beneficiaries and their families through access to the patient’s health information and online wellness materials. AHCCCS was successful in developing and implementing a web-based HIE utility and ASP that provided access by Project participants to patient discharge summary, lab results and medication history information. However, realization of the anticipated outcomes was not fully achieved due to the limited data in the system, the limited time in use, and the small number of partner organizations involved in the Pilot proof of concept.

17. Decision Drivers Decision Drivers Product Content (Cont.) Product Content (Cont.) 1 1 Political Influences Political Influences 27 27 Implementation Difficulty Implementation Difficulty Project Management Project Management 28 28 System Dependencies System Dependencies 2 2 Definition of the Project Definition of the Project 29 29 Security Requirements Security Requirements 3 3 Project Objectives Project Objectives Development Process Development Process 4 4 Leadership Leadership 30 30 Quality Assurance Approach Quality Assurance Approach 5 5 PM Approach PM Approach 31 31 Development Documentation Development Documentation 6 6 PM Communications PM Communications 32 32 Use of Defined Engineering Processes Use of Defined Engineering Processes 7 7 PM Authority PM Authority 33 33 Early Identification of Defects Early Identification of Defects Project Parameters Project Parameters 34 34 Defect Tracking Defect Tracking 8 8 Hardware Constraints Hardware Constraints 35 35 Change Control for Work Products Change Control for Work Products 9 9 Reusable Components Reusable Components 36 36 Secure Coding Techniques Secure Coding Techniques 10 10 Budget and Resource Size Budget and Resource Size Development Environment Development Environment 11 11 Cost Controls Cost Controls 37 37 Tools Availability Tools Availability (AHCCCS Project Team) (AHCCCS Project Team) 12 12 Delivery Commitment Delivery Commitment 38 38 AHCCCS Support for Development AHCCCS Support for Development 13 13 Development Schedule Development Schedule 39 39 Disaster Recovery Disaster Recovery 14 14 Information Security Information Security 40 40 Isolation of Development Environment Isolation of Development Environment Project Team Project Team 41 41 Support for Existing/Planned Sec Monitoring Support for Existing/Planned Sec Monitoring 15 15 Team Member Availability Team Member Availability 42 42 Vulnerability Management Vulnerability Management 16 16 Team Productivity Team Productivity Deployment Deployment 17 17 Designated Information Security Focus Designated Information Security Focus 43 43 Customer Service Impact Customer Service Impact Organization Management Organization Management 44 44 Data Migration Required Data Migration Required 18 18 Organization Stability Organization Stability 45 45 Pilot Approach Pilot Approach 19 19 Executive Involvement Executive Involvement 46 46 External Hardware/Software Interfaces External Hardware/Software Interfaces Customer/User Customer/User 47 47 Day Zero Security Day Zero Security 20 20 User Involvement User Involvement Maintenance Maintenance 21 21 User Acceptance User Acceptance 48 48 Design Complexity Design Complexity 22 22 User Training Needs User Training Needs 49 49 Support Personnel Support Personnel Product Content Product Content 50 50 AHCCCS Support for Maintenance AHCCCS Support for Maintenance 23 23 Requirements Stability Requirements Stability 51 51 Patch Management Patch Management 24 24 Requirements Complete and Clear Requirements Complete and Clear Legal Legal 25 25 Testability Testability 52 52 Regulatory Compliance Regulatory Compliance 26 26 Design Difficulty Design Difficulty 53 53 Policy Development Policy Development Executive SummaryAMIE Project Final Assessment – Project Areas Assessed

18. AMIE Project Final Assessment Area Ratings Process Focus Areas Fully Met Low Risk Partially Met Med Risk High Risk Not Met Decision Drivers Decision Drivers ü ü Project Management Project Management ü Project Parameters Project Parameters ü Project Team Project Team ü Organization Management Organization Management ü Customer/User Customer/User ü Product Content (HIE) Product Content Development Process Development Process (HIE) ü Development Environment (HIE) Development Environment ü ü Deployment Deployment (HIE) ü Maintenance Maintenance (HIE) ü Legal Legal Executive SummaryAMIE Project Final Assessment - Scorecard Gartner’s Final Assessment of the AMIE Project is that AHCCCS successfully achieved the high level objective documented in the Transition Grant, i.e., the development and deployment of an HIE and ASP within two years of the Project’s inception. However, realization of the specific outcomes documented in the Grant were not achieved due to a variety of reasons including the limited data and data partners in the system, the limited number of organizations accessing and using the information, and the short timeframe the system was deployed and in user. This has been reflected in the above ratings for the three areas – Customer/User, Product Content and Deployment in terms of a YELLOW Partially Met assessment for each of these areas. However, it is important to note that the system has received high marks from end-users in terms of 1) Medication history, lab reports and discharge record information provided. 2) The ease of use in terms of navigation and the presentation of patient information. And 3) the excellent end-user training and on-call operational support provided by AHCCCS.

19. Executive SummaryRational for the Final Assessment Rating • Since its inception two years ago a number of key milestones were achieved by the AMIE Project: • Recruiting and organizing a Project team (both technical and business focused). • Implementation of a software development and quality assurance process. • Developing and documenting the business and technical requirements for a HIE. • Defining and developing key programmatic policy documents (security, privacy, consent, etc.). • Developing, documenting and executing a partner on-boarding process. • Developing and documenting partner end-user training processes and materials. • Designing and developing the HIE and viewer application and database. • Designing and developing the pilot hardware and network infrastructure for the initial HIE rollout. • Development of a 7/24 system support concept and operational model. • Successful deployment of the AMIE Pilot system. • Planning for a system second release (version 2.0) in February. • Expansion of the AMIE system to support the Behavioral Health Community. • Development and publication of a Project Post Implementation System Assessment Report.

20. Executive SummaryRational for the Final Assessment Rating (continued) • The AMIE system was successfully deployed as a Pilot proof of concept on September 29, 2008. Project partner participants included: • Banner Baywood Medical Center • Banner Desert Medical Center • Banner Estella Medical Center • Banner Gateway Medical Center • Banner Heart Hospital • Maricopa County Heath System • Saint Joseph's Hospital and Medical Center • Sonora Quest • Managed Care Pharmacy Consultants • As of January 2009 AMIE contained over 2,409,329 patient records that were being accessed by 67 end-users. • 1,139,607 Lab Results • 1,226,334 Medication History Reports • 43,388 Discharge Summaries

21. Executive Summary Rational for the Final Assessment Rating (continued) • AMIE utilization has reached a plateau following initial deployment end-user enthusiasm with the realization that the system currently has limited data availability. However, response to the design, development and delivery of the AMIE application has been positive - a testimony to the system’s overall design, development and implementation. • Easy to use. • Simple and effective navigation. • User friendly presentation of requested patient information. • End-users view medication history information as the center piece and most useful information provided by the AMIE application, with lab and discharge summary information following in importance that order. • System performance has been excellent with sub-second response to end user data requests. • The system’s initial use has been focused in Emergency Departments and Homeless Clinics. Workflow issues somewhat impacted its full adoption in other clinical settings early on. • Users understand and appreciate the value provided by AMIE in terms of enhanced healthcare delivery and want more data in the system: • Imaging (x-ray) information and reports – users view this as providing them with an opportunity for significant cost savings due to the number of “duplicate films” that have to be taken due to lost or misplaced films. • Emergency Department Reports (i.e. “ER discharge” summaries).

22. Project Lessons Learned

23. Project Lessons LearnedOrganization of Project Lessons Learned Findings • Project Lessons Learned have been organized into the following areas: • Planning and Project Management. • Staffing and Team Organization. • System Development and Implementation. • Data Partner and End-user On Boarding Process. • System Training and Operational Support.

24. Project Lessons LearnedPlanning and Project Management Lessons Learned Focus Areas • Planning and Project Management includes the following areas: • Executive Leadership and Support. • Project Definition and Scope. • Funding Identification. • Project Management Processes and Methodology: • Program Management. • Project Management. • Communication and Status Reporting. • Issues and Risk Management. • Budget Management. • Scope Management. • Quality Assurance. • Delivery Assurance.

25. Project Lessons LearnedPlanning and Project Management (continued) • Lessons Learned: • Strong executive sponsorship was critical to the Project’s overall success: • Successful acquisition of funding. • Formulation of an offsite team (i.e., a “special project organization) outside the AHCCCS mainstream was instrumental to AMIE’s success resulting in: • Shaper team focus on addressing Project issues and activities without the distraction of having to “run the business” proved to be very effective in enhancing team productivity. • Increased flexibility in staffing (hires, contracting and transfers/terminations). • Additional “hands on” executive level engagement in the partner development and on boarding process may have helped expedite this activity. • The inability to clearly define the Project’s scope early in the Project’s lifecycle adversely impacted the team’s productivity: • The upfront development and documentation of the Business Case for the HIE would have provided needed clarity and Project focus. Not having that in place prior to the start of development activities resulted in time and resources being spent on unfruitful activities. This delayed defining and addressing critical issues such as data partner selection and development and the development and implementation of the on-boarding process which turned out to be more complex and time consuming than originally planned. • Team rolls and responsibilities where not well defined early in the Project’s lifecycle impacting team productivity and the effective use of Project resources (staff and dollars) including development of the Project’s resource and staffing plans and supporting Project budget. • Although difficult to quantify, early in the Project’s lifecycle resources and dollars where spent on activities of limited value to the Project.

26. Project Lessons LearnedPlanning and Project Management (continued) • Lessons Learned continued: • Strong and effective Program Management was critical to the Project’s success in a number or areas: • Team formulation and development: • Implementation of a flexible contract staffing model (ability to choose the best of the best) enhanced the team in terms of providing key subject matter expertise and knowledge when needed to meet a challenging project schedule with limited budget impact. • The creation of an effective team structure (rolls, responsibilities and reporting relationships) as the Project progressed facilitated the achievement of the team’s shared vision for the HIE. • Development and stewardship of a strong team “chemistry” and the fostering of an environment of cooperation resulting in both the business and technical groups working collaboratively to address and resolve project issues. • Aggressive management of the system development and delivery process: • Agile software development methodology and process offered the team flexibility in addressing the evolving set of system requirements. • Comprehensive and thorough quality assurance processes provided a solid product for pilot rollout. • Rigorous testing and turnover to production, i.e. the soft go-live two weeks before “formal release” was effective in addressing issues and minimizing end-user impacts early on. • Although initially delayed in its deployment, the Project schedule and budget management processes proved effective in managing limited Project resources (staff, dollars and schedule). • Definition and successful execution of the on-boarding process (the foundation of trust) enabled the Pilot to be a success.

27. Project Lessons LearnedPlanning and Project Management (continued) • Communications, although steadily improving throughout the Project’s lifecycle, could have been more effective early in the Project: • Steering Committeebriefings would have been more productive and effective if specific detail regarding project progress to critical path activities, accomplishment of key milestones, staffing and budget updates (planned vs. actual) had been presented and advice sought. • The AMIE Project team’s communication with the larger AHCCCS organization was impacted early on by a number of factors : • The lack of a fully defined Project scope early in the Project’s lifecycle impacted the larger AHCCCS organization’s understanding of the need for, and potential value of, AMIE in supporting AHCCCS’ business objective of health care cost containment. • The formulation of an “off-site” organization to develop AMIE somewhat impacted the effective communication between the Project team and the larger AHCCCS organization resulting in an initial inability of AHCCCS and the Project to more effectively collaborate in addressing issues that surfaced during the Project.

28. Project Lessons LearnedStaffing and Team Organization Lessons Learned Focus Areas • Staffing and Team Organization includes the following areas: • Organization Structure. • Definition of Rolls and Responsible. • Interaction and Teamwork. • Team Communication. • Team Productivity.

29. Project Lessons LearnedStaffing and Team Organization • Selection of the right people for the right jobs was critical to the Project’s success. • “With a little bit of luck and a Great Team anything is possible”. The AMIE Project team (at all levels) embodied this statement. It is the “A Team”: • Communications and cooperation between all team members (including vendors) was open and frank which enhanced team productivity. • Team members worked effectively both individually and together. Each brought a unique set of expertise and skills to the Project. • The high degree of mutual respect that each team member exhibited for each other helped “bond the team” and contributed to their delivery of the Project’s “vision”. • Program Management created an atmosphere of trust and support that allowed for an environment of creativity, the free and open communication of ideas that was essential to the Project’s success. The team was “free to fail” – which is how great ideas are born. • The division of program and project management responsibilities and the assignment of key team members responsible for specific project areas (i.e., the proper division of labor) enhanced team productivity and focus allowing the program manager to better architect and manage the overall delivery process and assess team progress and to identify areas needing additional focus and support.

30. Project Lessons LearnedStaffing and Team Organization (continued) • The Project’s “staffing” contract vehicle established for third party vendor support, allowed the Project to select from multiple vendor resource pools and obtain the best of the best, affording the Project the flexibility to staff on a “near real time basis” and cost effectively address evolving Project requirements. • Program Management was nimble in addressing resources needs (adds and terminations) as the Project activities unfolded. This proved to be both cost effective and ensured everyone on the team “pulled their weight”. Overall team productivity was excellent. • The team embodied an esprit de core and pride in what they were being asked to do and what they accomplished which bread an environment that inspired peers to perform even harder and to support one another when needed. This “All For One and One For All” philosophy and work ethic drove the Project’s success.

31. Project Lessons LearnedSystem Development and Implementation Lessons Learned Focus Areas • System Development and Implementation includes the following areas: • Software Development Methodology and Tools. • Requirements Identification and Validation Process. • System Design and Development Process. • Change Control and Configuration Management. • System Testing and Validation Process. • Software Quality Assurance and Controls. • Pilot Deployment Process. • Turnover to Production Process and Controls. • Post Implementation Assessment Process.

32. Project Lessons LearnedSystem Development and Implementation • The creation of an environment (through open communication and mutual respect) fostered collaboration between the business and system development teams and was key to the Project’s success in terms of the timely development and delivery of a pilot system that addressed both data partner and end-user needs within the budget and time constraints placed on the Project. • The adoption of an Agile development process coupled with frequent builds that effectively addressed evolving requirements was instrumental in the development and delivery of a system with an intuitive user interface that has been positively received by AMIE end-users. • The robust approach taken in terms of software quality assurance and the methodology employed (i.e. all QA areas were addressed and aggressively managed even though this was a “proof concept” project, ensured no corners were cut). This was critical in keeping Project’s development process on budget and schedule by minimizing team productivity impacts that would have been associated with problem mitigation activities. • The use of a “soft go-live” two weeks prior to the actual system rollout date was a stroke of genius that helped ensure a near seamless deployment.

33. Project Lessons LearnedData Partner and End-user On Boarding Process Lessons Learned Focus Areas • Data Partner and End-user On Boarding includes the following areas: • Data Partner Selection, “Contracting” and On Boarding Process. • End-user Selection and On Boarding Process. • Legal, Privacy and Security Issues Identification and Management.

34. Project Lessons LearnedData Partner and End-user On Boarding Process • Initial activities and progress in this area were impacted by a lack of focus that resulted from the initially broad scope of the Project and the subsequent team “churn” that prevented the proper focus needed in this key area. • The focus of the Project on the exchange of patient clinical information vs. other types of information (i.e., claims) made the AMIE Project unique and has “plowed new ground” in furthering the development and implementation of statewide HIE systems. • This was, and continues to be a critical area of the Project as it is where AHCCCS builds the necessary foundation of trust that data partners and end-users require to feel comfortable (in terms of risk reduction) in order to join the AMIE team. Even though initially viewed as a complex undertaking by the team, issues associated with the sharing of patient information and data from a legal, privacy and data partner risk perspective proved more daunting than originally anticipated. Several items were critical in the team’s success in dealing with these issues including: • The selection and assignment of the right resources to focus, address and deliver the required solution. • The team’s ability to successfully understanding both the business (healthcare delivery, legal and privacy issues) and technical (data accuracy, security and timeliness) requirements of both data partners and end-users was a key Project success factor.

35. Project Lessons LearnedData Partner and End-user On Boarding Process (continued) • The delay in on boarding the medication history data provider impacted the amount of patient information initially in the system and the initial realization of the full potential and value AMIE can provide to the State’s health care community. A key lesson learned is to ensure a full and complete load of all available data into the system prior to go-live to enhance end-user adoption and use. • The overall complexity and time required to address, develop and implement the on boarding process was underestimated but the products and processes produced where excellent and fundamental to the Project success.

36. Project Lessons LearnedSystem Training and Operational Support Lessons Learned Focus Areas • System Training and Operational Support includes the following areas: • Training Plan Development and Execution. • Operational Support Planning and Execution. • Disaster Recovery and Backup Process. • System Performance and Tuning. • Post Implementation Block Release Process. • User Group Process.

37. Project Lessons LearnedSystem Training and Operational Support • Detailed planning and a laser focus were key to the success of the system training and operational support provided to AMIE’s end-users and data partners. Each was driven by the team’s clear understanding of what needed to be accomplished to ensure success. • As in other areas of the Project, putting the right people with demonstrated experience and understanding of what needed to be accomplished to facilitate the delivery of a successful solution was key to the successes achieved in this area. Critical attributes of team members working in this area included: • A passion for quality – training and support are often the last items a team wants to (or addresses) in a project – that was not the case for the AMIE Project. • Excellent communication skills – building trust and confidence was critical to the team’s success in this area. • The ability to listen and effectively respond to “client” needs in a timely fashion established the level of commitment that the Project’s partners could expect once the system went live. The team understood that you have to show client’s that you truly care and are willing to respond to their needs as fast as possible to ensure their success if you are to build trust and confidence – the AMIE team did just that. • Honesty, openness and integrity fostered team credibility. • A deep understanding of both the business and technical environments of the Project and the impact each had on the end-user’s ability to accomplish their jobs was critical to the Project’s success – In the end, AMIE was a business solution – not a technology implementation and the team never lost that focus.

38. Final Thoughts and Closing Comments

39. Final Thoughts • The Project team accomplished a great deal over that last two years: • The AMIE Project, although not meeting the full extent of the outcomes documented in the Transformation Grant, successfully delivered significant value to the State in a number of areas: • Demonstration of the value a clinical HIE can provide to the health care community. • Development of the core processes needed for the implementation of an HIE. • Technical • Legal • Security • Privacy • On-boarding… • Demonstration of AHCCCS’ expertise in the HIE arena and the resulting strong and positive relationship that resulted between AHCCCS and the Project’s data and end-user partners. • The Project is at a crossroads: • On one hand - AMIE needs to mature in functionality through the addition of additional data partners and the on-boarding of more end-users in order to deliver the outcomes documented in the Transformation Grant. • On the other hand - if AMIE can not move forward due to budget issues then AHCCCS needs to execute a robust exit strategy that provides both the Project’s business partners and Project team with the lead time necessary to take required action. • Recommendation: • AHCCCS is strongly encouraged to work aggressively with CMS on the implementation of a Transformation Grant framework that will allow AMIE to continue. At the same time AHCCCS needs to work collaboratively with local Universities for them to adopt AMIE and utilize it as both a research and educational tool and to “guide” and manage its needed enhancement and transition into the public/private sector over the next two years.

40. Closing Comments • Gartner would like to thank AHCCCS and the AMIE Project Team for their confidence in, and support of, Gartner during this engagement. We were proud to have been selected as a partner in this critical activity and we look forward to providing additional support where and when needed to help ensure the overall success of AHCCCS’ HIE and EHR initiatives.

41. Contact Information Client Contact Arizona Health Care Cost Containment System EHR and HIE Project Assessment Anthony Rodgers, Director, AHCCCS Telephone: +1 602 417 4711 E-mail: Anthony.Rodgers@azahcccs.gov Gartner Contact Engagement and Project Manager Richard Flowerree Office: +1 619 542 4815 Mobile: +1 619 515 1500 E-mail: richard.flowerree@gartner.com