Southwestern Va Medical Technology Summit Oct. 2, 2009

1. Southwestern VaMedical Technology SummitOct. 2, 2009

2. Presentation Overview • Background • Coordination of Care for Individuals • Regional Public Health Status Improvement • Current Status • Regional Participation and Capabilities • State-level initiatives • National • Future Plans • Support participants to achieve “Meaningful Use” • Expansion of cooperative efforts • Tracking and reporting of outcomes

3. Background: Regional Health Improvement CareSpark’s Mission: to Improve the Health of People in northeast Tennessee and southwest Virginia through the Collaborative Use of Health Information • 750,000 citizens • (2/3 in Tennessee, 1/3 in Virginia) • Disproportionately High Rates for • Premature mortality • Chronic Diseases • Prescription Drug Overdose • Uneven Access to Services • 18 hospitals • 1400 physicians • 18% uninsured

4. 1. 2. 3. 4. CareSpark’s Core Strategies Provide patient information and decision supportat the point-of-care Empower patientsto make informed decisions and healthy choices Compile and analyze aggregate data for population health improvement Align financial incentives for patients, providers, purchasers

5. Community-Wide Collaboration • Employers: Eastman Chemical Company, CGI, BAE Systems, City of Kingsport, • Food City, ntara, the Creative Trust, Steadman Corporate Design, • Payors: Blue Cross Blue Shield of Tennessee, John Deere Health / United Healthcare, Cariten • PHP, Highlands Wellmont Health Network, CIGNA • Hospitals: Mountain States Health Alliance, Wellmont Health System, Johnston Memorial • Hospital, Quillen V.A. Medical Center, Laughlin Memorial • Physician Practices: Holston Medical Group, Highlands Physicians, Health Alliance PHO, • Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Frontier Health, • Southwest Virginia Community Health System, Mountain Region Family Medicine, Medical Care PLLC • Health Education: East TN State University School of Medicine / College of Nursing/ College • of Public and Allied Health, University of Appalachia College of Pharmacy, University of Virginia • Public Health:Sullivan and Northeast Regional Health Departments in TN, Cumberland • Plateau and Lenowisco Health Districts in VA, Tennessee Department of Health, Virginia Department • of Health and Human Resources • Community Non-Profits: Kingsport Tomorrow, United Way of • Kingsport, Rotary Club of Kingsport, Kingsport Chamber of Commerce, • Bristol Chamber of Commerce, NETWORKS Sullivan County Partnership • Patient Advocacy Groups: American Cancer Society, • Minority Health Coalition, Mountain Empire Older Citizens, Savvy Patient • Technology Companies: ActiveHealth, AllScripts, Anakam, BCTI, Cisco, • CGI, Deliberare, Healthvision, Holston Technology, Initiate Systems, Intellithought, Intel, • LucentGlow, OnePartner, Oracle, Wellogic

6. Key Strategic Decisions • 1. Enable voluntary participation by all patients and providers in region • 2. Enroll patients through default Passive Enrollment (“opt-out”) with option for Active Enrollment (“opt-in”) • Hybrid Model, combining Federated Repositories and Centralized Repository for limited clinical data • - Enabling coordination of care decision support, monitoring and aggregate data analysis • 4. Data Access and Uses • Patient: view content of records, view access log • Provider: payment, treatment, operations • Public health: required reporting and authorized queries • Payers: de-identified aggregate data • Research: IRB-approved studies • Fee-Based Revenue Model • - Contracts with public agencies, insurers and employers • - Transaction fees for data providers (labs, hospitals, large practices) • - Contributions (cash and inkind) • 6. Commitment to standards (ISO, IHE / HITSP / NHIN, other)

7. CareSpark Data-Sharing Options

8. CareSpark’s infrastructure • We’ve Built a standards-compliant Clinical Document Exchange Network • Exchanges clinical documents between providers • Accepts patient demographic information from Providers • Controls clinical data in accordance with patient consent preferences • Supports direct integration and access through provider EMRs (standard and non-standard) • Allows access for providers without EMR • High levels of security

9. Technical Architecture

10. CareSpark Providers Patient Management System Patient Identity Feed Patient Queries Send Clinical Documents Query For Clinical Documents Retrieve Clinical Documents EMR ActiveHealth Subscriber Management System Subscriber Identity Feed Clinical Documents CareEngine Health Information Exchange Infrastructure CareSpark Service Providers DB Server Clinician Portal Two-Factor Authentication Anakam Oracle XDS DocumentRepository Cloverleaf CGI XDS RepService OnePartner/BCTI ConsentRepository MPOPConsent Healthvision ATNA AuditRepository ATNAWinSysLog Wellogic XDS PDQService InitiateEMPI XDS PatientIdentitySource (MPI) XDS PIXService ADTService PostGreSql CareSpark XDS Data Store - For Patient Care XDSRegistry NIST XDS DocumentRegistry XDS RegService XDS Key Store CT TimeClient

11. CareSpark RHIO Timeline Clinical document Exchange Strategic Planning document registry and repository Physician Portal, authentication Immunization registry MPI build begins Build clinical data repository Jan 07 Jun 08 Jan 09 Jan 10 Jan 11 Jan 05 Jan 06 Decision Support delivered electronically Tn non-profit org chartered Data-sharing agreements Revenue-generating services (med hx, results delivery) Claims-based decision support

12. Funding Sources – Planning Phase • BlueCross BlueShield of Tennessee $162,125 • Foundation for eHealth Initiatives $100,000 • (Office for Advancement of Telehealth, HRSA, DHHS) • AllScripts HealthCare Solutions $ 25,000 • John Deere Health $ 41,500 • Eastman Chemical Company $ 50,000 • Mountain States Health Alliance $ 50,000 • Wellmont Health System $ 50,000 • Novartis Pharmaceuticals Corporation $ 15,000 • Frontier Health $ 10,000 • Health Alliance PHO $ 10,000 • Highlands Physicians Inc. $ 10,000 • Holston Medical Group $ 10,000 • United Way of Greater Kingsport $ 10,000 • Rotary Club of Kingsport $ 10,000 • East TN State University / Medical Education Assistance Corp. $ 5,000 • Laughlin Memorial Hospital $ 2,500 • Johnston Memorial Hospital $ 2,500 • Kingsport Tomorrow $ 1,500 • Cardiovascular Associates $ 250 • Total funds contributed: $562,875

13. Revenue Sources July 2005 – July 2009 • Local Support $4,185,120Employer contributions: $ 678,000 • State grants / contracts $1,600,000 • Technology Partners $2,250,000 • CareEngine enrollment fees $1,257,120 • State contracts $1,669,600 • Tennessee $1,369,600 • Virginia $ 250,000 • Federal contracts $4,917,098 • NHIN Prototype $ 308,000 • NHIN Trial Implementation $3,609,125 • NHIN Option year 1 $ 999,973 • Total Funding: $10,771, 818

14. Participation and Capabilities

15. CareSpark’s Strategic Objectives • Population Health Clinical Premature Mortality Adult Diabetics, Rx filled, vision / foot, HBA1C<7 New Diabetes Cases Lipid Panel LDL < 100 Flu Vaccines for 65+ Pneumo Vax for ages 65+, <2 ER Visits for Health Attack Stroke Therapy Post- MI followup Cancer Screenings (PAP, Mammogram, colorectal) Deaths from Rx Overdose Pain Medication Financial Savings -- ROI • Patient • Clinician • Facilities • Purchaser (health plan, employer, taxpayer, individual)

16. Convergence of Interests Governance and Policy Clinical Privacy & Confidentiality Patient-Centered Care Patient-Centered Care Administrative Billing & Claims Consumer / Personal Health Record Research Best Practices Technical Infrastructure Financial Incentives

17. Nationwide Health Information Network: “network of networks” NHIN Prototype Demonstration 2006-07 design for exchange between CareSpark, West Virginia, Kentucky providers NHIN Trial Implementation 2008 * Core Services: Consumer permissions Security exchange Standardized interfaces Summary medical record * Medication Management eRx, med history, decision support * Consumer Empowerment personal health record, registration and medication history

18. Health Information Exchange in Tennessee

19. Common Portal • Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards • Interoperability • Transparency • Value • Quality/Cost H.I.E. EMR / EHR/PHR implementation Structured notes & paper records Administrative transactions (claims…) Secure clinical messaging (labs, imaging, email….) E-prescribing roll out Broadband % of Access, Stakeholders, Automation Framework for trust and collaboration Tennessee Roadmap for Health IT • Tennessee eHealth Council: seed funds for RHIO’s, grants for eRx, broadband

20. Virginia RHIO initiatives

21. Virginia Health IT Council

22. Health Information Exchange Stages of Evolution Pre-operational 1: Recognize need 2. Organizing and planning 3. Securing resources 4. Developing and implementing Operational 5. Transmitting data 6. Sustainable business model 7. Expanding participation In August 2008, 57 report being operational, 88 pre-operational

23. HIT-Enabled Health ReformAchieving Meaningful Use 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Criteria HITECH Policies Protect privacy and security, 2011 Meaningful Use Criteria (Capture/share data electronically) 2013 Meaningful Use Criteria (Advanced care processes with decision support, patient access) 2015 Meaningful Use Criteria (Improved Outcomes) 23

24. Overview of Federal HIT Programs 24

25. Federal Stimulus Funds • HITECH legislation in February 2009 • Increased privacy and security requirements • Funding for health information exchange (State HIE Cooperatives) • Funding for National Research Center (“comparative effectiveness”) and Regional Health IT Extension Centers • Funding for Healthcare Workforce Development • Incentivesfor adoption and “meaningful use” of health information technology EMR eRx Quality Reporting Patient Access $$$$$$$$ 2011-2015 HIE + + + =

26. State HIE Cooperatives • Health Improvement Partnership of Tennessee (HIP-TN)not-for-profit entity formed to facilitate and oversee application and distribution of ARRA funds • workgroups: Technical, Privacy & Security, Clinical, • Governance / Policy, Financial Sustainability • Board members from this region: • Doug Varney, David Sensibaugh • Virginia Health IT Interoperability Commission established under Virginia Department of Health by executive order • priorities to be addressed: childhood immunizations, infant mortality • Local appointee: Liesa Jenkins

27. Regional Health IT Extension Centers • Virginia: statewide collaboration with regional variation, led by • Va Health Quality Center • Tennessee: statewide proposal submitted • by QSource, contracting with regional partners for delivery of services • Letters of intent submitted Sept. 8 • Full proposals due Oct. 16, if requested

28. Future Plans for CareSpark Local Increased participation: Enhanced capabilitiesSustainability Providers Secure messaging for users Fees for services Patients Clinical data repository Regional Extension Centers Knoxville / Danville Population Health Improvement Virginia Public health Other Immunization telemedicine Rx Monitoring HIT Commission VHEN Tennessee Public health Other Immunization HIP-TN Rx Monitoring National NHIN Gateway Other Federal agencies (VA, SSA) Benchmarking Other HIE’s (NC, KY, WV) Sharing best practices

29. Next Steps for YOU • Begin planning for EMR • Assess your organization’s business requirements, including functionality, cost, privacy and security protection • Evaluate, select certified, standards-based solution, contract, train users and implement (assistance from Regional Health IT Extension Center or other) • Consider modularity for future needs: eRx, decision support, analytics and reporting, patient access • Participate in Health Information Exchange • Enter into Data-sharing agreements • Access broadband services and network(s) • Train users • Inform patients • Shared costs for infrastructure and services • Monitor your results • Measure your own results (efficiency, cost, patient outcomes) • Report outcomes to access incentives payments • Benchmark with peers, share best practices • Participate in research to improve effectiveness • Take pride in your success!

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