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José E. Piovanetti-Pérez, MD, CMIO, CIO

Contact Licenses / IDs (787) 615-4884 (M) (407) 969-8400 (M)

richiepiovanetti@mac.com richiepiovanetti@healthcareinfopartners.com

State Medical ............................. 12736 (PR) | In Process (FL) Controlled Substances ............... DM-12539-3 (PR) DEA .......................................... FP4905874 NPI ........................................... 1851382881

Objective(s) • Leader or executive that transforms capture, processing, analysis, integration and delivery of clinical data and services to improve

care and evidence-based services at the point-of-care (POC); improving oversight, quality, public health and cost-containment. • Policymaker for a health organization in need of scarce combined expertise in information technology (IT), data communications,

health informatics and management, striking balances between technical, fiscal and health care realities. • Administrative role mediating between IT (i.e. CIO, IT-personnel), clinicians (i.e. physicians, nurses, ancillaries), researchers and

management, bridging priorities, knowledge and communication-gaps between parties and stakeholders. • Management role with multidisciplinary groups as consensus-builder, motivator, leader and subject-matter-expert (SME) about

adoption of Health Information Technology (HIT) and Information Exchange (HIE) in the global evolution of health care. • Maintain a primary / general medical services practice with highly empathic environment towards patients.

Professional Experience(s) Healthcare Informatics Partners ..................................................................................................................................... 2012 to Present CMIO, CIO, Certified-EHR and Ancillary HIT and HIE Consultant • Restructure a healthcare’s corporate structure, IT infrastructure and workforce-informatics-awareness to create the first

“Integrated Behavioral and Physical Medical Services Organization” in central Florida • Led, guide and attain “Meaningful Use” (MU) of Certified EHR (different EHR vendors), and get “incentives payments” • Achieve MU-compliance - Stage 2; different EHR vendors. • Surmount CMS HIT and Quality initiatives (i.e. ePrescribing, PQRS, Hospitals IQR/OQR, …); different EHR vendors. • Perform HIPAA / MU “Risk Analysis” and implement findings mitigation and compliance. • Perform Gap-analysis with “As-Is” & “To-Be” HIT-adoption; with Budgets and Cost-benefit Analyses. • Identify, Write and Implement missing IT, Operations and Administration Policies and Procedures (P&P). • Realize HIE though State-designated Organizations using “NHIN Direct” & “FHA/NHIN CONNECT” standards. • Guide EHR/CPOE and Clinical Decision Support (CDS) implementation and Change Management. • Architect and implement “Continuous Quality Improvement” (CQI) with PRQS and Hospital IQR. • Originate Governance initiatives and processes for ongoing regulatory and certification compliance. • Achieve management and workforce “buy-in” and support for Governance, Change Management, and HIT/EHR-adoption. • Train Clinical- and IT-workforce representatives on HIPAA- and MU-compliance and P&Ps. • Clinical-, Technology-, Operations- and Administrative- Support, Mediation and Arbitration.

PR-DoH and PR’s Health Care Umbrella ............................................................................................................................. 2010 - 2012 CMIO, CIO and State HIT Coordinator • Led multi-stakeholder Steering Committee named by the State-government to determine State’s HIE Strategic and Operational

Plans through Cooperative Agreement Grant between Office of the National Coordinator (ONC) and the State. • Write, review, amend and get approval of Strategic and Operational Plans agreed by PR’s Steering Committee, ONC and State. • Establish Federal Health Architecture (FHA) and National Healthcare Information Network (NHIN) HIT/HIE guidelines for all

Public and Private health stakeholders and HIT/HIE projects in the Island. • Develop, lead and supervise all ARRA/HITECH- and PPACA-sponsored projects and grants; including the “incentives

payments” program through Medicaid for providers demonstrating “Meaningful Use” of Certified EHRs. • State-resource to coordinate State’s and ONC’s approved Strategic and Operational plans and Private HIT/HIE projects. • Architect of all HIT/HIE on State’s HIT-related projects. • Train and supervise personnel working on State’s HIE State Designated Entity (a.k.a. “HIO”) defined in Strategic and

Operational Plans between State and ONC, with regards to medical/clinical informatics, delegated work and/or responsibilities. • Led implementation and adoption of EHR in 28 “Points-of-Care” (i.e. Hospitals, Clinics, etc.) operated by PR-DoH. • Joined the Puerto Rico Medical Reserve Corps (PRMRC) as physician. • On-call physician-liaison to all state health facilities; one weekend-per-month, from Friday 5:00 PM to Monday 8:00 AM.

o Respond to medical emergencies calls made to government health-entities, discuss cases, triage severity of incidents and route patient(s) to appropriate public or private health facilities, finally log and prepare report for Secretary of Health and Governor or each intervention.

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Arizona State University (ASU), University of Arizona (UA) & AZ Health Care Cost Containment System ............... 2008 - 2009 Associate Research Professor / HIT/HIE Subject-Matter-Expert • Write Request for Information (RFI) and Request for Proposal (RFP) for Arizona’s Health Care Cost Containment System

(AHCCCS), Arizona’s sole State Medicaid Program “Purchasing and Assistance Collaborative for EHRs” (PACeHR) initiative. • Write Arizona’s Statewide HIE Self-sustainability Business Plan. • Led ASU Biomedical Informatics Department “Outpatient CPOE (O/R)” Project. • Architect of the system to identify candidate-patients for clinical trials in real time, from HIE data-flows. • Clinical Informatics Professor for UA School of Medicine Medical Students, Attending to Emergency- and Family-Medicine

Residents at their respective programs locations in Phoenix and Tucson.

First Point Healthcare Group ................................................................................................................................................. 2003 - 2008 Partner, Medical Informatics R&D Director • Direct medical informatics research and development (R&D) for First Point clients. • Develop interfaces (HL7 and proprietary) for client organizations and EHR components, development and deployment. • Improve “Outpatient CPOE”. [See Page #3, under “R Medical Informatics PR Corp....”]

o Publish first “Open Source Outpatient Orders and Results (O/R)” project in U.S. via SourceForge.net with AGPL license. o Certify ePrescribing module with RxHub and SureScripts; add schema for LOINC-based structured eLabs (1st Outpatient CPOE in USA

to achieve this), plus schema for eReferrals/eConsults and eImaging with access to source-PACS original-DICOM-images (if allowed). • Perform HIPAA-compliance process for 75% of covered entities of the State-governments of PR and USVI. • Clinical-consultant in creating HIPAA’s X12N 4010 “Addendum 1” (i.e. ANSI 4010A1) transactions. • Instructor for WEDI and CMS on HIPAA Transactions and Code-sets, Privacy and Security Rules. • Advocate Clinical-Change-Management for health-related entities initiating HIT and EHR adoption. • Part-time Private-PCP practice (i.e. scheduled and walk-ins).

Avant Technologies .................................................................................................................................................................. 2000 - 2003 Vice President of Medical Informatics and Health Care R&D • Responsible for pre-sales support, budgeting and personnel of the medical informatics division. • Led work with Avant’s video-surveillance R&D engineering team to develop a patient-monitoring device by extending Avant’s

primarily banking-sector video-surveillance hardware and software into healthcare and telemedicine domains. • Complete implementation of the Vieques telemedicine project; adding telesonography to supported services. • Translate Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) to Spanish for the College of American

Pathologists (CAP). • PCP-clinic for Avant’s employees.

Integration Technologies (Intech) ........................................................................................................................................... 1998 - 2000 Medical Informatics Unit and Medical Director • Create Puerto Rico’s (PR) State Community Health Information Network (CHIN) using “Outpatient CPOE” as initial

infrastructure and standards-based services. [See Page #3, under “R Medical Informatics PR Corp....”] • Oversee network-architecture design and pre-sales support for Intech’s healthcare sector clients. • Manage successful Medical Receivables Practice Management System (MR-PMS) such as:

o Raised collections from less than 10%/yr. to >85%/yr. in 1st year at Puerto Rico’s State Emergency Medical Services (EMS) Agency. o Migrated four (4) billing systems to one (1) at CT Radiology Complex (i.e. Caribbean’s largest diagnostic-imaging center). Increased

productivity ten-fold and achieved collections above 93%/yr. in 1st year. • Led State-government health program use of HEDIS and other quality initiatives and measures. • Architect and hands-on implementer of Puerto Rico’s State’s first telemedicine project.

o Implemented live video-conferencing, ER consults, psychiatric-emergencies and other services between the island-municipality of Vieques and the Puerto Rico Medical Center (PRMC).

o Use tele-radiology for radiological images interpretation from PRMC radiology faculty as well as residency program members. • Architect of Baxter’s “Pharmaceutical’s Request System” (PRS); so hospitals could ordered parenteral or compound-preparations

electronically from Baxter’s FDA-approved “pharmacy preparations clean-room”. • PCP-clinic for Intech’s employees

Digital Arts and Sciences / Puerto Rico (DASPR) ................................................................................................................. 1997 - 1998 COO, Executive Director, Medical Informatics Fellow • Translate HL7 (v2.3.1) to Spanish for the “Instituto Mejicano de Seguro Social” (i.e. “Mexican Social Security Institute”). • Lectured on HIE by adopting standards for data/information exchange between U.S., Central and South America, Europe, etc. • Develop Arden Syntax Medical Logic Modules (MLM) repository. • Cross-reference SNOMED and UMLS. • Wrote first “White Paper” in U.S.A on a Java-based interface engines modules and plug-ins.

o Architect and developed first JAVA-components for HL7-message creation, parsing, transformations, conversions, ...

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• Developed medical digital-image capture, storage, exchange and analysis project with University of PR School of Medicine (UPR-SoM) to improve treatment follow-up of through digital-image comparison and extraction across time.

• Developed nursing-data-acquisition and data-management using 1st generation Windows-based Fujitsu tablet-computers. o Improved nursing-documentation and patient-services >50% in 1st year.

• Researched, lectured and published peer-reviewed articles on Object-Oriented Databases (OODB) advantages over Relational Database Management Systems (RDBMS) for HIT.

o Lectured and wrote on of OODB advantages addressing “navigational traversal interfaces mismatch” (i.e. object-relational-mapping), “workstation cache synchronization”, “schema evolution (i.e. attribute-volatility)”, ….

• Establish R&D agreements with organizations in medical informatics R&D, such as: o San Juan HIV Institute - Test MLMs protocols and measure nursing paper-records vs. nursing-data-acquisition with tablet-computers. o San Juan Veterans Administration Hospital (“VA Caribbean Healthcare System”) to test HL7 Java-component for systems interfaces. o UPR-SoM Pathology & Radiology Departments using controlled terminologies to test concept-encoding in computer records. Also with

Dermatology & Ophthalmology Departments, using digital medical-image capture, storage and processing to follow treatment progress. o Advisor to InterAmerican University of Puerto Rico (San Juan/Metro Campus) and University of Puerto Rico (Mayaguez Campus)

computer-science post-graduate (i.e. Masters and Doctoral) candidates on health informatics projects for their graduate-theses.

R Medical Informatics PR Corp. (D.B.A. “Healthcare Informatics Partners”) ............................................................. 1985 to Present Founder and President • Architect and develop first U.S. Outpatient CPOE; with Master Person Index (MPI) and Health-data Source Index (i.e. Record

Locator Service.) o Handles extended-naming practices and conventions like double last-names, maiden names by married individuals, etc. o Available as “Free Open Source Software (FOSS) through “SourceForge.net” as “HIP Outpatient CPOE”1. o Based upon “HL7 Orders and Results (O/R) Reference Information Model (RIM)”, thus, handles any electronic O/R message including e-

prescribing, e-clinical labs, e-referrals, etc. • Patent on the concept of “electronic submission of ambulatory health care orders without having to define order-recipient”2;

protecting and complying with patient’s consent and “Freedom-of-Choice” basic rights 3, 4 in health care, • Architect and develop first Graphical User Interface (GUI), cross-platform, concurrent multi-platform, multi-user, multi-site,

multi-specialty Practice Management System (PMS) o Published first versions in 1985 for Mac OS, 1993 for MS-Windows, and 2001 for Linux/Unix. o HL7 interoperability since 1998 - connects to any HL7-capable HIT / EHR system. o Continuously up-to-date and available as FOSS through “SourceForge.net” as “Medical Receivables”5

Public Healthcare Services Centers / Private PCP practice ............................................................................................... 1998 to 2015 Generalist / PCP, Locum Tenens and Emergency-services Physician • Primary care diagnosis, stabilization, treatment and urgent/trauma-care. Began by moonlighting and then as spare/part-time. • No adverse-events or litigations to date.

Education Undergraduate ................ B.S., Biology6; Masters-studies in Biochemistry6 ................................................................... 1981 - 1988

InterAmerican University of PR – San Juan, PR/USA Graduate .......................... Medical Doctor (MD) .............................................................................................................. 1990 - 1995

Universidad Central del Caribe (LCME# 04203) - Bayamón, PR/USA Residency ......................... Internship / Ophthalmology (ABO and ACGME-approved) .................................................. 1995 - 1996

San Juan Municipal Hospital and UPR-SoM ophthalmology residency program at PRMC - San Juan, PR/USA Fellowship ........................ Medical Informatics (NLM-sponsored, Donald A. B. Lindberg, MD, Director) .................... 1996 - 1998

Center for Learning Resources (UPR-SoM at PRMC, San Juan, PR/USA), Harvard Medical School NLM-sponsored IAIMS-program at Massachusetts General Hospital (Boston, MA) and DASPR [See Page 2]

Computer Skills EHR / HIT Experience >20 vendors including Cerner/Siemens; Epic; WorldVistA, MedSphere; Meditech;

ClinNet; NexGen; HMS; MedHost; MedQ; Omnicare; Amazing Charts; Practice Fusion Clinical Terminologies,

Classification and Code-sets ICD; DSM; CPT; HCPCS; SNOMED; LOINC; NDC; RxNorm; UMLS; DRG; CDT; Drug Databases MediSpan and FirstDataBank; ANSI and HL7 “Small Codes”; HL7-CTS; ICFDH/ICF; HUGO-HGNC; NCBI-GENE

1 http://sourceforge.net/projects/hip-outpat-cpoe/ 2 For example; in ePrescribing, prescriptions can be sent to a “pending dispensing repository”, liberating prescribers from selecting a “dispensing-

pharmacy”; hence, patient decides who dispenses prescription(s) without prescriber intervention or influence. 3 FJ Hellinger. Any-willing-provider and freedom-of-choice laws: an economic assessment. Health Affairs, 14, no.4 (1995):297-302 4 Social Security Act, §1802(a) - Entitled “Free Choice by Patient Guaranteed” 5 http://sourceforge.net/projects/medicalrec/ 6 Member of Tri-Beta (a.k.a. “Beta Beta Beta”), Natural Biological Honor Society, Chapter Zeta Zeta

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HIE Transactions ANSI X12N; HL7; NCPDP; XML CCD, CDA, CCR, C-CDA; IHE; ONC Direct; NwHIN CONNECT

Clinical Quality Measures CMS’s ePrescribing Incentives, PQRS and Hospitals IQR; DOQ-IT; AHQR; NCQA; HEDIS

Productivity and/or Office Suites Microsoft Office (Win & Mac) ; Open/LibreOffice (Win, Mac & Linux) Graphics Representations InkScape; Visio; OmniGraph; Canvas; GIMP; Libre/Open Office Draw; Adobe CS

Collection; GraphicConverter, Canvas Statistics and Data-Analytics SPSS; GNU-PSPP; R; MS Excel

Object-Oriented (OO) Programming

Java; Omnis; AJAX; HTML; CSS; node.js; SQL (TSQL, PSQL, etc.); C#; VB; C/C++; .Net/Mono; MUMPS

Integrated Dev. Environment Eclipse; NetBeans; InteliJ IDEA; Omnis Studio; Visual Studio / Mono-Develop Relational Databases MS SQL; Oracle; DB2; PostgreSQL; MySQL/MariaDB; MS Access; FileMaker

Other DBs (NoSQL, OODB; …) MUMPS (Caché, GT.M.); Cassandra; Apache Hadoop; Objectivity; HPCC/LexisNexis Reports, Data Mining and BI JasperReports; BIRT; Crystal Reports; Cognos; Pentaho; MS Excel

Data ETL, Interoperability and Systems Interfaces

Mirth Connect; MS BizTalk; Iguana; Data Junction; Pentajo; Cloverleaf; SOA/ESB

Java Application Servers Glassfish; Tomcat; Geronimo; Jetty; JBoss Network Monitoring, Datacenter

and Cloud Nagios; Cacti; Zenioss IT Management; OpenStack; Apache CloudStack

Operating Systems Windows (WS and Server); Mac OS; Linux/Unix

Regulatory-compliance Skills • Health Insurance Portability and Accountability Act of 1996 and (HIPAA) and HIPAA Omnibus of 2010 (i.e. Rules for Fraud and

Abuse, Transactions and Code-sets, Privacy, Security, Breach-notification, Non-compliance Penalties, …) • Patient Protection and Affordable Care Act of 2010 (PPACA / ACA) • Medicare Modernization Act of 2003 (MMA) • Genetic Information Nondiscrimination Act of 2008 (GINA) • Federal Information Security Management Act of 2002 (FISMA) • Health Information Technology for Economic and Clinical Health Act (HITECH) • Risk Analysis and Mitigation (i.e. as required by HIPAA, HITECH, MMA, GINA, PPACA, FISMA, …)7

Professional Affiliations • American Medical Association (AMA) ........................................................................................................................ 1997 to Present • American Medical Informatics Association ................................................................................................................. 1998 to Present

o Clinical Information Systems; Education; Knowledge Representation and Semantics Workgroups .......................................... 1998 to Present • Association of Medical Directors of Information Systems (AMDIS) .......................................................................... 2003 to Present • American College of Physician Executives (ACPE) ........................................................................................................ 2003 to 2012 • American College of Physicians ................................................................................................................................... 2000 to Present • Federal Health Architecture (FHA) - Initially referred to as “Consolidated Health Informatics” (CHI)

o NwHIN CONNECT Initial Interoperability Testing and Implementation ................................................................................... 2007 to Present o NwHIN CONNECT Developer and “OHT Contributor8” ............................................................................................................ 2007 to Present o Architecture & Modeling; Data Exchange & Interoperability Workgroups ................................................................................ 2008 to Present

• Nationwide Health Information Network (NHIN) State Coordinator .............................................................................. 2004 to 2012 • Workgroup for Electronic Data Interchange (WEDI)

o HIE Lecturer and Electronic Medical Information Advisory Council Partner ................................................................................ 2000 to 2005 o Transactions and Code-set; Privacy; Security; HIE Workgroups .................................................................................................... 2000 to 2005

Other • President of the Puerto Rico College of Physicians and Surgeons (PRCPS) and Puerto Rico Medical Association Medical

Informatics Committees; PRCPS’s peer-reviewed medical journal Editorial Board Founder and co-Chair (ISSN: 2169-9577). • Adept in Primary Care and Specialties practices HIT and HIE requisites according to workflows; Inpatient and Outpatient. • Developer / Implementer of Master Patient/Person Index (MPI) and Record Locator Service (RLS). • Proficient in Predictive Modeling, and Data -Analytics, -Mining and –Drilling. • Extensive Academic Medical Centers experience; medical students and residents medical/clinical informatics Attending, nursing

students informatics lecturer; train medical and nursing faculty in their respective clinical informatics domains. • LEAN/Six Sigma for Health Green Belt; Black Belt in process

7 Use “NIST Data-security Special Publications (SP)” as reference for Policies, Procedure and Governance implementation and compliance. 8 On May 2014, HHS/ONC began migrating Governance and Code-management to “Open Health Tools” (OHT) – http://www.oht.org.