HealthBridge is one of the nation’s largest and most successful health

information exchange organizations.

“From Interactionto Integration

to Transformation: Healthcare’s Journey &

Information’s Role”

Mike MoteVice President

Product & Service Strategy 1

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HealthBridge

Background

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HealthBridge

One of the nation’s oldest, largest, most advanced and successful health information exchanges

In operation since 1997

501c3 Not for Profit

One of only a handful of HIE/RHIOs nationwide with a sustainable business model

• (Pre ARRA) 97% of revenue from fees; <3% grants

• 5-12% annual return for last eight years

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HealthBridge

Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010

Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors,

60+ versions Provide technology infrastructure for four other HIEs – Dayton

HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network

• 26 local hospitals in Kentucky, Ohio and Indiana• 5500+ physicians• 17 local health departments• Large commercial, hospital, & physician office labs• Diagnostic centers

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HealthBridge

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HealthBridge HIE Value ProgressionMeaningful Use, Medical Home and Payment Reform

Basic

HIE

• Stage 1 MU • EHR Adoption (REC Services)• Basic Electronic Messaging (NHIN DIRECT)• Community Portal • Web-Based Results Delivery • Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency

Intermediate HIE

• Stage 2&3 MU• Structured Data Delivery to EHRs• Results Delivery (Lab, Rad, ADT, etc.)• ED, Admission, & Discharge Alerts & Notices• Summary Record Exchange (CCD)• Value: Necessary to achieve truly electronic workflows; Dramatic increase in

efficiency

Advanced HIE

• PCMH, ACO & Payment Reform Readiness•Data Warehouse & Analytics • Disease Registry•Quality Reporting Support•Full Integration Services & Bidirectional Exchange•Value: Dramatic improvements in quality and performance

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HealthBridge – HIE Services

EHR Integration/Interfaces Electronic Results Delivery –

• Labs, Radiology, ADT, etc. Electronic Order Entry E-Prescribing HIE Portal & User Management HIE Technology Support – Master Patient Index, Provider

Directory and Record Locator Service Summary Record Exchange Nationwide Health Information Network Direct and CONNECT

Gateway & Connectivity Public Health Reporting & Syndromic Surveillance Billing and Eligibility Verification HIE Consulting, Outsourced Technology & Implementation

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HealthBridge – Future Plans

REC - Expanded Meaningful Use Assistance for Stages 2-3 Beacon - Enhanced Suite of Quality Improvement, Care

Transformation and Accountable Care Services and Tools (Data Warehouse, Data Analytics, Summary Patient Records, etc.)

Patient Engagement - Connectivity to Personal Health Records, Mobile Technologies and Consumer Technologies (Beacon, IN Challenge Grant)

HIE Expansion – • Connect to new providers and stakeholders for improving

continuity of care (home health, long-term care, payers, etc.) • Connect with State HIEs and Provider Networks (IN, KY, OH) • Use Nationwide Health Information Network (NwHIN) Direct and

CONNECT platforms• Spread of Advanced Technologies to Other Communities • Community Credentialing

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“From Interactionto Integration

to Transformation: Healthcare’s Journey &

Information’s Role”

Creating a CommunityData Repository

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Healthcare’s Journey Whether or not you believe that REFORM is coming here are some

thoughts to ponder:

• The US healthcare system is broke; the current rate of growth can not be sustained; 1/6th of the US economy is based upon healthcare

• New York Times article claims “By 2020 the American health insurance industry will be extinct.”

• Accountable care is coming; Value based payments are coming; Volume based payments will continue to decline

• Missing data today results in missed opportunities to:

• Prevent complications• Ensure better outcomes• Reduce unnecessary costs• Reduce patient’s safety risks• Improve transitions in care

2012

2015

2020

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Incentives

Penalties

Business Realities

The “Journey”

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Care Transactions

Individual ProviderCare Plans with some

coordination via referrals

Care Integration

Coordinated Care Plans &

Early stage PCMH

Care Transformation

Single Care Plan &Advanced stage PCMH;

theMedical Community

Care Delivery’s Journey

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Care Transactions

Patient Outcomes Measures

Care Integration

Population based metrics & health status

measurements

Care Transformation

Demonstrable Improvement in

Population Health with ongoing refinement

of the metrics

Quality Metrics’ Journey

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Care Transactions

Fee for Service

Care Integration

Pay for Performance & Shared Savings

Care Transformation

Providers at Partial to Full Risk

Payment Reform’s Journey

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Care Transactions

Provider-centric reporting based upon productivity & patient

care protocols

Care Integration

Population based quality & performance analysis, health status

analysis, & risk analysis

Care Transformation

Predictive modeling & performance

forecasting, outcomes analysis, & incentive

modeling

Data Analytics’ Journey

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Care Transactions

Individual EHR or paper medical records;

individual vendor or provider application of

standards & codes

Care Integration

Clinical information sharing with standards based interoperability

moving to data integration with

semantic normalization

Care Transformation

Community based clinical & claims data

repository with community data and

coding standards

Information’s Journey

Information’s Role

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Care Transactions

Support Provider delivered care; support

patient level quality reporting

Care Integration

Longitudinal patient record, ED & Public

Health alerts; Point-of-care decision support, PHR, & remote patient

monitoring

Care Transformation

Enable predictive modeling, risk

adjusted analytics, accountable care

business & operational modeling

Information’s Role – Domain Requirements

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People & Organizations

Lab Orders & Results

Medications & Prescription Information

Patient

Provider

Payer

Staff

Facility

Immunizations

Radiology & Transcribed Reports

Referrals & Authorizations

Medical Conditions (Allergies, Family-social-medical history)

Encounters

Appointments

Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography

Revenues (Charges, Grants ..)

Products

Member Enrollment

Medical & Rx Claims

Revenue, Billing, & Payment Data

Utilization

Provider PayerLegend:

Clinical Observations & Vital Signs

Expenses (Payroll, Supplies, Infrastructure, …)

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Creating a CommunityData Repository

&Establishing a

Community Data Trustee

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HealthBridge’s Data Infrastructure

New Suite of Health Care Innovation & Quality Improvement Tools and Services funded through Beacon Program: • Disease Registry • Clinical & Claims Data Warehouse• Data Analytics and Business Intelligence• Alerts & Notifications • Transitions in Care Assistance• Quality Reporting Support • Process Improvement and Workflow Redesign Support

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HealthBridge’s Solution Components

Enterprise Master Patient Index (eMPI)

• IBM’s Initiate™

Clinical & Claims Data Repository & Clinical Analytics

• PluralSoft’s CareQuotient™

Semantic Data Normalization

• Clinical Architecture’s Symedical™

Claims Data Grouping Engines

• OPTUMInsight’s Symmetry™

Patient Registry

• WellCentive’s Registry™

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Why?

Today this enables

• Identification of gaps in care

• Point-of-Care Decision Support

• Patient engagement

• Longitudinal Patient Record

• ED, Admission, & Discharge Alerts & Notices

• Information exchange at the point of Transitions in Care

• Intra-practice comparative performance analytics

• Interoperability between organizations (“Rosetta Stone”)

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Why?

Tomorrow this will enable:

• Population-based performance measurement

• Risk adjusted comparative performance analytics

• Risk adjusted comparative cost analytics

• Predictive modeling & performance forecasting

• Service demand forecasting

• Payment incentive modeling

• Revenue versus cost modeling

• ACO business and operational modeling

• Best practice identification & modeling

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Q & A