Pennsylvania ehealth Partnership Authority. Health Information Organization Survey. December 2013

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1 Pennsylvania ehealth Partnership Authority Health Information Organization Survey December 2013 Pennsylvania ehealth Partnership Authority 613 North Street l Harrisburg, PA l l Fax l Improving your care through the exchange of health information

2 PA ehealth Partnership Authority February 2014 Table of Contents Introduction... 3 Key Findings... 5 HIO Functions... 6 Delivery Methods per Use Case... 8 Structure and Vocabulary Standards Participating Providers Service Coverage Area Legal Finance Communication Page 2 of 20

3 PA ehealth Partnership Authority February 2014 Introduction The PA ehealth Partnership Authority, hereafter referred to as the Authority, conducted a survey in October and November of 2013 in order to determine the current environment for Health Information Organization (HIO)* efforts within the Commonwealth of Pennsylvania. This survey refreshes information gathered in similar surveys completed in 2011 and The previous survey results gave all stakeholders a clear picture of what HIO activities were already underway and planned in the Commonwealth and helped facilitate the development of the Authority s strategic and operational plans. This year 14 organizations were invited to participate. The list of participants was based on last year s list and input from the Authority staff and stakeholders. Eleven organizations responded. Two of last year s responding organizations did not participate this year, but two new HIOs did participate. The results of the survey are included in this document, with one of the new HIOs choosing not to be identified. This HIO is hereafter referred to as HIO A. The survey consisted of 276 questions covering the following five categories: Operations and Technology Communications, Outreach and Research Finance Legal Hospital Engagement Each section of this report begins with a table summarizing the results. An increase in 2013 to 2014 results is shown in green in the rates columns. A decrease in 2013 to 2014 results is shown in red in the rates columns. If the 2013 to 2014 results are the same, then the results are shown in black. Certain portions of the information gathered are of a proprietary nature and therefore have been omitted from this report. * There has been considerable confusion resulting from the fact that the acronym HIE (Health Information Exchange) can be used both as a verb and as a noun. In an effort to alleviate this confusion in the future, the Authority has adopted a standard of using ehie to describe the activity while using the term health information organization (HIO) to describe organizations. The Authority will apply this convention in this and all future reports, but will not adjust previously published reports. Page 3 of 20

4 PA ehealth Partnership Authority February 2014 For presentation purposes, several HIOs legal names have been truncated in the charts in this report. The following table is a crosswalk between legal names and the names used in this report. Health Information Exchange Name Crosswalk Legal Name Listed in Survey As ClinicalConnect HIE ClinicalConnect HealthShare Exchange of Southeastern Pennsylvania, Inc. HealthShare Exchange Highmark Inc. Highmark Keystone Health Information Exchange (Geisinger Health System) KeyHIE Lancaster General Health Lancaster General Lehigh Valley Health Network Lehigh Valley St. Luke's University Health Network St. Luke's Page 4 of 20

5 PA ehealth Partnership Authority February 2014 Key Findings 1. For a third year in a row, all responding HIOs are supporting exchange of discharge summaries and provider-to-provider clinical messaging. Other strongly adopted functions include longitudinal medical records and order/lab results delivery. 2. The least adopted functions appear to be those already supported by EMR systems such as computerized physician order entry and e-prescribing. 3. While push (including DIRECT) methods are becoming more popular for many use cases, query-based exchange is also increasing. 4. There is a clear increase in the adoption of standards for structure and vocabulary across Pennsylvania s HIOs. 5. All provider types included in the survey will be served by at least two HIOs by the end of 2014 and at least six HIOs by the end of All responding HIOs plan to offer services to hospitals, primary care practices and specialty practices. 7. There was a very large increase in the number of primary care practices participating in HIE (2,205 now, up from 476 in 2012), but a large drop in the number of specialists reported.* 8. Most other provider types show steady or slightly increased participation. 9. As of this survey, there is at least one HIO providing service in every county in the Commonwealth, with planned coverage by at least three in every county. 10. At least six HIOs now plan coverage in each of the areas surrounding Philadelphia, Pittsburgh, and Harrisburg. 11. Planned interstate connection is increasing and all HIOs plan to connect with other PA HIOs. 12. Adoption of business associate agreements and data use and reciprocal support agreements is increasing. 13. The leading legal issues of concern to HIOs remain monitoring for internal compliance and release of super protected information. Readiness of EHRs to handle date segmentation is a rapidly rising concern. 14. The most common sources of planned HIO sustainability funding remain hospital participant fees, payer participant fees, and state grants. 15. A little over half of responding HIOs have a sustainability plan in place. 16. There is an upward trend for communication material that is aimed at patients. * Some year-to-year changes are of sufficient magnitude that they beg the question of the reason for the change. The Authority will conduct further inquiry in these cases and publish our findings in a supplement to this report. Page 5 of 20

6 ClinicalConnect HealthShare Exchange Highmark HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2011 Rate 2012 Rate 2013 Rate PA ehealth Partnership Authority February 2014 HIO Functions Responders were asked which functions they have implemented or plan to implement. Rates include both HIOs who are planning to or are currently offering one of the use cases. The results of the survey are compiled in the Table 1. Table HIO Survey Results Functional Summary - Schedule Use Case Active care coordination N N % 91% 64% Clinical/quality event reporting (registries) N 15 70% 64% 55% Computerized physician order entry/lab 14 N N 90% 55% 27% Discharge summaries N N 13 N N 14 N N % 100% 100% Enrollment/eligibility verification N 14 N 20% 18% 27% eprescribing N N 10% 27% 18% Historical lists (medications, allergies, etc ) N 13 N N N N 100% 91% 73% Longitudinal medical records N 15 N 13 N N 14 N 14 N 80% 82% 91% Master patient index N 14 N 13 N N 14 N N N 90% 91% 91% Meaningful use analysis and reporting N % 45% 64% Order/lab results delivery 1 N N N 14 N N 14 N N N 100% 82% 91% Order/lab results request N 13 N N 15 N 100% 82% 73% Patient portal N N N N 15 70% 64% 82% Provider directory/index 14 N N N 14 N N 90% 91% 82% Provider to patient clinical messaging N N % 82% 73% Provider to provider clinical messaging 14 N N N N 100% 100% 100% Quality/safety analysis and reporting 2 15 N % 82% 45% Record locator service N 13 N 14 N 70% 73% 64% Referral/consultation delivery N N N 100% 91% 73% Referral/consultation request N N N 100% 91% 73% Registries (HIE operated/maintained) 14 N N % 55% 45% Role based access control (RBAC) N N N 13 N N 14 N N N N/A 91% 91% 1 For the first two years of the survey, results delivery was presented as a single question. This year, this has been broken into two questions: one for delivery and one for request. The same situation applies to Referral/consultation. 2 - The Authority will follow up with the HIOs to understand the reason for the decline and will publish results in supplemental report. Legend Operational now N Planned Planned Planned 2015 and beyond 15 No answer or not applicable Page 6 of 20

7 PA ehealth Partnership Authority February 2014 HIO Function Findings The functions most frequently adopted include: o Discharge summaries o Longitudinal medical records o Master patient index o Order/Lab result delivery o Provider to provider clinical messaging o Role based access control For a third year in a row, 100% of the responding HIOs reported that they currently have the ability or are working on the ability to exchange discharge summaries and provider-to-provider clinical messages. The functions least frequently adopted include: o Computerized physician order entry/lab o Enrollment/eligibility verification o eprescribing These low areas of adoption suggest that HIOs are focusing less on areas that can already be handled by electronic health record (EHR) systems. The five HIOs that reported the highest number of functional use cases were Lancaster General (21), (19), Highmark (17), KeyHIE (17) and (17). Most changes in year-to-year rates are accounted for in the change in the population of HIOs participating in the survey. Those functions with the most significant declines include: Active care coordination Quality/safety analysis and reporting Page 7 of 20

8 ClinicalConnect HealthShare Exchange Highmark PA ehealth Partnership Authority February 2014 Delivery Methods per Use Case Survey participants were asked which methodology they planned to use for sharing data. Table 2 summarizes the data collected from the survey. Table 2 HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2013 HIO Survey Results Functional Summary - Methodology Use Case Active care coordination D B B D Clinical/quality event reporting (registries) P D B Computerized physician order entry/lab B P Discharge summaries P D D B B B Q P P Q P Enrollment/eligibility verification B eprescribing P Historical lists (medications, allergies, etc ) B B B Q B Q Q P Longitudinal medical records B D B B Q Q P Q P Master patient index B Q P P Meaningful use analysis and reporting D B P D Order/lab results delivery 1 P D B B B P P P P Order/lab results request 1 B D B B Q Q P Q Patient portal Q B B P Q Provider directory/index D B Q D D D Provider to patient clinical messaging D D D D P D D Provider to provider clinical messaging D D D D D D D D D Quality/safety analysis and reporting B Record locator service B B Q Referral/consultation delivery 1 D B D Q P B D Referral/consultation request 1 D B D P B D Registries (HIE operated/maintained) D Q Role based access control (RBAC) B 1 For the first two years of the survey, results delivery was presented as a single question. This year, this has been broken into two questions: one for delivery and one for request. The same situation applies to Referral/consultation. Legend DIRECT Push (other than DIRECT) Query Both push and query No answer or not applicable D P Q B Page 8 of 20

9 PA ehealth Partnership Authority February 2014 Participants were given the following choices: DIRECT Push via the DIRECT protocol, frequently via a HISP. Push - other than DIRECT Data is pushed from one provider to another either manually or via some automated process (i.e. scheduled or event-based). Query Allows the user to pull data on demand from the HIO. Both push and query A combination of push and query methods. Note that HIOs did not provide this data for every use case they identified as planned or currently provided in Table 1. Note that non-answers and answers of not applicable are both left blank in the summary table. Delivery Methods Findings The following table shows the summary of the delivery method findings for those HIOs who responded both last year and this year (HIO A and excluded): Delivery Method 2012 Total 2013 Total Total % Change DIRECT % Push (other than DIRECT) % Query % Both push and query % Push and DIRECT have supplanted query as the preferred delivery method for many use cases. This is partially due to more robust reporting in this section of the survey this year, but also likely due to the relative maturity of the technology and the fact that it is a relatively lowcost option accessible to smaller practices. The decrease in query is offset by an increase in both push and query. Eight of 11 participants plan to offer some level of query functionality, up from only seven of eleven last year. Page 9 of 20

10 PA ehealth Partnership Authority February 2014 Structure and Vocabulary Standards For the 2013 survey, the Authority s technical staff was asked for their input regarding the current standards being used in the industry compared to the baseline of what was asked in the 2012 survey. After careful consideration, it was decided that the Authority would keep the same questions as the previous year. The following table summarizes the collected data. Blanks in Table 3 indicate either no response was provided or a reply of not applicable. Table 3 HIO A ClinicalConnect HealthShare Exchange Highmark KeyHIE Lancaster General Lehigh Valley St. Luke's 2011 Totals 2012 Totals 2013 Totals 2013 HIO Survey Results Standards Summary Standards Do you use C-32 Yes Yes Yes Yes Yes Yes Yes Yes Yes 20% 55% 82% Do you use C-62? Yes Yes Yes Yes Yes No Yes Yes 10% 27% 64% Do you use CCD? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 20% 91% 100% Do you use CDA? Yes Yes Yes Yes Yes Yes Yes Yes No Yes 20% 64% 82% Do you use HL7? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 90% 91% 100% Do you use ICD 9/10? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 20% 82% 91% Do you use LOINC? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 20% 55% 91% Do you use OID? Yes Yes Yes Yes Yes No Yes No Yes Yes 0% 64% 73% Do you use SNOWMED CT? Yes Yes Yes Yes Yes Yes Yes No Yes Yes 10% 64% 82% Structure and Vocabulary Standards Findings This year shows continued advancement towards the adoption of standards across the HIOs. A few notable points are: CCD, HL7, ICD-9/10 and LOINC are being used by all the HIOs responding to the question. The overall level of adoption has increased for each category. The change in the overall landscape suggests that there is greater cohesion in the state and more uniformity in the marketplace. Page 10 of 20

11 PA ehealth Partnership Authority February 2014 Participating Providers The HIOs were asked with which types of providers they are currently connecting and which types they planned for future connections. If the HIOs planned connection in the future, then they were asked to specify which year that was projected to start. Table 4 shows the results. Rates include both those currently connected and those planned to connect. Table 4 HIO A ClinicalConnect HealthShare Exchange Highmark KeyHIE Lancaster General Lehigh Valley St. Luke's 2011 Rate 2012 Rate 2013 Rate 2013 HIO Survey Results Summary By Participant Type Participant Type Ambulance/EMS services N/R 55% 64% Ambulatory surgery centers N 14 30% 82% 55% Community clinical/fqhc N N/R 55% 82% Home health N % 73% 73% Hospitals N N 13 N N 14 N N 14 60% 100% 100% Independent imaging centers N 14 30% 64% 55% Independent reference laboratories N 15 20% 64% 64% Long-term care facilities N N % 73% 73% Mental health/substance abuse facilities N % 55% 64% Other diagnostic service centers N N 15 20% 64% 64% Outpatient cancer treatment centers N N 14 N 14 30% 73% 73% Payer N % 73% 82% Physical therapy/occupational therapy practices N N/R 73% 82% Primary care physician practices N N N 14 N N 14 60% 100% 100% Rehab centers N N % 82% 82% Specialist physician practices N N 14 N N 14 50% 100% 100% Urgent care centers N % 73% 64% Legend Operational now N Planned Planned Planned 2015 and beyond 15 No answer or not applicable Participating Providers Findings KeyHIE is the HIO that is currently operational with the most provider types. ClinicalConnect, Highmark and have plans to interact with all provider types by the end of All HIOs plan to provide service to hospitals, primary care and specialist physicians. All the HIOs are planning expansion of participant categories. Based on this information, the least-served provider types by the end of 2014 will be ambulatory surgery centers and independent imaging centers. Page 11 of 20

12 PA ehealth Partnership Authority February 2014 Summary of Providers Actively Signed Up For each provider type that was listed in the survey, the HIOs were asked to list how many active providers they had signed up. When reviewing the data in Table 5, it is important to note that the number of participants is based on only some of the respondents filling in this portion of the survey. Table HIO Survey Results Totals by Participant Type Participant Type 2012 Totals 2013 Totals Ambulance/EMS services 3 2 Ambulatory surgery centers 2 2 Community clinical/fqhc 1 2 Home health 2 28 Hospitals 1,329 1,344 Independent imaging centers 1 1 Independent reference laboratories 1 0 Long-term care facilities* Mental health/substance abuse facilities 0 8 Other diagnostic service centers 0 3 Outpatient cancer treatment centers 2 7 Payer 2 1 Physical therapy/occupational therapy practices 0 1 Primary care physician practices* 476 2,205 Rehab centers 3 4 Specialist physician practices* 1, Urgent care centers 2 1 Findings for Providers Actively Signed Up The number of hospitals is based on 44 hospitals being reported from the HIOs and Lancaster General having access to 1,300 hospitals via EPIC s Care program. There was a significant increase in the total number of primary care practices, but a significant drop in the total number of specialists. The Authority will follow up to better understand this change and provide an update in a supplement to this report. The other major year-to-year change is the increase in participation by longterm care facilities and home health providers. Page 12 of 20

13 ClinicalConnect HealthShare Exchange Highmark HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2012 Total 2013 Total ClinicalConnect HealthShare Exchange Highmark HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2012 Total 2013 Total PA ehealth Partnership Authority February 2014 Service Coverage Area The following table shows current and planned coverage areas for each HIO by county. The following pages show this information in graphic format. Table HIO Survey Results Summary of HIOs by County County County Adams PP PF PP CP CF 3 5 Lackawanna PF PP CP CF 3 4 Allegheny CP PF CP CP CF PP 4 6 Lancaster PF PP PP CP CF 5 5 Armstrong CP PF PP CF 3 4 Lawrence CP PF PP CF 3 4 Beaver CP PF PP CF 3 4 Lebanon PF PP CF 5 3 Bedford CP PF PP CP CF 3 5 Lehigh PF PP PP CP CF PF CF 5 7 Berks PF PP PP CP CF PP 5 6 Luzerne PF PP CP CF 5 4 Blair PP PF PP CP CF 4 5 Lycoming PP PF PP CP CF 3 5 Bradford PF PP CF 3 3 McKean CP PF PP CP CF 2 5 Bucks PF PF PP PP CP CF CP CP CP 7 9 Mercer CP PF PP CF 3 4 Butler CP PF PP CF PP 3 5 Mifflin PP PF PP CP CF 3 5 Cambria CP PF PP CP CF 3 5 Monroe PF PP CP CF 4 4 Cameron CP PF PP CF 2 4 Montgomery PF PF PP CP CF PP CF 6 7 Carbon PF PP CP CF PP 5 5 Montour PF PP CP CF 4 4 Centre PP PF PP CP CF 4 5 Northampton PF PP PP CP CF PF CF 5 7 Chester PP PF PF PP PP CP CF CF 6 8 Northumberland PF PP CP CF 4 4 Clarion CP PF PP CP CF 3 5 Perry PP PF PP PP CP CF 3 6 Clearfield CP PF PP CF 4 4 Philadelphia PF PF PP PF CP CF CP 5 7 Clinton PP PF PP CP CF 3 5 Pike PF PP CP CF 3 4 Columbia PF PP PP CP CF 3 5 Potter PP PF PP CF 3 4 Crawford CP PF PP CP CF 3 5 Schuylkill PF PP PP CP CF 4 5 Cumberland PP PF PP PP CP CF 4 6 Snyder PF PP CP CF 4 4 Dauphin PF PP PP CP CF 4 5 Somerset CP PF PP CP CF 3 5 Delaware PF PF PP PP CP CF CP 5 7 Sullivan PF PP CP CF 3 4 Elk CP PF PP CF 2 4 Susquehanna PF PP CP CF 3 4 Erie CP PF PP CP CF 3 5 Tioga PF PP CP CF 3 4 Fayette CP PF PP CP CF 4 5 Union PF PP CP CF 4 4 Forest CP PF PP CF 2 4 Venango CP PF PP CP CF 3 5 Franklin PP PF PP CP CF 3 5 Warren CP PF PP CP CF 4 5 Fulton PP PF PP CF 4 4 Washington CP PF PP CP CF PP 4 6 Greene CP PF PP CP CF 4 5 Wayne PF PP PP CP CF 3 5 Huntington PP PF PP CP CF 4 5 Westmoreland CP PF PP CP CF PP 4 6 Indiana CP PF PP CP CF 4 5 Wyoming PF PP CP CF 3 4 Jefferson CP PF PP CF 4 4 York PF PP CP CF 4 4 Juniata PP PF PP CP CF 4 5 Total Legend Status Reported As Current - Full CF Current - Partial CP Planned - Full PF Planned - Partial PP Page 13 of 20

14 PA ehealth Partnership Authority February 2014 Page 14 of 20

15 PA ehealth Partnership Authority February 2013 Health Information Organization Survey Page 15 of 20

16 PA ehealth Partnership Authority February 2013 Health Information Organization Survey Service Coverage Area Findings In 2012, two HIEs planned to operate statewide. One of these no longer exists, but two others, and Lancaster General, have joined Highmark in intentions for statewide coverage. One other, KeyHIE, continues to plan to operate in most, but not all counties. All responding HIOs are intending to expand their geographic area of coverage, except Lancaster General, which is already active statewide. Last year all counties in the state were covered by at least two HIOs. This year all the counties in the state will have at least three HIOs from which to choose. The densest HIO planned coverage continues to be in the area around Philadelphia, with six to nine HIOs covering each county in the region. Additional pockets of overlap by at least six planned HIOs have emerged in the areas near Harrisburg and Pittsburgh. Page 16 of 20

17 ClinicalConnect HealthShare Exchange Highmark HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2011 Rate 2012 Rate 2013 Rate PA ehealth Partnership Authority February 2013 Health Information Organization Survey Service Coverage Area - Additional States Each of the survey participants was asked which states they were planning to connect to for interstate exchange. In addition, each participant was asked if they are willing to connect to or were currently connected with other HIOs in the commonwealth. Table HIE Survey Summary of Participation by State County Delaware P P P P C C 30% 36% 55% Maryland P P P C C 20% 10% 45% New Jersey P P P P C P 20% 45% 55% New York P P P C 30% 36% 36% Ohio P P P C 50% 27% 36% West Virginia P P P P C 3% 36% 45% Connect with other PA HIOs? P P P P P P C P P P P 100% 100% 100% Status Planning Current No Answer/N/A Legend Reported As P C Findings for Service Coverage in Additional States Planned interstate connection is increasing. All HIOs are either currently exchanging with other HIOs or plan to connect with other PA HIOs. Lancaster General s current connections are based on access to EPIC s Care program. The program allows Lancaster General to exchange data with any other EPIC Care Program participant nationwide. Other Operational Questions Each survey respondent was asked a series of operational questions to help understand their intention and direction. A few interesting items of note were: Four of the HIOs currently operate a HISP and three additional HIOs plan to operate a HISP. Of the four HIOs that operate a HISP, only one is currently certified with the Authority and one is currently in the process of certifying. With the exception of Saint Luke s, all the other HIOs are planning to create functionality to support non-electronic practices. Page 17 of 20

18 PA ehealth Partnership Authority February 2013 Health Information Organization Survey Legal - Consent Management, Individually Identifiable Information and Legal Agreements Responders were asked specific questions regarding the legal framework surrounding their HIO operations. Due to the sensitivity of this information, the answers are shown only in aggregate this year. The following summarizes answers for the key questions that were asked. The majority of the responding HIOs use both business associate agreements (BAA) and data use and reciprocal support agreements (DURSA). These are used as templates to establish the legal framework that governs medical information within their organization. The adoption of these instruments has increased since % percent of HIOs replied that they have the ability to audit what person was looking at specific information within a medical record, and produce logs that are periodically audited. While 55% of HIOs stated that patients have the ability to decide how their data is being used, almost none provide patients with the ability to invoke specific restrictions on how much of their information is made available for medical records sharing. A total of 64% of the respondents have patient-facing information to tell them how their data is used and disclosed. Page 18 of 20

19 ClinicalConnect HealthShare Exchange Highmark HIO A KeyHIE Lancaster General Lehigh Valley St. Luke's 2011 Rates 2012 Rates 2013 Rates PA ehealth Partnership Authority February 2013 Health Information Organization Survey Finance HIOs were asked a series of questions concerning their funding, from the start-up phase to the sustainability phase. Table 10 is a summary of the findings followed by a comparison to previous years findings. Answers other than Yes or No have been omitted. Table HIO Survey Results Summary of Finance Questions Finance Will/do you use federal grants to fund your HIE? No Yes No Yes Yes No No No No 30% 18% 27% Will/do you use state grants to fund your HIE? Yes No Yes Yes Yes Yes Yes No Yes No 30% 55% 64% Will/do you use private grants to fund your HIE? No Yes Yes No Yes Yes No No No 0% 18% 36% Will/do you use hospital provider participant fees to fund your HIE? Yes Yes Yes No Yes Yes No No No Yes 70% 73% 55% Will/do you use professional practice participant fees to fund your HIE? Yes Yes No No Yes Yes No No No Yes 50% 45% 45% Will/do you use Payor participant fees to fund your HIE? No Yes Yes Yes Yes Yes No Yes 50% 64% 55% Is there a sustainability plan in place for your organization? Yes Yes Yes Yes No Yes No Yes No 67% 64% 55% Do you expect any changes to your fee structure over time? Yes No Yes No Yes Yes No No Yes No 67% 45% 45% Finance Findings Only a small number of the HIOs are planning to use federal or private grants for funding. Despite fewer HIOs planning to leverage hospitals and payors for sustainability funding compared with last year, the most common sources of planned sustainability funding remain hospital participant fees, payer participant fees, and state grants. Only a little over half of the HIOs have a sustainability plan in place. The decrease in the number of HIOs who have a sustainability plan is due to the new HIOs in the market place. Page 19 of 20

20 PA ehealth Partnership Authority February 2013 Health Information Organization Survey Communication In the final section of the survey, participants were asked about communications materials they had developed or were developing, target audiences, and communications vehicles. Table 11 is a review of the findings followed by a comparison to previous year s findings. Table 11 HIO A ClinicalConnect HealthShare Exchange Highmark KeyHIE Lancaster General Lehigh Valley St. Luke's 2012 Rates 2013 Rates 2013 HIO Survey Results Summary of Communications Questions Communications and Planning Has your organization developed any HIE communication materials regarding the HIE? Yes Yes No Yes Yes Yes No Yes Yes No 73% 64% Was the communication developed for providers? Yes Yes Yes Yes Yes Yes No Yes 73% 64% Was the communication developed for patients? Yes No Yes Yes Yes Yes Yes Yes 55% 64% Was the communication developed for vendors? No Yes Yes No No No No 22% 18% Are any communication materials translated into a foreign language? No No No No No Yes No No No 0% 9% Is your organization willing to share your communication materials? Yes Yes Yes Yes Yes Yes No Yes Yes 67% 73% Has your organization conducted any consumer opinion research regarding HIE? No No No No Yes No No Yes No 27% 18% Has your organization conducted any consumer opinion research on security of patient data? No No No No No No No Yes No 0% 9% Communications Findings There is an upward trend for the communication material that is aimed at patients and a decrease in materials aimed at providers and vendors. Most year-over-year changes result from the change in the responding HIOs. Page 20 of 20

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