HIE heritage. Founded in 1995

HIE heritage Founded in 1995 Market: 2 nd largest city, 107 Nielsen DMA 3 competitive large (500+ bed hospitals) 15 hospitals in 11 surrounding counties 1300 practicing independent physicians Low/No Managed Care, No dominant insurer No dominant employers (hospitals are largest)

Patient safety is increased simply because information is there accessible anywhere Hospital Ambulance Helicopter

Document management

Cost/Efficiency Physicians Nurses / Technologists Billing Reception Transcription Medical Records

WebChart supports paper and online use taking practice chartless, not paperless

Auto Forms: -All internal forms are printed online -Chart prep is replaced with push button printing to save time and encourage use -Bar-coding eliminates indexing effort

EHR modules Document Management High Speed Scanning Forms Library Dictation Transcription e-prescribing Allergy / Intolerance PACS/DICOM Storage Diagnostic Imaging Viewer Tasking/Reminders Encounter Workflow e-sign Check-in Scheduling Immunizations Allergy Injection Management Lab Results/Flowsheets Lab Order Entry CPOE Problem List Management Cell Phone Access Charge Capture Hospital Rounding List Data Comparison/Reconciliation Master Patient Index Inbound Fax Outbound Fax Ins. Eligibility - CORE Certified Reporting Point-Click/Progress Note/H&P E&M Coding Calculator Clinical Decision Support PQRI PHR Integration EOB Scanning Specialty Highlights Psychiatry 5 Axis Problem List-DSM3/4 Cardiology Coumadin Tracking Cardiac Progress Note IC3/Pinnacle Cardiac Echo Template Cardiac Nuclear Template Pediatrics Growth Charts Pediatric Milestones OB/GYN Mammo Tracking MQSA OB Flow sheet Began development in 1998, today complete EHR

Context MIE heritage Med-Web Statistics: -Accessible by 90+% of NE IN physicians -1.5 million monthly HL7 messages -More than 225,000 monthly diagnostic reports -Nearly 15,000 monthly radiology studies NE IN EHR Adoption: -65% of NE IN physicians have some form of EHR Lessons Learned

Certification First 18 products CCHIT Certified CCHIT 2011 on October 2010 ONC ATCB Certification in November 2010

Our clients Physicians Employers Hospitals Universities Government Health Plans RHIOs/HIEs Safety Net Consumers Over 15+ Specialties Cardiology OB/GYN Neurology Pediatrics Primary Care Radiology Dermatology Surgery ENT Psychiatry Gastro Nephrology Ophthalmology Internal Med Urology Urgent Care Orthopedics

Meaningful Use Final Rule on July 13 th, 2010 -Updated October 13 th CMS: 42 CFR Parts 412, 413, 422, and 495 Provider Incentive Program 25* Measures (15 Core, 9* Menu of which 5 selectable) One of the 5 must be a population health measure (1) http://www.cms.gov/ehrincentiveprograms/ Specifies providers must adopt certified EHR technology ONC: Final Rule 45 CFR Part 170 Standards, Implementation Specifications Certification Criteria for Electronic Health Record Technology http://www.ofr.gov/ofrupload/ofrdata/2010-17210_pi.pdf

Provider Incentives Physician Incentives for Meaningful EHR Use 2011 2012 2013 2014 2015 2016 TOTAL 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 2012 $18,000 $12,000 $8,000 $4,000 $2,000 $44,000 2013 $15,000 $12,000 $8,000 $4,000 $39,000 2014 $15,000 $12,000 $8,000 $35,000 2015 $0- $27 Billion $63,750 (through Medicaid) per clinician over 6 years Fee reductions: Providers who do not demonstrate meaningful use in 2014 will see, in their 2015 fee schedules from Medicare, a decrease of 1%. An additional decrease will be affected in 2016 and 2017 down to a total of 97% of the regular fee schedule; it can further be reduced to 95% if the Secretary determines that total adoption is below 75% in 2018. *First payments to EP, May of 2011 after 90 days of demonstrated meaningful use

Register: for the program Registration/Attestation a link on the Registration web page at http://cms.gov/ehrincentiveprograms/ Demonstrate: 90 days of attaining meaningful use measures. Perform one time measures (like security, connectivity tests, and quality reports) Attest Return to the CMS website in April Starting in 2012, CMS will initiate electronic submission Payment CMS will start sending payments in May when billing reaches bonus levels (75% of allowable charges).

Measures # MIE Name Objective Measure Measure Calculation Burden Estimate C01 Meds CPOE Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE EHR C02 Drug Interaction Implement drug-drug and drugallergy interaction checks The EP/eligible hospital/cah has enabled this functionality for the entire EHR reporting period Attestation 1 min C03 Problem List Maintain an up-to-date problem list of current and active diagnoses More than 80% of all unique patients seen by the EP or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data EHR C04 erx Generate and transmit permissible prescriptions electronically (erx) More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology EHR C05 Med List Maintain active medication list More than 80% of all unique patients seen by the EP or admitted to the 7eligible hospital s or C8AH s inpatient or Em9ergency department (PO10S 21 or 23)have at least o11ne entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data EHR C06 Allergy List Maintain active medication allergy list More than 80% of all unique patients seen by the EP or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data EHR Record demographics o preferred language More than 50% of all unique patients seen by the EP or admitted to the eligible hospital s or CAH s inpatient or

Meaningful Use Measures EHR Standard Features Meds Patient Engagement Connectivity C03-Problem List C07- Demographics C01-Meds CPOE C02-Drug Interaction C12-E-copy to Pt C10-Quality Reporting C08-Chart Vitals C11-Decision Support M08 C13-Pt Clinical Summary Summary of Care C09-Smoking Status C13-Patient Summary M03 Condition Report C04-eRx C06-Allergy List M01- Formulary C05-Med List M07-Med Reconciliation M04-Patient Reminders M05-Personal Health Record M06-Pt Education C14-Exchange M02-eLab M09-Immunizations M10-Syndromics* Standards CCR/CCD/HL7 SNOMED-CT ICD-9 RxNorm LOINC CPT-4 CVX Security C15-Risk Analysis & Management Authentication Access Control Integrity Audit Logging Encryption

C03 Problem List C09 Smoking Status C04 erx M07 Med Rec C02 Drug Interactio n 1min C01 Meds CPOE C07 Demographic s C11 Decision Support 1 min C05 Med List C06 Allergy List M01 Formulary 1 min C08 Chart Vitals C13 Patient Summary Meds M08 Summary of Care M03 Condition Report Encounters Meaningful Use Security C12 E-copy to Patient Patient Engagement C15 Security 6 hr Connectivity M05 PHR M04 Patient Reminders 1 min M09 Immunizations 1 hr M02 elab M06 Patient Education C14 Exchange 1 hr C10 PQRI M10 Syndromics 1 hr

Meaningful use meter demo

What s Missing? No need to point-and-click: HPI, ROS, Exam, Plan (except prescriptions) Physicians do not need to self enter everything. Workflow is important.

Security # MIE Name C15 Security Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Objective Measure Measure Calculation Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process Attestation Burden Estimate 6 hr Security C15-Risk Analysis & Management Authentication Access Control Integrity Audit Logging Encryption

Patient Engagement EHR Standard Features Meds Patient Engagement Connectivity C03-Problem List C07- Demographics C01-Meds CPOE C02-Drug Interaction C12-E-copy to Pt C10-Quality Reporting C08-Chart Vitals C11-Decision Support M08 C13-Pt Clinical Summary Summary of Care C09-Smoking Status C13-Patient Summary M03 Condition Report C04-eRx C06-Allergy List M01- Formulary C05-Med List M07-Med Reconciliation M04-Patient Reminders M05-Personal Health Record M06-Pt Education C14-Exchange M02-eLab M09-Immunizations M10-Syndromics*

Consumer Empowerment Patient Portal # MIE Name C12 C13 E-copy to Patient Patient Summary Objective Measure Measure Calculation Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request Provide clinical summaries for patients for each office visit More than 50% of all patients of the EP or the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days Clinical summaries provided to patients for more than 50% of all office visits within 3 business days EHR EHR Burden Estimate M04 Patient Reminders Send reminders to patients per patient preference for preventive/follow up care More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period EHR 1 min M05 PHR Provide patients with timely electronic access to their health information (including lab results, problem list, medications lists, medication allergies) within four business days of the information being available to the EP More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withhold certain information EHR M06 Patient Education Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate More than 10% of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 23 or 23) are provided patient-specific education resources EHR

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