Janet King's presentation at Naked Hospital 2010- "The Middle TN eHealth Connect"- www.midtnehealth.com

1. The Middle Tennessee eHealth Connect Nashville Technology Council August 26th, 2010 www.midtnehealth.com

2. The Middle TN eHealth Connect (MTeHC) Historical summary of activities: 2007-2008-2009 Our work in: 2010 Future plans: 2011 and beyond

4. History of the Middle Tennessee eHealth Connect - 2008 Reggie Coopwood, MD as convener and later as Chairman of the Board Regional Informatics as facilitators of the process February 4th planning session Work Groups were established Charge given by the Board to investigate the possibility of “piggybacking” on the Memphis Exchange 3-4 months of work ensued with a decision to adopt the governance model

5. History of the Middle Tennessee eHealth Connect - 2009 Work began to define a sustainability model for Health Information Exchange. Members of our team developed a proforma modeling tool to look at multiple ways to fund the exchange. The question is “who receives value from the existence of the exchange?” Bylaws were adopted and the Middle Tennessee eHealth Connect was incorporated as a non-profit. ARRA was passed by Congress. MTeHC issued an RFP in July. HIP TN activities began in August/September timeframe. Request came to MTeHC to stop vendor selection process.

6. History of the Middle Tennessee eHealth Connect – 2010 (Jan-June) MTeHC re-started the process to build an exchange MTeHC received $150,000 grant from Cigna The MTeHC Board (with assistance from the Tennessee Hospital Association) studied ED utilization in Davidson County The Board decided to investigate whether joining with Memphis on the ICA infrastructure would help in keeping costs low. Dr. Coopwood departs to Memphis (The MED) Larry Kloess (TriStar) becomes the Chairman of the Board

7. Middle Tennessee eHealth Connect 2010 Currently… We expect to sign a Community Amendment to Memphis/ICA Core Service Agreement within the next 45 days. MTeHC will be a second HIE operating on the same infrastructure as Memphis gaining some economies of scale. Middle TN and Memphis data will not be co-mingled. We will adhere to the idea that we must keep technology and operational costs low in order to be sustainable. Work Groups are, once again, active in their respective roles.

8. Looking Ahead to Upcoming Activities Office of eHealth offers state planning grant to create a business plan Gives MTeHC the opportunity to engage in a strategic planning process Plan will also include a goal for expansion of Board membership to be representative of the cross-section of our community Other HIEs (planned and operational) will also be creating their business plans.

9. 2010 Current Governance & Infrastructure Board of Directors Larry Kloess – HCA/TriStar Health System, CEO (President & Board Chair) Wes Littrell – Saint Thomas Health Services, President & CEO STHS Affiliates/Chief Strategy Officer Jason Boyd – Nashville General Hospital, Interim CEO Larry Goldberg – Vanderbilt University Hospital, CEO Craig Becker – Tennessee Hospital Association, President Kasey Dread – Nashville Academy of Medicine, Executive Director Dr. Clifton Meador – Safety Net Consortium/Meharry-Vanderbilt Alliance, Executive Director State of TN Metro Government of Nashville & Davidson County Project Management Office Regional Informatics at Vanderbilt (independent) We operate under strict guidance from the board

10. Why do this? We have access issues and will continue to have access issues. We have people who move from care setting to care setting regularly. We have overuse problems across all payer types. We have primary care and non-emergent care being delivered in high-cost Emergency Department settings. We believe HIE can support care improvements through the provision of health information required to support measurable improvements and efficiencies in the health of populations. Our evaluation plan in Memphis is not yet published but will show some benefits.

11. Initial Stakeholders of the MTeHC (Patients and their families are the focus of the Middle Tennessee efforts) These organizations either provide care or support the care delivery process. Ambulatory Providers Safety Net Clinics Hospitals Employers Heath Plans Government (as a payer and an employer)

12. Initial Work Initially Availability of information at Hospitals and Safety Net Clinics ARRA – Medicare & Medicaid Meaningful use incentives Growth Aggressive expansion of data from other providers with expanded access Northern border to Southern Border in Middle TN Other Possibilities Patient Centered Medical Home ACOs Population Health Research

13. MTeHC HIE General Architecture – Data Handling Clinical Results, Encounters, and Patient Demographics Hospital 1 Hospital 2 ICA Parsers Clinic 1 Clinic 2

14. Examples of data in the Exchange Encounter Summaries Laboratory Results Discharge Summaries

15. Potential Benefactors of Exchange Patients Decreased duplicate testing, Out Of Pocket expenses, Opportunity Costs, Radiation exposure Data can be accessed across multiple providers More opportunity to be informed about their care Clinicians/Providers Immediate access to patient information from other institutions Reports that obviate the need to order tests Safer transitions in care Lower costs burden of quality reporting Employers Reduced utilization of services Lower costs to insure employees Reduced medical spending associated with adverse events (such as hospitalizations) Government Lower costs of Medicare and Medicaid care delivery Public Health Measure and track health improvement initiatives through research and public programs Track influenza outbreaks

19. www.midtnehealth.com