The document summarizes Missouri's plans to develop a statewide health information exchange network. It discusses: 1) Establishing the Missouri Statewide Health Information Organization (MSHIO) as a non-profit public-private partnership to govern the statewide HIE network. 2) The network will connect regional health information organizations and allow providers to exchange health information across the state in accordance with national standards. 3) MSHIO will provide core services like a patient index and secure messaging to support information sharing and help providers meet meaningful use requirements. 4) Missouri has received $22.3 million in federal funds to plan and implement the statewide HIE and support providers' adoption of electronic health records.

1. Missouri Statewide Health Information Organization MO-HITECH http://dss.missouri.gov/hie/

2. Missouri’s Health Information Exchange: Missouri has an unprecedented opportunity to access federal funds to plan, design, implement and support the statewide exchange of electronic health information. 2

3. Current state vs. future vision Pharmacies Pharmacies Labs Hospitals Labs Hospitals Health Info Exchange Physicians Clinics Physicians Clinics Consumers Government Payers Government Payers Consumers Current Confusion Evolving and Competing Landscape Future Vision Improved Access and Use of Health Information 3

4. 4 ARRA and HITECH Act:Opportunity for Missouri’s Health Care Providers and Consumers

5. ARRA & HITECH Funding ARRA American Recovery & Reinvestment Act $787 Billion federal stimulus package passed by Congress and signed by President Obama in February 2009. HITECH Act Health Information Technology for Economic & Clinical Health Act $50 billion section of the stimulus package focused on funding and supporting widespread adoption of health information technology. MO-HITECH Missouri Office of Health Information Technology $1 billion funding opportunity for Missouri over the next five years. 5

6. Above $1 Billion $500 Million - $1 Billion $100-500 Million Below $100 Million Estimated Meaningful Use Funding by State Missouri: Projected funds from State HIE Program: $13.8 M Projected funds from Medicare Meaningful Use: $442 M Projected funds from Medicaid Meaningful Use: $404 M 6

7. Missouri Opportunities Under HITECH:$1 Billion Potential Investment 7

8. 8 Support for Missouri’s Health Care providers

9. 9 Development of Missouri’s Health Information Exchange:Goals, Planning and Timelines

10. 10 State Goals Improve the quality of medical decision-making and the coordination of care; Provide accountability in safeguarding the privacy and security of medical information; Reduce preventable medical errors and avoid duplication of treatment; Improve the public health; Enhance the affordability and value of health care; and Empower Missourians to take a more active role in their own health care.

12. Advisory Board and Workgroups formed

13. Public invited to review, comment and offer feedback

14. More than 200 stakeholders engaged across the state11

15. MO-HITECH MO-HITECH Framework Advisory Board Manatt & State Employees to Staff & Facilitate Workgroups Governance Workgroup Technical Infrastructure Workgroup Finance Workgroup Business & Technical Operations Workgroup Consumer Engagement Workgroup Legal/ Policy Workgroup Draft Strategic and Operational Plans Draft Sections of Strategic and Operational Plans Strategic and Operational Plans 12

16. MO-HITECH Advisory Board Barrett A. Toan Private Sector Co-Chair Ronald J. Levy, Director, DSS and MO-HITECH Coordinator Donald Babb CEO, Citizens Memorial Hospital, Bolivar Steve Calloway Pharmacy Representative Shalonn Curls Margaret T. Donnelly Director DHSS Karen Edison, MD Missouri Center for Health Policy Tracy Godfrey, MD Family Physician, Joplin Tom Hale, MD, PhD Sisters of Mercy Health System Sandra Johnson, JD, LL.M Emerita Professor of Law and Health Care Ethics, St. Louis University School of Law Herb B. Kuhn President & CEO, Missouri Hospital Association Ian McCaslin, MD Director, MO HealthNet Division Joe Pierle, CEO Missouri Primary Care Association Verneda Robinson CEO, Swope Health Systems Andrea Routh Health Advocacy Alliance Senator Eric Schmitt MahreeSkala Missouri Association of Local Public Health Agencies Steven C. Walli President & CEO, United Healthcare MO David Weiss, CIO BJC Healthcare Karl Wilson President & CEO, Crider Health Center 13

18. Mitzi Cardenas, CIO, Truman Medical Center

19. Doug Young, CIO, Information Technology Services Division

20. Legal/Policy

21. Sandra Johnson, Professor Emerita of Law and Health Care Ethics, St. Louis University School of Law

22. Doug Nelson, Deputy Chief of Staff, Governor Jay Nixon

23. Finance

24. John M. Huff, Director, Department of Insurance

25. Donna Checkett, Senior Vice President, Aetna Medicaid

26. Governance

27. Steve Roling, Healthcare Foundation of Greater Kansas City

28. Ronald J. Levy, Director, Department of Social Services

29. Consumer Engagement

30. Scott Lakin, Lakin Consulting

31. Margaret T. Donnelly, Director, Department of Health and Senior Services

32. Business and Technical Operations

33. Karl Kochendorfer, MD, University of Missouri - Columbia

34. Ian McCaslin, MD, Director, MO HealthNet Division 14

36. Develop privacy and security plan

37. Develop technology plan

38. Develop financing plan

39. Develop EHR adoption plan

41. Strategic

42. Operational

43. State Medicaid Plan

44. Regional Extension Center

45. EHR adoption planHealth IT is the enabler, not the result

47. Conduct stakeholder interviews

48. Establish MO-HITECH

49. Establish Advisory Board

50. Convene Workgroups

51. Draft Strategic Plan

52. Publish Draft Strategic Plan for Review

53. Develop detailed project timeline and work plan

54. Engage and educate stakeholders

55. Convene Advisory Board & Workgroups

56. Draft Operational Plan

57. Publish Draft Operational Plan for Review

58. Update project timeline and work plan

59. Engage and educate stakeholders Funding Announcement 16

60. 17 Missouri’s Health Information Exchange:A Strategic and Operational Roadmap

62. Statewide HIO provides statewide policy guidance, core services to enable interoperability

63. Statewide HIO leads collaborative governance with Qualified Organizations

64. Abandon core services focus, leaving the private market to address interoperability

65. Provide backfills where market fails to assure ‘No provider left behind’

66. Focus on education, convening, and statewide policy guidance

67. Divide Missouri into markets/territories assigned to existing HIOs, new HIOs or the Statewide HIO

68. Statewide HIO provides governance, manages monopolies for public good

69. Statewide HIO may provide core services to Qualified Organizations

70. Statewide HIO is primary vehicle for HIE

71. Statewide HIO builds infrastructure, consolidates HIOs for economies of scale

72. MO HIOs focus on local governance, adoptionGiven the relatively nascent HIE market in Missouri and the desire to pursue an effective public-private governance model, Missouri intends to develop a “Statewide Network Comprised of Diverse Qualified Organizations.” 18

73. Governance: Board of Directors Statewide HIE in Missouri will be governed by a collaborative multi-stakeholder organization – the Missouri Statewide Health Information Organization (MSHIO). Not-for-profit – 501c3 – public/private partnership 15-member MSHIO Board appointed by MO-HITECH Advisory Board June 30 13 private sector representatives 2 state representatives Consumer advocates and providers must be represented on the Board at all times Draft articles of incorporation and bylaws completed 19

75. Technical, legal, policy and procedural obligations as defined by MSHIO

77. Hospitals, health systems, provider groups, FQHCs/RHCs, regional HIOs, etc.

78. Private, non-provider networks:

79. Clearinghouses, payors, vendors

82. Consumer Advisory Council will be established

83. Consumer engagement and information strategy will be developed23

84. Technical Infrastructure: Principles MSHIO will support the development of regional HIE (qualified organizations) efforts while linking those networks together to enable statewide exchange of health information. Principles No provider left behind Alignment with meaningful use Interoperability and accessibility Leverage resources – public and private Consistency with national standards 24

86. Provider registries and Master Patient Index (MPI)

87. Secure messaging and clinical information exchange

88. Consent management

89. Electronic access to Medicaid data

90. Reporting services

91. Potential value-added services:

92. Electronic lab ordering and results delivery

93. Electronic prescribing (e-prescribing)

94. “EHRLite” web viewers for providers without EHRs25

95. Legal/Policy: Patient Consent Model Evaluation and final decision related to an opt-in versus opt-out model is complex and must consider the following: Consumer and provider trust State and federal requirements Clinical value of the information Technical feasibility and cost Administrative burden and implementation cost Preliminary recommendation is that MSHIO utilize an opt-in patient consent framework. 26

97. $1.7 million Medicaid IT planning grant

98. $6.8 million for Regional Extension Center

99. These funds represent “seed money” for the planning and implementation of statewide HIE and provides for meaningful use and adoption of EHRs.

100. A model and plan is being developed to ensure there is long-term financial sustainability for operating the MSHIO.27

101. 28 Finance A six year all-in cost model for statewide HIE

103. 30