This document discusses the concept of a "naked HIE", which is described as an open health information exchange that provides seamless access to all available patient information through any application, while maintaining accurate patient and provider identities and respecting privacy policies. The goals of a naked HIE include enabling information sharing to demonstrate value to participants, supporting meaningful use requirements, and helping to improve care and outcomes. Roadmaps are presented for using a naked HIE to connect various healthcare organizations and share different types of clinical data over time in order to increase efficiency, quality, and patient satisfaction.

1. Sean Cassidy, SVP, GM, Healthcare – Initiate, an IBM Company 26 August 2010 The Naked Health Information Exchange Document number

2. What is a naked HIE? Open to all stakeholders Provides seamless and transparent access to all available information Accessible by any application, no technology constraints Maintains accurate patient and provider identity Respects policy, privacy and preferences Enables evolution as well as revolution Demonstrates clear value to participants Supports ‘meaningful use’ Helps deliver better care and outcomes Information Management 2

3. Information Management Seamless access Aggregate & harmonize Value Uniquely identify patients,providers & organizations Connect organizations EMR at the point of care Scope of Information Sharing HIE value delivery roadmap (UMass Memorial view) 3

4. Information Management “Get Information” Quality Reporting Outcomes Analysis BI Platform Analyze Access Value Exchange Connect Scope of Information Sharing HIE technology deployment roadmap “Request Data” Virtual Patient Record Integrated Workflow Terminology/Vocabulary Services “Subscribe to Data” Orders, Results and Referrals; Admin Transactions Queuing and Reconciliation Community Enabled EMPI and Provider; XDS; Consent “Push Data” Secure Connectivity Message Translation and Mapping Auditing and Logging 4

5. Information Management Accountable Meaningful User Value “Easier to do Business with” Connected and Collaborating HIE organizational evolution roadmap Computerized Scope of Information Sharing 5

6. How HIE roadmap impacts patients Admission History Information Management Population Population-Level Health Research Chronic Disease Management ClinicalInformationSharing for Patient Improve Patient Access Impact Over Time Patient 6 6

7. Private health information exchange Information Management 7

8. Foundational connectivity & exchange application architecture Information Management Orthopedic Results Portal Health System A HostedEMR Office 1 Interface Engine Interoperability Services Remote Office 2 Clinical Systems Maintainlocal Interfaceto Initiate Agent Results Delivery Other Systems Oncology/Hematology Order/Results Mgmt Referral & Consults Remote Printing& DocumentCapture Shared Registration Document & Image Sharing Family Practices EMR IPA Network EMR PM Identity Services: Patient & Provider Remote Office 6 Remote Office 5 Remote Office 4 EMR-Generated Orders Document Registry & Repository (XDS) 8

9. Traditional uses of an EMPI HEALTHCARE PROVIDER #01 Name: Dr. Debbie Dozier-Becker 9146 E. Via Del Sol Address: Local Identifier: 12/19/61 - 727 Netown, CA 45883 Address 2: PATIENT INFORMATION HOSPITAL #02C Debbie Becker, M.D. Name: First: Debbie 9146 E. Via Del Sol Local Identifier: ABC98765 Address: Netown, CA 45883 Address 2: Last: Becker Address: 9146 E. Via Del Sol PHARMACY Name: Deb Becker, M.D. City: Netown Null UPIN #: Local Identifier: DBECKER1234 State/Zip: 5555-55-1234 CA / 45883 ID#: Name: Dr. Debbie Dozier Gender: F 1918282 UPIN #: Local Identifier: PIN122341 Age: 30 5555-55-1234 ID#: 1/1/65 DOB: CLINIC / DOCTOR’S OFFICE Name: Debbie Becker 9146 E. Via Del Sol Address: Local Identifier: VR:1432141234 480-473-3486 Phone: Information Management EMPI Clinical Info Sharing Customer Svc / Billing Hospital Registration Data Quality 9

10. HIS Community Master Patient Index Enterprise Master Patient Index ADT HIS Shared registration Information Management Health System HIE Services Affiliate ADT Search “Enterprise” Patient Ambulatory EMR Search ADT ‘Trusted’ ‘Un-trusted’ 10

11. Results reconciliation & delivery Information Management Health System HIE Services Affiliate Exceptions Mgmt. Results Reconciliation & Delivery Ambulatory EMR Lab System Results (With MRN) Results (No MRN) Community Master Patient Index 11

12. Information Management Health System HIE Services Affiliate Document Subscription Mgmt Document ‘subscription’ Ambulatory EMR HIS Request Documents Documents Documents XDS Registry/ Repository SubscriptionRequest Community Master Patient Index Provider Index Relationships 12

13. Information Management Health System HIE Services Affiliate Order Queue Mgmt. Exceptions Mgmt. Order/Results Reconciliation & Delivery Ambulatory EMR Lab System Orders Orders Results Order reconciliation & delivery Results ADT Community Master Patient Index HIS ADT 13

15. Allergies

16. Immunizations

17. Medications

18. Etc.

19. Problem ListMeditech Allscripts Imagecast Soarian VISICU NextGen Community Master Patient Index 14

20. Additional identity management related HIE scenarios Referrals & consults PHR integration/authorization Inter/cross network exchange and ‘hub of hubs’ Patient consent (patient master) Provider policy management (e.g., Information sharing preferences) Data governance/stewardship Information Management 15

22. Referral management

23. Shared registration

24. Community patient search (virtual patient object support)

25. Provider management16

26. Information Management at Orders & referrals Results & documents UMass MemorialHealth Care PhysicianPractice Efficiency Revenue Quality Efficiency Cost-effectiveness Quality Patient satisfaction Patient satisfaction 17

27. What is a naked HIE? Open to all stakeholders Provides seamless and transparent access to all available information Accessible by any application, no technology constraints Maintains accurate patient and provider identity Respects policy, privacy and preferences Enables evolution as well as revolution Demonstrates clear value to participants Supports meaningful use Helps deliver better care and outcomes Information Management 18

28. 19 Information Management Thank you “ The SaaS model allows us to support our mission of improving the healthof our communities by being able to quickly connect our physician community while giving us the flexibility to expand the scope at our own pace.” – Jeff Allport, Vice President, IT Solutions Delivery, St. Joseph Health System Contact: Sean Cassidy, Senior VP, GM, Healthcare Phone: 312-208-0468 Email: scassidy@us.ibm.com

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