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2014 NeHII Annual Report Overview

Lincoln Association of Health Underwriters

April 6, 2015

Adoption and increased usage

Sustainability

2014 major projects

NeHII staffing

Preview of the future

Q&A

Contact information

2014 ANNUAL REPORT OVERVIEW

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ADOPTION AND INCREASED

USAGE3

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NEHII PARTICIPANTS

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NEHII ADOPTION

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www.connectnebraska.net 11

Opt out platform

No “Break the Glass” considerations

Special protected data or 42 CFR Part 2 scrubbedfrom the ePHI available

Individual consumer education and consentmanagement processes and support

Privacy/Security Policies address treatment,payment and healthcare operations

NEHII CONSENT MANAGEMENT

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SUSTAINABILITY13

NEHII’S SUSTAINABILITY STRATEGY

License fee model paid by all participants

Health systems

Providers

Payers

State of NE

Continuum of care providers

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SUSTAINABILITY PLAN COMPONENTS

Payer participation

State of Nebraska’s financial support

HITECH 90/10 funding

Revised pricing structure with vendor

Expense management

Financing through Mutual of Omaha Bank

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PAYER PARTICIPATION

BCBS of NE long standing supporter

Implemented ADT alerting services

Coventry now Aetna

Arbor Health Plan

UnitedHealthcare

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STATE OF NEBRASKA FUNDING SUPPORT

2013 – 2014 $500,000 appropriation to assistproviders and hospitals in meeting MUrequirements

2014 – 2015 $500,000 appropriation to supportMU requirements and $500,000 directly to NeHIIfor operational support

2015 – 2016 requesting annual appropriation of$1 million

NeHII serves as the PDMP for the State

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HITECH 90/10 FUNDING OPPORTUNITY

Funding request approved by CMS early October tosupport additional HIE adoption activities and allowfor added functionality for eligible providers andhospitals

Available to another 35 CAHs, FQHCs and 6remaining major hospitals to remove HIEimplementation fees

Waive the NeHII implementation fee of $10,000 forthe CAHs, however EHR interface fees remain

Also offers 12 months of free usage of the VHR toproviders

Added functionality includes the Public HealthGateway for syndromic surveillance and expandedADT messaging

Must be implemented by September 30, 2015

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REVISED VENDOR PRICING STRUCTURE

Re-negotiated master services agreement

Migration to HIE 2.0 will require completely newpricing model based upon # of lives with PHI inthe system and # of feeds

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FINAL TWO CATEGORIES

Ongoing expense management for operationalsupport

Financing through Mutual of Omaha Bank

Paid down line of credit

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2014 MAJOR PROJECTS21

ADDED FUNCTIONALITIES PRIORITIZATION

Identified in 2013 Decision Accelerator

Followed by decision scorecard process

HITECH 90/10 funding availability

Input and feedback from various stakeholdersand participants

Recent physician survey

Focus on sustainability and ROI for addedfunctionalities

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ADDED FUNCTIONALITIES 2014-2015

Single Sign-on Enhanced ADT Messaging to include admitting, working,

discharge diagnosis and allergies Direct Services implementation Public Health Gateway implementation for syndromic

surveillance Optum HIE 2.0 platform migration Open Access to support C-CDA exchange Data analytics using Optum One tools Usage analytics Enhanced PDMP functionality Case management reporting HIE to HIE Gateway Statewide Provider Directory for Direct users Radiologic image exchange Two factor authentication Mobile device alerting

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EXTERNAL NEHII SECURITY AUDIT

Three year cycle

Performed September 2014 by SHS included onsitevisit of NeHII team members

NeHII “has developed and implemented strongsecurity controls throughout the institution and isexceptionally compliant with its own policy”

Reviewed 288 items of which 263 or 91% foundcompliant

Resulting security action plan addressed primarilypolicy revisions and included the implementation ofemployee background checks and drug testingprocedures

Detailed plan not made public for protective reasons24

SECONDARY USE OF DE-IDENTIFIED DATA

POLICY

To support research efforts using de-identifieddata

Utilizes IRB review and approval

Complete “Access to and Use and Disclosure ofInformation Policy” Found in Exhibit E

Approved December 2014 by Privacy & SecurityCommittee and NeHII Board

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CYBER SECURITY EDUCATIONAL EFFORTS

Annual NeHII staff training

Cyber security workshops

Cyber security newsletter

Partnership with outside vendors

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ADT Alerting/Notification Service

For payers, providers and hospitals

Notification admits for inpatient stays

Notification of Emergency Department visits

Notification of discharges

Thirty Day Readmittance

Notification when a patient is admitted to ahospital within 30 days of discharge

Patient consent considerations

POPULATION MANAGEMENT

SERVICES/SPECIAL PROJECTS

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Produce comprehensive daily census reports onadmissions, discharges and ED visits

Improve care transitions/case management

Improve efficiency

Avoid unnecessary service

Streamline utilization management obligationsto payers

Beginning population health strategy support

Future support public health alerting

PURPOSE OF

ALERTING/NOTIFICATION SERVICES

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What is Direct messaging?

Trusted secure encrypted email service that supportselectronic communication between healthcare providers andpatients

Privacy, security, and trust-in-identity controls of Directexchange are VERY important!

Consider HIPAA and the new penalties for breach of privacy

Supports Stage 2 MU objectives related to Transitions ofCare and Patient Engagement

DIRECT MESSAGING SERVICES

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DATA EXCHANGE TO PROMOTE

COORDINATION OF CARE

StandardizedContinuity of

Care Document

HospitalLTCRehab Facility

Primary CareSpecialty CareHome HealthReferral Hospital

“Transition of Care” – The movement of a patient from one setting of care(hospital, ambulatory primary care practice, ambulatory specialty carepractice, long-term care, home health, rehabilitation facility) to another.

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Direct is a push-based transport

Direct addresses are used to route Direct messages

Digital certificates are used to protect Direct messagesin transit and to express trust relationships

SMTP is used to transport Direct messages

Security/Trust Agents (STAs) such as HealthInformation Service Providers (HISPs) are responsiblefor providing the services necessary for exchange usingDirect

Trust communities, e.g. DirectTrust facilitate theexchange of Direct messages

KEY CONCEPTS IN DIRECT

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DIRECT – IN SUMMARY

Privacy, security, and trust-in-identity controls ofDirect exchange are VERY important!

Consider HIPAA and the new penalties forbreach of privacy

HISPs are Business Associates and “trustedagents”of Direct users. CAs/RAs aresubcontractors.

EHRs have 3 options for enabling Directexchange:

1. EHR can be a HISP for its customers (and patients?)2. EHR can partner with a single full service HISP.3. EHR can configure connections (SOAP XDR) to

allow customers to choose a HISP, in which case anEHR vendor might have relationships with multipleHISPs.

In all three options, it is ultimately the provider’sresponsibility that privacy is protected andidentity is assured!

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CURRENT DIRECT PARTICIPANTS

Wayne Family Medicine (part of Faith RegionalPhysician Services

Colglazier Demmel Medical Clinic – Grant, NE CHI Health

Good Samaritan Hospital – Kearney, NE Nebraska Heart Hospital – Lincoln, NE St. Francis Medical Center – Grand Island, NE St. Elizabeth Regional Medical Center – Lincoln, NE

Pathology Services, P.C. – North Platte, NE NeHII, Inc. 3 skilled nursing and rehabilitation facilities

Linden Court – North Platte, NE Hilltop Estates – Gothenburg, NE Heritage Estates – Gering, NE

Total Direct users to date: 6133

DIRECT USE CASES UNDER DISCUSSION

Need for Statewide Provider Directory of Directaddresses

VA – care coordination

BCBSNE – claims & case management

Additional nursing home referrals

Interstate Direct message exchange Successful tests performed with:

IDPH – Iowa Department of Public Health

KHIN – Kansas Health Information Network

MHC – Missouri Health Connection

CORHIO – Colorado Regional Health InformationOrganization:

South Dakota Health Link 34

PDMP ENHANCEMENTS REQUESTED BY

NMA

Mandated consumer participation

Reporting of all controlled substances to thesystem

Free access for physicians across the State

Secure grant funding to accomplish the goals

LB471 introduced January 2015

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2014 ANNUAL MEETING Held August 7, 2014 at CHI’s McAuley Center in

Omaha, NE Sponsored by CHI Health, BCBS of NE, Baird Holm

Law and SHS More than 120 attendees Keynote speakers included Jim Hetherington,

Manager of HIE Applications for CHI; Scott Afzal,Program Director for CRISP; and Nicholas Blake,Client Services Manager with Briljent

Ken Lawonn, Sr. VP and CIO of Sharp Healthcarerecognized with the Visionary Leader of HIE Award

NeHII Council and Committee reporting Meeting presentation available at www.nehii.org,

Downloads/Forms & Documents/2014 NeHII AnnualMeeting Presentation

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LEGISLATIVE ADVOCACY EFFORTS

BCBS lobbyist team

Raise the awareness of State Senators

Secure annual funding from the State

Received $500,000 to support NeHII’s operations

Revised LB237 so that NeHII could secure grantfunding to enable PDMP enhancements

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NEHII STAFFING38

OPERATIONAL EXPENSE MANAGEMENT

Annual budget $2.6 million

Virtual workplace with 6 FTEs and contracted PT servicesas needed CEO Project Managers – 2 Data Analyst – 1 Physician Trainer – 1 Administrative - 1

Delicate balance between increased adoption and addedservices/new projects while maintaining current users

Outsourced contracted roles CFO Legal Counsel Privacy Officer

Met 2014 goal of 100 new providers/quarter39

PREVIEW OF THE FUTURE40

MEET ADOPTION AND ADDED

FUNCTIONALITIES PROVIDED BY HITECH90/10 FUNDING

Support sustainability and MU requirements

Hospital and provider adoption activities

Added functionalities:

Expanded ADT messaging to include admitting,working and discharge diagnosis and allergies

Advance Directives

Public Health Gateway for syndromic surveillance

Ability to create and exchange CCD not availableuntil HIE 2.0 (Open Access)

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CAPITAL EXPENDITURES BUDGET

Functionalities not included in HITECH 90/10funding

HIE 2.0 platform migration

Single Sign-on

Usage and data analytics

Statewide Provider Directory for Directaddresses

Additional care coordination and casemanagement services

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Added flexibility, cloud based Oracle solution

Planned to begin March 2015

Project plan for migration completion – sixmonths

No data migration costs from Optum

New pricing model

Currently collecting OIDs from NeHIIparticipants

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MIGRATION TO HIE 2.0 PLATFORM

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EXHIBITS44

2014 ANNUAL REPORT EXHIBITS:

A: Growth of NeHII Users

B: Future Functionalities in Optum HIE 2.0

C: Sample NeHII Project Proposal

D: NeHII 2014 Financial Statements

E: NeHII Secondary Use of Data Policy

F: Direct Participants Listing

G: NeHII State Senator One Page Overview

H: NeHII Project & Operational Responsibilities

I: NeHII 2015 Projected Projects

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IN CONCLUSION46

Q & AThank you for joining us today!47

Dr. Michael Westcott – President, NeHII Board of Directors

Deb Bass - Chief Executive Officer, NeHII

Lianne Stevens – Security Officer/Project Manager, NeHII

NeHII, Inc.

P.O. Box 27842

Omaha, NE 68127

Deb’s Cell: 402.981.7664

dbass@nehii.org

Lianne’s Cell: 402.290.7029

lstevens@nehii.org

www.nehii.org 48

NeHII CONTACT INFORMATION