State Success Spurs National Innovation

in Health Information Exchanges

Fall 2009
State Success Spurs National Innovation in Health Information Exchanges

TABLE OF CONTENTS

State Success Spurs National Innovation in Health Information Exchanges....................... 3

Integrate Web-Based Platforms................................................................................................. 3

Demonstrate Strong Commitment to Privacy and Security................................................... 4

Start With a Single Population................................................................................................... 4

Ensure Successful and Meaningful Use.................................................................................... 4

Leverage Lessons Learned........................................................................................................ 5

The Continuing Evolution of HIT................................................................................................. 5

About Shared Health.................................................................................................................. 6

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©2009 Shared Health. All rights reserved.
State Success Spurs National Innovation in Health Information Exchanges

As any governor will tell you, innovation and leadership in health care often begin at the state level.
Individual states are often the proving ground for big ideas. And when winning solutions percolate
up to the national level, there are key lessons learned and best practices that can be applied on a
regional and even national scale.

In the realm of health information technology (HIT), Tennessee has been one of those proving
grounds, emerging as a Health Information Exchange (HIE) leader due in large part to the efforts of
Shared Health®, one of the nation’s largest public/private HIEs.

Since 2004, when the organization began working with TennCare, Tennessee’s Medicaid program,
Shared Health has established a track record of success that has resulted in improved patient care
and efficiencies. As a result, Shared Health offers unique perspective and insights on how states and
regions can quickly get their own HIEs up and running to qualify for federal funding.

We are currently embarking on a time of unprecedented federal funding for HIT expansion — more
than $33 billion via the American Recovery and Reinvestment Act to facilitate critically needed inte-
gration in what is, surprisingly, one of the last industries to consistently store and share data. At this
critical juncture, Shared Health offers the following five key strategies that hospitals and health care
institutions might consider as they too seek to fully leverage the power of HIEs to reduce costs,
improve quality, and maximize efficiency.

Integrate Web-Based Platforms

“Prior to the movement of electronic data, each doctor was working in a silo, even though the average
patient sees numerous physicians,” says Dr. Bruce Taffel, Vice President and Chief Medical Officer for
Shared Health. “The idea (behind a web-based platform) was to get information to physicians at the
point of care, to encourage better decision making, and coordinate better patient care.”

A web-based platform has distinct advantages over traditional electronic health records (EHRs) and
in-house, access-only HIE models. When it comes to the challenges of gathering and synthesizing
disparate patient data, web-based platforms make data easily accessible to multiple stakeholders.
They also help to ensure that data is dynamic and effectively woven into the daily workflow of
physicians and clinicians.

For Shared Health’s users, a comprehensive web-based solution, which includes decision support and
population management tools, has helped plug data gaps and facilitate a collaboration of physicians,
payers, patients, hospitals, laboratories, pharmacies, and employers. In addition to supporting clinicians
with access to more comprehensive clinical information — including laboratory results, medications,
immunization and allergy records, and prescriptions — web-based data-sharing also reduces paper
use and unnecessary duplication.

“We have learned a lot about the kinds of information necessary for continuity of care,” says Taffel.
“We had to transform the data received into timely, clinically relevant records that doctors can access
and use at the point of care.”

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©2009 Shared Health. All rights reserved.
Integrate Web-Based Platforms (continued)

Shared Health’s robust clinical decision support goes beyond alerts and warnings to explore what
a patient’s problems are, assist with disease management, identify potential areas of non-compliance,
and suggest evidence-based tasks.

“Once we did a certain amount of data processing, we developed an intelligence engine that
transforms large volumes of data into actionable, meaningful data that cuts across facilities,” says Taffel.

The results are dramatic. In Tennessee, there was a 17-percent improvement in overall efficiency, 30
percent fewer hospital re-admissions and 40 percent fewer services performed in the ER.

Demonstrate Strong Commitment to Privacy and Security

Maintaining the security and privacy of patient records and adhering to federal and state guidelines is an
ongoing concern for all stakeholders. But, as Taffel points out, there can be tension between increasing
the flow of data to improve health care outcomes and ensuring confidentiality of patient records.

Shared Health addressed both considerations head-on — by going above and beyond what is legally
required in these sensitive areas.

“We established a concept of creating communities of patient-centric information that were both
private and secure,” he says.

Start With a Single Population

Shared Health recommends focusing on one major population — Medicaid, for example, or a major payer
or major delivery system — as a way to gain traction. From there, HIEs can build on core competencies.

After starting with TennCare, today, Shared Health stewards health information for nearly 3 million
patients — including nearly 60% of all Tennesseans. In terms of participation, there are more than
4,200 registered users, more than 42,000 records accessed monthly, and more than 28,500 electronic
prescriptions written monthly.

Shared Health’s outcomes include a 21 percent lower cost per visit, a 20-percent decrease in length
of patient stay, a 16-percent increase in generic drug use and an $8 reduction per prescription submitted
electronically. Additionally, preventive care has been enhanced with a 25-percent increase in colon
cancer screenings, a 25-percent increase in influenza vaccinations and a 10-percent increase in
children’s wellness screenings.

Ensure Successful and Meaningful Use

Without question, physician practices and hospital administrators will need a high level of support as
they deploy HIT solutions.

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Ensure Successful and Meaningful Use (continued)

As Tina Grande, senior vice president for policy at the Healthcare Leadership Council, notes, it’s a
time-consuming, overwhelming, and expensive process to transfer paper records to an electronic format,
upload accurate information, troubleshoot glitches, and ensure interoperability. “Meaningful use”
requirements will soon add yet another layer of complexity. Naturally, those burdens create both
resistance and frustration, and the sense of urgency created by the national spotlight on HIT only
adds to the pressure.

Shared Health recognizes the importance of providing education before, during, and after implementation
of its solutions to build user confidence.

“Drop-and-run technology is what tends to fail. Planning, training, and support are vital to success,”
Taffel says.

Leverage Lessons Learned

Hurricane Katrina’s devastation extended beyond homes to EHRs, destroying 75 percent of paper
medical records in the New Orleans area alone. The take-away? Safeguarding medical data during
natural or man-made disasters is a priority for every state.

“Hurricane Katrina was a huge lesson learned,” says Linda Matern, chief operating officer for Shared
Health. “Electronic record keeping ensures that critical patient information is not displaced or lost.”

Shared Health is extending its Tennessee success to Mississippi, adapting its insights to new challenges.

In July 2009, Shared Health was awarded the State of Mississippi’s Division of Medicaid contract
for implementation and operation of an EHR system and electronic prescribing solution for 600,000
Mississippi Medicaid beneficiaries. The company is working closely with key technology partners,
including Oracle, IBM, Initiate, and Axolotl.

The Continuing Evolution of HIT

Hospitals and physicians have a full plate, focusing on ARRA guidelines, identifying key features and
functions of technology, evaluating vendors, analyzing cost of ownership, exchanging information with
colleagues, consulting medical associations, and pursuing training, education, and ongoing support.

Shared Health is heartened by the level of enthusiasm for real change and is confident that health
care in the U.S. can be transformed with HIT – not only because of the unprecedented commitment
to improving patient care, but also because Shared Health is already seeing the transformation that
has happened in Tennessee. Applying these lessons learned will help pave the way for success on a
national scale.

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©2009 Shared Health. All rights reserved.
About Shared Health

Shared Health’s vision was formed in 2004 with the mission to transform health care by offering
secure, innovative, HIT solutions. With the records of nearly three million patients in its HIE, Shared
Health’s web-based applications securely share and connect medical information across a patient’s
network of clinicians. Shared Health strives to be the clinician’s trusted partner for sharing relevant
patient information at the point of care, enabling both health care professionals and consumers
to improve outcomes.

For more information on Shared Health, visit smarterhospital.com or call 1.888.283.6691.

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©2009 Shared Health. All rights reserved.