California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014 PROBLEMHIE readiness varies considerably throughout California. Funding provided directly to communities can accelerate implementation of HIE throughout the state in an effective way within a very short timeframe.SOLUTIONCreate a flexible grant program to make funding available to communities through a variety of funding mechanisms that meet the current and immediate needs of stakeholders. The Accelerating HIE Funding Opportunities provided 10 separate opportunities and awarded funding to 22 organizations representing over 20 counties.RATIONALE FOR SOLUTIONWhile interest in HIE is growing, much work is still needed to enable communities around the state to participate in HIE. The HIE Acceleration Programs focused on stimulating this nascent interest in exchange, both by building infrastructure, piloting innovative solutions, and generating best practices in governance and policy.Additionally, the many diverse counties in California are in different stages of development. The HIE Acceleration Programs provided many diverse funding opportunities and technical assistance to accommodate the unique challenges in different part of the state’s HIE landscape.The HIE Acceleration Programs included:

HIE Expansion to expand HIE capacity to enable California providers to achieve the meaningful use of Electronic Health Records, and improve health care quality, coordination, and efficiency HIE Planning to accelerate community-based needs assessments, goal-setting, project planning, and governance development for HIE. HIE Infrastructure to further expand HIE capacity by funding significant one time investments in infrastructure to enable exchange between unaffiliated providers. HIE Innovation to HIE Interface Implementation to advance interface development between HIOs, provider EHRs, and other systems, focusing on laboratory connectivity and care summary exchange and expand the participants in existing HIOs and build connections to the California Immunization Registry.

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014 California Trust Framework Pilot to develop and test an infrastructure to create statewide scalable trust and exchange among existing HIOs.More detail about the results of each of the above are included in the Benefits section below.The HIE Acceleration Programs aimed to stimulate robust HIE in California for provider achievement of Meaningful Use exchange objectives, coordinated care to improve health outcomes, and efficient reporting to state and federal agencies. Funding was targeted toward HIE initiatives in development, operational HIOs and their participants, as well as provider organizations. The HIE Acceleration Programs have invested over $6 million in HIE development in California.OUTCOME AND NEXT STEPS

The HIE Acceleration Programs have been successful in accelerating the development of HIE infrastructure around the state. While there continues to be a need for further HIE development to meet the care coordination needs of providers in this state, there is a significant number who benefit both directly and indirectly from the infrastructure built with this funding. There is opportunity to continue to support HIE development in California both through technical support, convening stakeholders, and through targeted funding for pilot projects and infrastructure. CHeQ has established itself as a trusted neutral party and could capitalize on this reputation in future endeavors.BENEFITMuch of the work completed under the HIE Acceleration Programs has been structural in nature. Because of these programs, more providers and organizations are able to connect with each other and have more options to participate in HIE. Prior to funding, there were only five operational HIOs; now, there are closer to fifteen. At the end of the funding period, Californians in 35 counties have access to an emerging or operational HIO in their communities. More than 15 million potential lives, or nearly 40% of the California population, are covered by HIE through awardees.HIE Expansion GrantsThis program expanded HIE capacity, to enable California providers to achieve the meaningful use of Electronic Health Records, and improve health care quality, coordination, and efficiency. Five grants totaling more than $3 million were awarded in 2011. The projects ran from 2011 to 2013.Awardees were:

1. East Kern County Integrated Technology Association (EKCITA) - $618,293

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014This project focused on the receipt of structured lab results, exchanging patient care summaries (CCD Exchange MU Stage 2), collection and forwarding of immunization data, and e-Prescribing data integration.2. Los Angeles County/Los Angeles Network for Enhanced Services (LANES) - $996,070The LANES project aimed to connect one of the largest populations of safety net providers in the country to critical HIE services that will improve healthcare delivery and outcomes for the most vulnerable citizens in LA County.3. North Coast Health Information Network (NCHIN) - $200,105This project aimed to lower barriers to EHR adoption in Humboldt County by helping to build a Health Information Organization with the capacity to provide lab results interfaces with data from local hospitals, as well as provide other expanded HIE services to the community.4. Orange County Partnership Regional Health Information Organization (OCPRHIO) -

$795,761 Through this grant, OCPRHIO deployed HIE services provided by new technology partners to meet community goals of improving patient care through better care coordination. 5. Redwood Med Net - $476,900This project expanded Redwood MedNet’s initial HIE services from a pilot scale of data traffic (connecting dozens of providers in two counties) to a substantially larger commercial volume of health data traffic (connecting hundreds of providers in seven counties).

HIE Planning GrantsHIE Planning Grants focused on accelerating community-based needs assessments, goal-setting, project planning, and governance development for HIE. Awarded projects developed a credible plan for data exchange within a proposed region or among a proposed set of project partners and must create the organizational, leadership, and policy foundation for a trusted environment for HIE. Projects were expected to move at a rapid pace and develop a plan to move swiftly to implementation for data exchange within 12 months of project commencement. Along with providing funding to four awarded organizations, CHeQ provided technical assistance to the four funding recipients and five other identified emerging communities who were working to implement exchange in their communities. Technical assistance was provided direct assistance through a consultant, and through three Emerging HIE forums that were held between June 2013 and November 2013. All organizations have made significant progress towards becoming

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014operational. All four of the organizations who benefitted from CHeQ’s Rural HIE Incentive Program received technical support and participated in the Emerging HIE Forums. Two of those organizations received Planning Grants. There is significant interest from emerging communities to continue to meet through either in person forums or other mechanisms to collaborate and share best practices.Planning Grants were made to four organizations, with funding totaling $100,000. Awardees were:1. ConnectHealthcare - $25,000The Planning Grant helped ConnectHealthcare make a number of operational advances in understanding the community, deciding on initial and follow-on services, beginning system selection, adopting a participation agreement, and developing policies and procedures. ConnectHealthcare was a beneficiary of the CHeQ Rural HIE Incentive Program.2. San Joaquin Community HIE - $25,000San Joaquin Community HIE used Planning Grant funding to extend and expand consulting support for the development of a governance strategy, strategic plan, and financial plan/sustainability model in coordination with community providers and stakeholders. SJHIE signed a contract with a HIE service provider and are well on their way to implementing HIE for their community.3. Tulare Kings HIE - $25,000TKHIE was able to work with the newly formed Governance Council during the Planning Grant to develop a business plan identifying the most cost-effective method of implementing an HIE that fulfills the requirements of the Governance Charter, satisfies ONC priorities, meets the needs of the community, and is sustainable based on participation fees. TKHIE joined with a separate community effort in Fresno and Madeira counties becoming Central Valley HIE. They were beneficiaries of the CHeQ Rural HIE Incentive Program. 4. The Children’s Partnership - $25,000This project allowed a public/private collaboration to develop a strategic plan for providing a personal health record (PHR) system to children and youth in foster care and link it to the broader health information exchange (HIE) initiatives currently underway in California. As a result of this planning process, The Children’s Partnership (TCP) was funded by CHeQ for a demonstration project for foster youth in Ventura County (see Innovation in Foster Care Awards).

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014HIE Infrastructure AwardsThis funding opportunity provided resources to HIE initiatives that were ready to make significant one-time investments in technology infrastructure enabling HIE across unaffiliated organizations and distinct EHR vendor systems. Projects implemented exchange infrastructure for improved treatment and care coordination among a large population and/or a broad geographic area in the state. Projects also enabled providers to meet at least two of the four HIE-related Meaningful Use criteria.Awards were made in 2012 to three organizations, with funding totaling $770,000.Awardees were:

1. Inland Empire HIE - $470,000This project connected IEHIE to three enterprise HIOs through Connect, developed infrastructure to enable 300 new providers to exchange lab and radiology orders and results and enabled these providers to connect to public health departments for immunization reporting and syndromic surveillance.2. OCPRHIO (Orange County) - $217,000This project built on the work funded through the Expansion Grant opportunity and provided standard interfaces to the top 5 EHRs used by physicians in the REC into the HIE and onboarded the 1,200 REC-affiliated providers in Orange County who are using one of those EHR systems. The project also provided lab results from LabCorp and Quest to all OCPRHIO-participating providers. OCPRHIO aimed to obtain Healtheway eHealth Exchange Certification.3. Redwood MedNet - $90,000This project built on the work funded through the Expansion Grant opportunity enabled providers to receive structured lab results from two hospitals and one outpatient laboratory operated by Sutter Health and enabled providers to facilitate transitions of care between a tertiary care hospital operated by St. Joseph Health and safety net primary care clinics in Sonoma County.

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014Innovation in Behavioral Health AwardsThis award aimed to understand requirements for the successful exchange of sensitive behavioral health information, integrate a behavioral health clinic into an HIO and pilot test the exchange of behavioral health information within this environment that is reproducible in other community HIO. This funding opportunity was awarded to OCPRHIO in 2013 with funding totaling 350,000. Through this funding opportunity, OCPRHIO developed a roadmap to allow others to integrate behavioral health information into their community HIOs.Innovation in Patient Access Awards (Blue Button)This Blue Button demonstration project allowed L.A. Care’s approximately 1,000,000 Medi-Cal beneficiaries to access their prescription information online for improved patient safety and care coordination. L.A. Care was awarded $400,000 to meet the deliverables for this project.Innovation in Foster Care AwardThis award funded a demonstration project to develop integrated PHR for foster children and youth in Ventura County. The project linked the county EMR system to PHR and determined needed technical and policy specifications for using CHeQ's Health Information Home for this use case. The Children’s Partnership was awarded $150,000 in 2013 for this demonstration project.Innovation in Data Analytics AwardsThis opportunity sought to incentivize HIOs and healthcare organizations to implement data analytics tools across unaffiliated provider systems to manage shared patient populations. These electronic tools support health maintenance and disease prevention services and chronic disease management, with emphasis given to projects that focused on a specific high-impact condition or sub-population of shared patients. This program supported emerging care delivery and value-based payment models, such as Patient-Centered Medical Homes and Accountable Care Organizations.Awards were made in 2013 to two organizations, with funding totaling $350,000. Awardees were:

1. Inland Empire HIE - $150,000Inland Empire HIE implemented the Orion Health business intelligence tool for business intelligence / clinical analytics. IEHIE intends to use the business analytics tool not only as an HIE-wide reporting tool for public health and community assessment purposes, but also as an option for individual practices. The focus of this project was on case management for diabetes patients.

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 20142. Tahoe Forest Hospital District (National Rural ACO) - $200,000Tahoe Forest Hospital District (TFHD) sought to ensure the success of the Sierra Crest ACO by creating a data warehouse and analytics platform to synthesize clinical, financial and patient satisfaction data, identify high-risk patients, and report and monitor required Accountable Care Organization (ACO) quality measures. Additionally, TFHD partnered with Inland Empire HIE to support the formation and success of the National Rural ACO.

HIE Interface and Immunization Interface Implementation AwardsThe HIE Interface Implementation Awards provided support for interface development between HIOs, provider EHRs, and other systems, focusing on laboratory connectivity and care summary exchange.Awards were made to four organizations, with funding totaling $608,680. The project period took place from 2012 to 2013. A total of 68 interfaces were developed.As part of the Interface Implementation awards, an Immunization-focused opportunity was created specifically to provide funding for connecting an HIO or provider organization to the CAIR Immunization Messaging Portal (IMP). The funding supported immunization interface implementations between HIOs and/or provider organizations to the IMP to facilitate reporting of immunization information, enabling providers to meet HIE-related Meaningful Use objectives for public health reporting.In 2013, awards were made to seven organizations, with funding totaling $115,125. A total of seven interfaces were created, connecting an estimated 357 individual sites to the IMP within the next six months. With the implementation of these interfaces, over 70,000 messages are being delivered to the IMP on a monthly basis.Interface and Immunization Interface Awardees were:1. Catalina Medical Center (RAIN Live Oak Technology) – Immunization Interface -

$10,000

2. Inland Empire HIE – Immunization Interface - $20,000

3. North Coast Health Information Network (NCHIN) – Interface and Immunization Interface - $20,000 and $7,125

4. OCHIN – Immunization Interface - $20,000

5. OCPRHIO – Immunization Interface - $20,000

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 20146. Redwood MedNet – Interface - $188,680

7. San Diego Regional HIE (SDRHIE) – Immunization Interface - $20,000

8. Santa Cruz HIE – Interface and Immunization Interface - $200,000 and $20,000

9. SynerMed – Interface - $200,000

California Trust Framework Pilot AwardsThe California Trust Framework was developed to enable exchange between unaffiliated organizations– community HIOs and enterprise systems – throughout California and with neighboring states. CHeQ established the California Trust Framework (CTF) Pilot as a test implementation to inform the policies, practices, and technologies necessary to establish the CTF. Awards were made to six organizations, with funding totaling $300,667. Two additional organizations participated without funding. The project period took place in 2013. Five of these organizations successfully on-boarded during the Pilot period, and four of these organizations also successfully completed testing.California Trust Framework Pilot Awardees were:1. Inland Empire HIE - $35,000

2. North Coast Health Information Network (NCHIN) – $25,000

3. OCPRHIO – $68,517

4. RAIN – Live Oak – $91,200

5. San Diego Regional HIE – n/a

6. Santa Cruz HIE – $60,950

7. Sujansky & Associates – n/a

8. UC Davis Health System - $20,000

California Health eQuality Project SummaryAcceleration Awards ProjectJanuary 2014