THE SEQUOIA PROJECT Trusted Convener of Industry Government

THE SEQUOIA PROJECT Trusted Convener of Industry & Government to Address Health IT Interoperability 1 © 2015 The Sequoia Project. All Rights Reserved.

Healtheway rebrands to reflect expanding mission for health IT interoperability, including: 2 © 2015 The Sequoia Project. All Rights Reserved. • Increasing number of collaborative initiatives • Enhancing interoperability education • Promoting industry-wide best practices

Why “The Sequoia Project”? • • Sequoia trees are among the most enduring, massive living things. An interconnected root system allows individual trees to support each other, making the entire system stronger. A thriving health IT community requires interconnected organizations working together for the benefit of all. Connected We Stand. 3 © 2015 The Sequoia Project. All Rights Reserved.

The Sequoia Project’s Role The Sequoia Project is the trusted, independent convener of industry and government Works to address the challenges of secure, interoperable nationwide health information exchange (HIE). SECURE 4 © 2015 The Sequoia Project. All Rights Reserved. INTEROPERABLE NATIONWIDE

Continued Support for Carequality and e. Health Exchange • The Sequoia Project will continue to serve as the steward of its independent initiatives. • The initiatives will continue to be governed independently by its respective members. • The Sequoia Project will be actively pursuing additional interoperability initiatives that will aid in making secure data exchange a reality in the U. S. More information will be forthcoming within the year. 5 © 2015 The Sequoia Project. All Rights Reserved.

Acting in the Public Interest As a nonprofit 501 (c) 3 organization operating in the public interest, our public-private governance process insures transparent oversight of this work. The Sequoia Project serves as a neutral, third party convener. The practical application of our work: • Enables consensus agreement on the policies and standards required to reduce barriers to data exchange • Advances development and continued support for health information exchange governance frameworks • Provides services that enable health information exchange networks to interoperate 6 © 2015 The Sequoia Project. All Rights Reserved.

The Sequoia Project Initiatives • The Sequoia Project’s • independent initiatives each • have their own: • Mission Governance Membership Structure The Sequoia Project is an ideal home for projects that require a collaborative environment where multiple parties with differing perspectives can work together. 7 © 2015 The Sequoia Project. All Rights Reserved.

Current Sequoia Project Initiatives The e. Health Exchange is the largest and fastest growing health information exchange network in the US Carequality is a public-private collaborative building consensus on a national-level interoperability framework to inter-connect networks 8 © 2015 The Sequoia Project. All Rights Reserved.

The Sequoia Project and Care Connectivity Consortium (CCC) Strategic Alliance • CCC is a collaborative of 5 prominent healthcare organizations: – Geisinger (PA) – Intermountain Health (UT) – Kaiser Permanente (CA, OR, WA, VA, MD, HI, GA, CO) – Mayo Clinic (MN, FL, AZ, GA, WI) – OCHIN (17 states) • 9 CCC enhances capabilities of current HIE technologies and allows for sharing between organizations and health IT systems © 2015 The Sequoia Project. All Rights Reserved. • The CCC aids e. Health Exchange growth by: – Serving as a test bed for new technologies – Contributing innovations to the e. Health Exchange community • The CCC participates in Carequality and serves on its: – – Steering Committee Trust Framework Work Group Query Work Group Operations Work Group

The Largest Health Information Exchange Network in the U. S. An initiative of 10 © 2015 The Sequoia Project. All Rights Reserved.

Introduction to the e. Health Exchange Rapidly growing network for securely sharing health information over the Internet Federal Govt States HIEs Care Facilities Tech Vendors Payers Shared Governance and Trust Agreement 11 © 2015 The Sequoia Project. All Rights Reserved. Pharmacies Common Standards, Specifications & Policies

10 Years of Progress 2012 2009 2006 ONC sponsors prototype architectures, followed by trial implementations. 12 2008 Focus shifted to supporting production pilots © 2015 The Sequoia Project. All Rights Reserved. First production exchange between Social Security Administration and Med. Virginia, followed by Veterans Health Administration and Kaiser Permanente Exchange transitions from government to private sector. Private sector connectivity increases 2015 Nationwide implementation across 50 states

Largest Health Information Exchange Network in the U. S. Today, the e. Health Exchange connects: All 50 states Four federal agencies (Do. D, VA, HHS including CMS, and SSA) 30% of U. S. hospitals 13 © 2015 The Sequoia Project. All Rights Reserved. 10, 000 medical groups 900+ dialysis centers 8, 200 pharmacies Supporting more than 100 million patients

e. Health Exchange Growth (2015 Projected) Projected Participants 150+ Total Participants 4 ONC Initiative: Nw. HIN Exchange 2009 14 23 44 • Network doubles • Operations supported by ONC 2011 © 2015 The Sequoia Project. All Rights Reserved. • Growth fueled by MU 2 TOC measures 81 • New use case • Network matures • Product Testing Program launched • New types of participants / networks • Enhanced capabilities • Streamlined testing / onboarding • Testing Program launched 2013 • Increased network adoption 2014 2015

e. Health Exchange Overview e. Health Exchange Has Trust Foundation – Legal Agreement – Governing Committee – Operating Policies and Procedures e. Health Exchange Uses Technical Services – Web services registry (phone book of network Participants) – Security (x. 509 Managed Certificate Authority) – Automated testing using Aegis platform 15 © 2015 The Sequoia Project. All Rights Reserved.

Sample Use Cases Treatment / Care Coordination Allows access to critical information (e. g. , test results, medication history, allergy info, immunizations) and makes available to providers when patient is transferred Responder Only Profile Supporting the Treatment Use case (New) Allows other networks (e. g. , release of info companies and SAAS model vendors) to respond to queries from e. Health Exchange Participants on behalf of their client Military/Veteran Health Do. D and VA exchange active service members and veterans’ records to provide government and private caregivers with up-to-date medical histories Disability Determination Social Security Administration requests claimant records electronically to make disability determinations. Cuts down claims processes from months to days Quality Reporting for the End Stage Renal Disease Program – CMS Allows Dialysis centers to send quality data to CMS to assure that individuals with End Stage Renal Disease receive the highest quality of care 16 © 2015 The Sequoia Project. All Rights Reserved.

e. Health Exchange: Benefits Benefit 17 How e. Health Exchange Achieves Benefit Reducing Costs Using common standards, legal agreements and governance enables participants to reduce legal fees and avoid building custom interfaces with trading partners. Improving Clinical and Business Decisions Access to a nationwide data sharing network provides secure access to the comprehensive health data that healthcare providers, pharmacies and payers require to improve clinical decision making, patient safety, process improvement and fair payment. Exchanging Data with Government Agencies Federal participation in the e. Health Exchange supports data sharing among all participants and with agencies such as Centers for Medicare & Medicaid Services, the Department of Defense, the Social Security Administration and the Department of Veterans Affairs. Planning for the Future Because the e. Health Exchange is governed by a representative set of participants, its multi-purpose interoperability platform has the ability to evolve and incorporate new use cases, standards, etc. © 2015 The Sequoia Project. All Rights Reserved.

Carequality for a Common HIE Framework Accelerating seamless, interoperable health information exchange among networks An initiative of 18 © 2015 The Sequoia Project. All Rights Reserved.

The Challenge What if you had a cell phone plan that only allowed you to call other customers of your carrier? That’s the situation for most healthcare providers today, when they join a data sharing network. 19 © 2015 The Sequoia Project. All Rights Reserved.

The Solution Carequality creates a standardized, national-level interoperability framework to link all data sharing networks Carequality is creating a web of interconnected networks 20 © 2015 The Sequoia Project. All Rights Reserved.

A Multi-Faceted Approach Carequality’s strength lies in its diverse stakeholder base. We approach the interoperability challenge from all sides. Multi. Stakeholder Carequality is Managed by Collaborative The Sequoia Project is a nonprofit acting in the public interest. It convenes industry and government to address common interoperability challenges. 21 © 2015 The Sequoia Project. All Rights Reserved. Open Real- World

The Carequality Community • Physicians • Consumers • Hospice and Home Care • Government Agencies • Research • Data Sharing Networks • Public Health • Payers • Vendors • Behavioral Health • Standards Development Orgs. • Acute Care • Long Term and Post-Acute Care 22 © 2015 The Sequoia Project. All Rights Reserved. • Pharmacies • EMS Services

Carequality Members 23 © 2015 The Sequoia Project. All Rights Reserved.

A Brief History Carequality Launch June 2014 February 2014 24 Steering Committee Formed January 2015 May 2014 Aug/Sept 2014 Operating Principles & Governance Model Advisory Council & Work Groups Chartered © 2015 The Sequoia Project. All Rights Reserved. Principles of Trust Adopted April 2015 Initial Rollout Kickoff

Essential Elements Common rules of the road: In order for the varied participants to trust each other with health information, everyone needs to have a legal obligation to abide by the same rules. Well-defined technical specs: Shared rules are not enough; clear standards must be laid out in an implementation guide that all implementers can follow. A participant directory: To connect using the common standards, systems must know the addresses and roles of each participant. 25 © 2015 The Sequoia Project. All Rights Reserved.

26 © 2015 The Sequoia Project. All Rights Reserved.

Carequality Initial Rollout Began April 2015! Legal Framework for Exchange: Provide feedback on Carequality’s legal framework, and implement the standardized terms once they are adopted Initial Use Case Implementation Guide: Implement the technical, business, and policy requirements outlined in the Query Use Case Implementation Guide, and provide feedback to inform the version of the Guide adopted for general public use It’s not too late to participate in the initial rollout! For information, contact admin@carequality. org 27 © 2015 The Sequoia Project. All Rights Reserved.

Carequality Initial Rollout Participants 28 © 2015 The Sequoia Project. All Rights Reserved.

Carequality Initial Rollout Coverage The initial rollout has have broad impact, covering: • 200, 000 Physicians • Over 2, 000 Hospitals • Over 40, 000 Clinics • More than 15 million patient records shared per month 29 © 2015 The Sequoia Project. All Rights Reserved.

There’s a lot more to health IT interoperability than document queries. The initial Query for Documents Use Case is just the beginning. The Carequality framework is flexible and is meant to be applied to many different use cases. 30 © 2015 The Sequoia Project. All Rights Reserved.

Stakeholder Focus Groups • Exploring other areas for potential use cases • Requesting input from stakeholder groups on use cases that matter most to them • Likely stakeholder areas for exploration are: – Payers – Mental and Behavioral Health – Long Term/Post-Acute Care – Population Health If you’d like to join the conversation, please contact us at admin@carequality. org and indicate your area of interest. 31 © 2015 The Sequoia Project. All Rights Reserved.

Thank You! 32 © 2015 The Sequoia Project. All Rights Reserved.